Extended Aortic Coverage in Thoracic Aortic Endovascular Repair is Not Associated with Spinal Cord Ischemia

Overview

Journal JTCVS Open

Specialty Cardiology & Vascular Diseases

Date 2024 Nov 13

PMID 39534332

Authors

George C Chachati

Sarah Yousef

James A Brown

Nishant Agrawal

Shwetabh Tarun

Kristian Punu

Derek Serna-Gallegos

Julie Phillippi

Ibrahim Sultan

Affiliations

Soon will be listed here.

Abstract

Objective: Spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) remains a debilitating complication, occurring in 10% of patients. Studies have shown that extended aortic coverage is a risk factor for SCI. This study evaluates whether extended aortic length coverage is a significant risk factor for SCI.

Methods: This study retrospectively reviewed 277 consecutive patients who underwent TEVAR successfully between 2006 and 2021 at a single institution. The patients were classified into 2 groups: ≥205 mm and <205 mm of thoracic aortic coverage. Analysis of variance was used to compare these variables and associated aortic coverage between the 2 groups. Univariable logistical regression was used to compare SCI and associated factors.

Results: Of the 269 patients who underwent successful TEVAR, 127 (47.2%) had ≥205 mm and 142 (52.8%) had <205 mm of aorta coverage. Patients with ≥205 mm of thoracic aorta coverage were more likely to be smokers ( < .01) and to have a history of previous stroke ( < .05). Patients with extended coverage were more likely to receive a preoperative lumbar drain (LD) ( < .01). Extended aortic coverage was not associated with a higher risk of SCI compared to standard aortic coverage (4.7% vs 4.2%; = .84). Extended aortic coverage with or without a preoperative LD did not have an association with SCI ( = .91). Type II endoleaks were seen more in extended aortic coverage ( < .01).

Conclusions: Extended aortic coverage (compared with the standard approach) was not associated with a higher risk of SCI; however, this may have been mitigated by a higher prevalence of prophylactic lumbar drainage in this population.

References

Zipfel B, Buz S, Redlin M, Hullmeine D, Hammerschmidt R, Hetzer R . Spinal cord ischemia after thoracic stent-grafting: causes apart from intercostal artery coverage. Ann Thorac Surg. 2013; 96(1):31-8. DOI: 10.1016/j.athoracsur.2013.03.010. View

Coselli J, LeMaire S, Koksoy C, Schmittling Z, Curling P . Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial. J Vasc Surg. 2002; 35(4):631-9. DOI: 10.1067/mva.2002.122024. View

Drinkwater S, Goebells A, Haydar A, Bourke P, Brown L, Hamady M . The incidence of spinal cord ischaemia following thoracic and thoracoabdominal aortic endovascular intervention. Eur J Vasc Endovasc Surg. 2010; 40(6):729-35. DOI: 10.1016/j.ejvs.2010.08.013. View

Etz C, Weigang E, Hartert M, Lonn L, Mestres C, Di Bartolomeo R . Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery†. Eur J Cardiothorac Surg. 2015; 47(6):943-57. DOI: 10.1093/ejcts/ezv142. View

Aucoin V, Bolaji B, Novak Z, Spangler E, Sutzko D, McFarland G . Trends in the use of cerebrospinal drains and outcomes related to spinal cord ischemia after thoracic endovascular aortic repair and complex endovascular aortic repair in the Vascular Quality Initiative database. J Vasc Surg. 2021; 74(4):1067-1078. DOI: 10.1016/j.jvs.2021.01.075. View

Hanna J, Andersen N, Aziz H, Shah A, McCann R, Hughes G . Results with selective preoperative lumbar drain placement for thoracic endovascular aortic repair. Ann Thorac Surg. 2013; 95(6):1968-74. DOI: 10.1016/j.athoracsur.2013.03.016. View

Lou X, Duwayri Y, Jordan Jr W, Chen E, Veeraswamy R, Leshnower B . The Safety and Efficacy of Extended TEVAR in Acute Type B Aortic Dissection. Ann Thorac Surg. 2020; 110(3):799-806. PMC: 7970341. DOI: 10.1016/j.athoracsur.2019.12.036. View

