Cardiothoracic & vascular anesthesia
Multicenter Study to Evaluate Endovascular Repair of Extent I-III Thoracoabdominal Aneurysms Without Prophylactic Cerebrospinal Fluid Drainage
Authors' conclusion
FB-EVAR of Extent I-III TAAAs without CSFD has low mortality and low rates of permanent paraplegia (2%). SCI occurred in 8% of patients, and rescue treatment improved symptoms in 73% of them.
Study context
- Population
- Patients treated for Extent I–III thoracoabdominal aortic aneurysms by fenestrated-branched endovascular aortic repair (FB-EVAR) without prophylactic cerebrospinal fluid drainage22 Extent I, 240 Extent II, 279 Extent III
- Participants
- 541 patients
- Exposure
- Extent I-II vs Extent III
- Extent IIIn = 279reference
- Outcome
- Any spinal cord injury (SCI)
Methodological detailsno prophylactic cerebrospinal fluid drainage
- No prophylactic cerebrospinal fluid drainage
Main finding
As reported in the abstract
Spinal cord injury (SCI), all patients
45
8%
Paraparesis
23
4%
Paraplegia
22
4%
Permanent paraplegia
12
2%
Observational data: associations, not effects.
Further findings
SCI by TAAA extent
P = 0.01
Independent predictors of SCI (multivariate logistic regression)
| OR (95% CI) | ||
|---|---|---|
| Sustained perioperative hypotension | 4.4 (1.7–11.1) | |
| Patent collateral network | 0.3 (0.1–0.6) | |
| Total length of aortic coverage | 1.05 (1.01–1.10) | |
| 0.050.21520Odds ratio (log scale) |
Rescue treatment for SCI
- Permissive hypertension in all patients; Cerebrospinal fluid drainage (CSFD)
- 22 (4%)
- Symptom improvement
- 73%
Patient survival · 3 years
- Survival
- 72%±3%
30-day mortality
- Mortality
- 3%
Safety
- Major drain-related complications
- 2 (0.4%)
Original publication
Multicenter Study to Evaluate Endovascular Repair of Extent I-III Thoracoabdominal Aneurysms Without Prophylactic Cerebrospinal Fluid Drainage. Ann Surg. Published 4 August 2022. doi:10.
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