Multicenter Study to Evaluate Endovascular Repair of Extent I-III Thoracoabdominal Aneurysms Without Prophylactic Cerebrospinal Fluid Drainage

• Published in: Annals of surgery Vol. 278; no. 2; p. e396
• Main Authors: Marcondes, Giulianna B, Cirillo-Penn, Nolan C, Tenorio, Emanuel R, Adam, Donald J, Timaran, Carlos, Austermann, Martin J, Bertoglio, Luca, Jakimowicz, Tomasz, Piazza, Michele, Juszczak, Maciej T, Scott, Carla K, Berekoven, Bärbel, Chiesa, Roberto, Lima, Guilherme B B, Jama, Katarzyna, Squizzato, Francesco, Claridge, Martin, Mendes, Bernardo C, Oderich, Gustavo S
• Format: Journal Article
• Language: English
• Published: United States 01.08.2023
• Subjects: Aortic Aneurysm, Abdominal - surgery; Aortic Aneurysm, Thoracic; Aortic Aneurysm, Thoracoabdominal; Blood Vessel Prosthesis Implantation - adverse effects; Cerebrospinal Fluid Leak - complications; Cerebrospinal Fluid Leak - surgery; Drainage - adverse effects; Endovascular Procedures - adverse effects; Humans; Multicenter Studies as Topic; Paraplegia - etiology; Paraplegia - prevention & control; Paraplegia - surgery; Retrospective Studies; Risk Factors; Spinal Cord Injuries - complications; Spinal Cord Injuries - surgery; Treatment Outcome
• DOI: 10.1097/SLA.0000000000005653

To assess outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) of Extent I-III thoracoabdominal aortic aneurysms (TAAAs) without prophylactic cerebrospinal fluid drainage (CSFD). Prophylactic CSFD has been routinely used during endovascular TAAA repair, but concerns about major drain-related complications have led to revising this paradigm. We reviewed a multicenter cohort of 541 patients treated for Extent I-III TAAAs by FB-EVAR without prophylactic CSFD. Spinal cord injury (SCI) was graded as ambulatory (paraparesis) or nonambulatory (paraplegia). Endpoints were any SCI, permanent paraplegia, response to rescue treatment, major drain-related complications, mortality, and patient survival. There were 22 Extent I, 240 Extent II and 279 Extent III TAAAs. Thirty-day mortality was 3%. SCI occurred in 45 patients (8%), paraparesis occurring in 23 (4%) and paraplegia in 22 patients (4%). SCI was more common in patients with Extent I-II compared with Extent III TAAAs (12% vs. 5%, P =0.01). Rescue treatment included permissive hypertension in all patients, with CSFD in 22 (4%). Symptom improvement was noted in 73%. Twelve patients (2%) had permanent paraplegia. Two patients (0.4%) had major drain-related complications. Independent predictors for SCI by multivariate logistic regression were sustained perioperative hypotension [odds ratio (OR): 4.4, 95% confidence interval (95% CI): 1.7-11.1], patent collateral network (OR: 0.3, 95% CI: 0.1-0.6), and total length of aortic coverage (OR: 1.05, 95% CI: 1.01-1.10). Patient survival at 3 years was 72%±3%. 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.