Protocolized Based Management of Cerebrospinal Fluid Drains in Thoracic Endovascular Aortic Aneurysm Repair Procedures
| Autor: | Robina Matyal, Huma Fatima, Omar Chaudhary, Maximilian S. Schaefer, Ameeka Pannu, Jessica Cassavaugh, Feroze Mahmood, Ajith J. Thomas, Yanick Baribeau, Rayan Rashid, Peter A. Soden, Marc L. Schermerhorn, Aidan Sharkey, Santiago Krumm, Ruma Bose |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Endoleak Clinical Decision-Making Aortic Diseases Context (language use) 030204 cardiovascular system & hematology Risk Assessment 030218 nuclear medicine & medical imaging 03 medical and health sciences Aortic aneurysm Blood Vessel Prosthesis Implantation 0302 clinical medicine Epidural hematoma Aneurysm Clinical Protocols Risk Factors medicine Humans Ulcer Aged Retrospective Studies Aged 80 and over Paraplegia Aortic Aneurysm Thoracic business.industry Spinal Cord Ischemia Endovascular Procedures General Medicine Middle Aged medicine.disease Surgery Catheter Aortic Dissection Treatment Outcome Cardiothoracic surgery Drainage Female Neurosurgery Cardiology and Cardiovascular Medicine business Aneurysm False |
| Zdroj: | Annals of vascular surgery. 72 |
| ISSN: | 1615-5947 |
| Popis: | Background Spinal cord ischemia (SCI) resulting in paraplegia is a devastating complication associated with thoracic endovascular aortic aneurysm repair (TEVAR) whose incidence has significantly declined over time. In this review, we present our experience with a multidisciplinary clinical protocol for cerebrospinal fluid (CSF) drain management in patients undergoing TEVAR. Furthermore, we aimed to characterize complications of CSF drain placement in a large, single center experience of patients who underwent TEVAR. Methods This retrospective review is of patients undergoing TEVAR with and without CSF drain placement between January 2014 and December 2019 at a single institution. Patient demographics, hospital course, and drain-related complications were analyzed to assess the incidence of CSF drain-related complications. Results A total of 235 patients were included in this study, of which 85 received CSF drains. Eighty patients (94.1%) were placed by anesthesiologists, while 5 (5.9%) were placed under fluoroscopic guidance by interventional neurosurgery. The most common level of placement was L3-L4 in 38 (44.7%) cases followed by L4-L5 in 36 (42.4%) cases. The mean duration of CSF drain was 1.9 ± 1.4 days. Complications due to CSF drainage occurred in 5 (5.9%) patients and included partial retainment of catheter, subdural edema, epidural hematoma, headache, and bleeding near the drain site. The overall 30-day mortality rate was 5.5% and did not differ between those who received a CSF drain and those who did not (P = 0.856). The overall incidence of SCI resulting in paraplegia was 1.7% in the studied patients. Conclusions A protocol-based CSF drainage program for spinal cord protection involves a multifaceted approach in identification and selection of patients meeting criteria for prophylactic drain placement, direct closed loop communication, and perioperative management by an experienced team. Despite the inherent advantages of CSF drain placement, it is not without complications, thus risk and benefit need to be weighed in context of the procedure and the patient with close communication and team approach. |
| Databáze: | OpenAIRE |
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