Publicação
Spinal cord ischaemia predictors and outcomes in complex endovascular aortic repair - a single centre retrospective study
| Resumo: | Abstract Introduction: Spinal cord ischaemia (SCI) is a rare, distressing complication following thoraco-abdominal (TAAA) and complex abdominal aortic aneurysm (CAAA) repair. Prior studies have reported conflicting findings on risk factors and preventive measures. We aim to analyse the incidence of SCI following endovascular treatment of complex aortic aneurysms at our centre and to provide a descriptive analysis. Methods: Single-centre retrospective study conducted in a tertiary care centre, including all patients with a TAAA or CAAA who underwent endovascular repair using a fenestrated/branched endograft from June 2010 to February 2025. Patient characteristics, peri-procedural and follow-up data were obtained. SCI was defined according to the Society for Vascular Surgery reporting standards as new-onset motor or sensitive deficits after endovascular treatment. Results: 145 patients (91% male, mean age 71 ± 6 years) were included, of which 59 (41%) had degenerative TAAAs (types I-V) and 57 (39%) CAAAs. Mean aneurysm diameter was 66 ± 14 mm. A prophylactic cerebrospinal fluid drainage (CSFD) was preoperatively placed in 61 patients (42%). The total incidence of SCI was 8% (12/145). Among the affected patients, minimal sensory deficits were noted in 33% (4/12), paraparesis in 8% (1/12) and complete paraplegia in 58% (7/12). Most patients (83%, 10/12) presented with delayed SCI. After symptom onset, all but one patient without prophylactic drainage (58%) underwent rescue CSFD. Regarding patients with complete paraplegia (n = 7), a complete recovery was observed in three patients, one patient experienced partial recovery, and three did not recover. No differences concerning prior aortic surgery, internal iliac artery patency, procedural staging or preoperative CSFD placement were found between SCI and no-SCI patients. Conclusion: In this study, SCI manifested mostly as a delayed event. Prophylactic CSFD may prevent permanent injury. The small sample size could hinder the investigation of more robust findings. Despite several risk factors and preventive measures having been identified, the most effective preventive approach remains lacking. Further studies are required to prevent this devastating complication. |
|---|---|
| Autores principais: | Gueifão,Inês |
| Outros Autores: | Alves,Gonçalo; Quintas,Anita; Cardoso,Joana; Fidalgo,Helena; Figueiredo,Adriana; Tavares,Carolina; Ferreira,Maria Emília |
| Assunto: | Spinal cord ischaemia endovascular complex abdominal aortic aneurysm thoraco-abdominal aortic aneurysm cerebrospinal fluid drainage |
| Ano: | 2025 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Fundação para a Ciência e Tecnologia |
| Idioma: | inglês |
| Origem: | SciELO Portugal |
| Resumo: | Abstract Introduction: Spinal cord ischaemia (SCI) is a rare, distressing complication following thoraco-abdominal (TAAA) and complex abdominal aortic aneurysm (CAAA) repair. Prior studies have reported conflicting findings on risk factors and preventive measures. We aim to analyse the incidence of SCI following endovascular treatment of complex aortic aneurysms at our centre and to provide a descriptive analysis. Methods: Single-centre retrospective study conducted in a tertiary care centre, including all patients with a TAAA or CAAA who underwent endovascular repair using a fenestrated/branched endograft from June 2010 to February 2025. Patient characteristics, peri-procedural and follow-up data were obtained. SCI was defined according to the Society for Vascular Surgery reporting standards as new-onset motor or sensitive deficits after endovascular treatment. Results: 145 patients (91% male, mean age 71 ± 6 years) were included, of which 59 (41%) had degenerative TAAAs (types I-V) and 57 (39%) CAAAs. Mean aneurysm diameter was 66 ± 14 mm. A prophylactic cerebrospinal fluid drainage (CSFD) was preoperatively placed in 61 patients (42%). The total incidence of SCI was 8% (12/145). Among the affected patients, minimal sensory deficits were noted in 33% (4/12), paraparesis in 8% (1/12) and complete paraplegia in 58% (7/12). Most patients (83%, 10/12) presented with delayed SCI. After symptom onset, all but one patient without prophylactic drainage (58%) underwent rescue CSFD. Regarding patients with complete paraplegia (n = 7), a complete recovery was observed in three patients, one patient experienced partial recovery, and three did not recover. No differences concerning prior aortic surgery, internal iliac artery patency, procedural staging or preoperative CSFD placement were found between SCI and no-SCI patients. Conclusion: In this study, SCI manifested mostly as a delayed event. Prophylactic CSFD may prevent permanent injury. The small sample size could hinder the investigation of more robust findings. Despite several risk factors and preventive measures having been identified, the most effective preventive approach remains lacking. Further studies are required to prevent this devastating complication. |
|---|