Optimization of factors for the prevention of spinal cord ischemia in thoracic endovascular aortic repair
| Autor: | Steven D. Abramowitz, Michelle C Sulzinski, Javairiah Fatima, Raghuveer Vallabhaneni, Joshua Dearing, Edward Y. Woo, Kyle B Reynolds, Misaki M Kiguchi, Abdullah Alfawaz, Krystal C Maloni, Matthew J. Rossi |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Time Factors Cord Ischemia Aorta Thoracic Dissection (medical) 030204 cardiovascular system & hematology Aortic repair Blood Vessel Prosthesis Implantation 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans Radiology Nuclear Medicine and imaging 030212 general & internal medicine Retrospective Studies Aortic Aneurysm Thoracic Spinal Cord Ischemia business.industry Endovascular Procedures Spinal cord ischemia General Medicine medicine.disease Surgery Treatment Outcome Cardiology and Cardiovascular Medicine Complication business |
| Zdroj: | Vascular. 30:199-205 |
| ISSN: | 1708-539X 1708-5381 |
| Popis: | Objectives Spinal cord ischemia following thoracic endovascular aortic repair (TEVAR) is a devastating complication. This study seeks to demonstrate how a standardized protocol to prevent spinal cord ischemia affects incidence in patients undergoing TEVAR. Methods Using CPT codes 33880 and 33881, all TEVAR procedures performed at a single tertiary care center from January 2017 to December 2018 were examined. Patients who had concomitant ascending aortic repairs or a TEVAR for traumatic indications were excluded from analysis, leaving 130 TEVAR procedures. Comorbid conditions, procedural characteristics, extent of coverage, peri-procedural management strategies, and post-operative outcomes were collected and analyzed retrospectively. Results One hundred thirty patients undergoing TEVAR were examined for four perioperative variables: postoperative hemoglobin greater than 10 g/dL, subclavian revascularization, preoperative spinal drain placement, and somatosensory evoked potential monitoring (SSEP). All conditions were met in 46.2% (60/130) of procedures; 37.8% (28/74) in emergent/urgent cases and 61.5% (32/52) in elective cases. Of patients who required subclavian coverage, 87.1% (54/62) underwent subclavian revascularization; 70.8% (92/130) of patients received spinal drains preoperatively; 68.5% (89/130) of patients had SSEP monitoring; 73.8% (93/130) of patients obtained a postoperative hemoglobin of >10 g/dL. Out of all patients, two (1.5%) developed spinal cord ischemia. Conclusion Incidence of spinal cord ischemia in our cohort was low at 1.5% (2/130). Individual and bundled interventions for the prevention of spinal cord ischemia were unable to demonstrate a statistically significant effect given the low rate. Nonetheless, we advocate for a proactive approach for the prevention of spinal cord ischemia given our experience in this complex population. |
| Databáze: | OpenAIRE |
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