Spinal Arterial Anatomy and Risk Factors for Lower Extremity Weakness Following Endovascular Thoracoabdominal Aortic Aneurysm Repair With Branched Stent-Grafts
- 1 June 2008
- journal article
- Published by International Society of Endovascular Specialists in Journal of Endovascular Therapy
- Vol. 15 (3), 356-362
- https://doi.org/10.1583/08-2426.1
Abstract
Purpose: To evaluate spinal arterial anatomy and identify risk factors for lower extremity weakness (LEW) following endovascular thoracoabdominal aortic aneurysm (TAAA) repair. Methods: A retrospective review was conducted of 37 patients (27 men; mean age 74.8±7.1 years, range 58–86) undergoing endovascular TAAA repair with branched stent-grafts at a single academic institution from July 2005 to December 2007. Data were collected on preoperative comorbidities, duration of operation, blood loss, type of anesthesia, extent of aortic coverage, blood pressure, cerebrospinal fluid (CSF) pressure and drainage, and postoperative development of LEW. Pre- and postoperative contrast-enhanced computed tomographic angiograms (CTA) in a 26-patient subset were analyzed to evaluate the number of patent intercostal and lumbar arteries before and after repair. Results: All patients were neurologically intact at the end of the operation. Seven (19%) patients developed LEW postoperatively: 6 perioperatively and 1 after discharge. LEW was associated with postoperative hypotension, internal iliac artery (IIA) occlusion, and fewer patent segmental arteries on preoperative CTA. Lowest mean systolic blood pressure was Conclusion: Endovascular TAAA repair inevitably occludes direct inflow to lumbar and intercostal arteries. The distal segments of these arteries to the spine, however, are seen to remain patent through collaterals. Measures to preserve collateral pathways and increase perfusion pressure may help prevent or treat LEW.Keywords
This publication has 26 references indexed in Scilit:
- Influence of Perioperative Hemodynamics on Spinal Cord Ischemia in Thoracoabdominal Aortic RepairThe Annals of Thoracic Surgery, 2007
- Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta☆European Journal of Cardio-Thoracic Surgery, 2007
- Comparison of magnetic resonance with computed tomography angiography for preoperative localization of the Adamkiewicz artery in thoracoabdominal aortic aneurysm patientsJournal of Vascular Surgery, 2007
- Lower limb paralysis from ischaemic neuropathy of the lumbosacral plexus following aorto-iliac proceduresInteractive CardioVascular and Thoracic Surgery, 2007
- Risk Factors of Neurologic Deficit After Thoracic Aortic EndograftingThe Annals of Thoracic Surgery, 2007
- Descending Thoracic Aortic Aneurysm Repair: 12-Year Experience Using Distal Aortic Perfusion and Cerebrospinal Fluid DrainageThe Annals of Thoracic Surgery, 2005
- Improved outcome after repair of descending and thoracoabdominal aortic aneurysms using modern adjunctsInteractive CardioVascular and Thoracic Surgery, 2005
- Cerebrospinal fluid drainage to prevent paraplegia during thoracic and thoracoabdominal aortic aneurysm surgery: a systematic review and meta-analysisJournal of Vascular Surgery, 2004
- Introduction of adjuncts and their influence on changing results in 402 consecutive thoracoabdominal aortic aneurysm repairs☆European Journal of Cardio-Thoracic Surgery, 2004
- Spinal cord blood supply in patients with thoracoabdominal aortic aneurysmsJournal of Vascular Surgery, 2002