Abstract 20595: Combined Thoracic Endovascular Repair and Cerebrospinal Fluid Drainage Can Prevent Postoperative Paraplegia
Postoperative paraplegia (PP) can significantly lower patient quality of life following surgical treatment of thoracic (TAA) and thoracoabdominal aortic aneurysms (TAAA). Despite refinements in surgical techniques for spinal protection, risk of PP remains high. Recently, cerebrospinal fluid drainage (CSFD) as an adjunct therapy achieved to decrease of the incidence of PP in conventional surgical field, and TAA has been shifted to thoracic endovascular aortic repair (TEVAR) due to low PP incidence. So we evaluate the impact of combination therapy with TEVAR and CSFD on the incidence of PP.
Methods: From January 1993 to March 2010, we utilized TEVAR for 1095 out of 1536 total TAA and TAAA surgeries. Of these 1095 cases, we assessed 311 patients that received TEVAR with the deployment below Th10 as the distal side of stent-grafts. All of 311 cases were performed CSFD. Among these cases, 97 cases underwent TEVAR with reconstruction of abdominal visceral arteries. Mean age of patients was 73.1 years old. Preoperative complications occurred at a high rate, especially respiratory failure and coronary artery disease. Mean length of devices was 25.6 cm (6 – 38 cm).
Results: Procedural success was achieved in all cases. We lost four patients within 30 days after surgeries due to emboli. Postoperative complications included minor brain infarction (n=1), prolonged intubation (n=3), acute renal failure (n=3), and prolonged ileus (n=3). We observed no incidences of paraplegia and one case of transient paraparesis due to hypotension. All patients were discharged after achieving independent gait. We tried to find Adomkiebitz arteries in 91 cases with MDCT, and 86 cases were detected them. Though all of these were occluded by TEVAR, there was no incidence of PP. In long-term results, mean follow-up time was 92.8 months. Freedom rates from aortic events were 92.7% at 2 years, 83.8 % at 5 years, 75.3 % at 8 years, and 72.9% at 10 years. During the follow up period, there was no delayed PP in this study.
Conclusion: Early and long-term results in this study were satisfactory with no evidence of postoperative paraplegaia. Our findings suggest that the combination therapy with TEVAR and CSFD has the potential to become a standard procedure for TAA and TAAA.
- © 2010 by American Heart Association, Inc.