Upchurch Jr G, Escobar G, Azizzadeh A, Beck A, Conrad M, Matsumura J . Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg. 2020; 73(1S):55S-83S. DOI: 10.1016/j.jvs.2020.05.076. View

Sa M, Jacquemyn X, Van den Eynde J, Chu D, Serna-Gallegos D, Singh M . Midterm Outcomes of Endovascular vs. Medical Therapy for Uncomplicated Type B Aortic Dissection: Meta-Analysis of Reconstructed Time to Event Data. Eur J Vasc Endovasc Surg. 2023; 66(5):609-619. DOI: 10.1016/j.ejvs.2023.07.004. View

10.

Brunkwall J, Kasprzak P, Verhoeven E, Heijmen R, Taylor P, Alric P . Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg. 2014; 48(3):285-91. DOI: 10.1016/j.ejvs.2014.05.012. View

11.

Feezor R, Martin T, Hess Jr P, Daniels M, Beaver T, Klodell C . Extent of aortic coverage and incidence of spinal cord ischemia after thoracic endovascular aneurysm repair. Ann Thorac Surg. 2008; 86(6):1809-14. DOI: 10.1016/j.athoracsur.2008.09.022. View

12.

HAMMOND E, Horn D . Smoking and death rates: report on forty-four months of follow-up of 187,783 men. 2. Death rates by cause. J Am Med Assoc. 1958; 166(11):1294-308. DOI: 10.1001/jama.1958.02990110030007. View

13.

Etz C, Kari F, Mueller C, Silovitz D, Brenner R, Lin H . The collateral network concept: a reassessment of the anatomy of spinal cord perfusion. J Thorac Cardiovasc Surg. 2011; 141(4):1020-8. PMC: 3062787. DOI: 10.1016/j.jtcvs.2010.06.023. View

14.

Chen S, Lee K, Napolitano M, Murillo-Berlioz A, Sattah A, Sarin S . Complications and Management of the Thoracic Endovascular Aortic Repair. Aorta (Stamford). 2020; 8(3):49-58. PMC: 7644296. DOI: 10.1055/s-0040-1714089. View

15.

Daye D, Walker T . Complications of endovascular aneurysm repair of the thoracic and abdominal aorta: evaluation and management. Cardiovasc Diagn Ther. 2018; 8(Suppl 1):S138-S156. PMC: 5949591. DOI: 10.21037/cdt.2017.09.17. View

16.

Estrera A, Miller C, Goodrick J, Porat E, Achouh P, Dhareshwar J . Update on outcomes of acute type B aortic dissection. Ann Thorac Surg. 2007; 83(2):S842-5. DOI: 10.1016/j.athoracsur.2006.10.081. View

17.

Yousef S, Sultan I . Commentary: Spinal cord ischemia after thoracic endovascular aortic repair. Prevention better than cure?. J Thorac Cardiovasc Surg. 2022; 168(1):26-27. DOI: 10.1016/j.jtcvs.2022.11.011. View

18.

Xue L, Luo S, Ding H, Zhu Y, Liu Y, Huang W . Risk of spinal cord ischemia after thoracic endovascular aortic repair. J Thorac Dis. 2019; 10(11):6088-6096. PMC: 6297439. DOI: 10.21037/jtd.2018.10.99. View

19.

Lederle F, Nelson D, Joseph A . Smokers' relative risk for aortic aneurysm compared with other smoking-related diseases: a systematic review. J Vasc Surg. 2003; 38(2):329-34. DOI: 10.1016/s0741-5214(03)00136-8. View

20.

Bianco V, Sultan I, Kilic A, Aranda-Michel E, Cuddy R, Srivastava A . Concomitant left subclavian artery revascularization with carotid-subclavian transposition during zone 2 thoracic endovascular aortic repair. J Thorac Cardiovasc Surg. 2019; 159(4):1222-1227. DOI: 10.1016/j.jtcvs.2019.03.060. View