Contemporary Single-Center Experience With Prophylactic Cerebrospinal Fluid Drainage for Thoracic Endovascular Aortic Repair in Patients at High Risk for Ischemic Spinal Cord Injury
Autor: | Richa Kalsi, Kenichi A. Tanaka, Ezeldeen Abuelkasem, Shabab Toursavadkohi, Charles B. Drucker, Michael A. Mazzeffi, Peter Rock, Donald G. Harris, Bradley S. Taylor, Robert S. Crawford |
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Rok vydání: | 2018 |
Předmět: |
Male
Risk medicine.medical_specialty Aorta Thoracic 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Cerebrospinal fluid Lumbar Epidural hematoma 030202 anesthesiology Humans Medicine Spinal cord injury Spinal Cord Injuries Aged Cerebrospinal Fluid Retrospective Studies Spinal Cord Ischemia business.industry Endovascular Procedures Retrospective cohort study Middle Aged Spinal cord medicine.disease Surgery Anesthesiology and Pain Medicine medicine.anatomical_structure Drainage Female Cardiology and Cardiovascular Medicine business Complication Paraplegia |
Zdroj: | Journal of Cardiothoracic and Vascular Anesthesia. 32:883-889 |
ISSN: | 1053-0770 |
Popis: | Objective To review rates of permanent paraplegia and lumbar drain-related complications in patients undergoing thoracic endovascular aortic repair (TEVAR) surgery with prophylactic cerebrospinal fluid (CSF) drainage at the authors’ institution. Design Retrospective cohort study. Setting Tertiary care, academic medical center. Participants Patients who underwent TEVAR with a high risk for ischemic spinal cord injury and prophylactic lumbar CSF drainage over a 5-year period. Interventions None. Measurements and Main Results One hundred and two patients underwent TEVAR with lumbar CSF drainage. Thirty-day mortality was 5.9%, and the rate of permanent paraplegia was 2%. Drain complications occurred in 4 (3.9%) patients, but no patient experienced permanent injury related to CSF drainage. Two patients in the cohort had complete resolution of paraplegia with increased CSF drainage and mean arterial blood pressure increases aimed to increase spinal cord perfusion pressure by 25%. A third patient experienced improvement in lower extremity strength but remained paraplegic, and a fourth patient demonstrated no improvement in symptoms. The 6 patients taking clopidogrel experienced no bleeding complications, and there were no apparent risk factors for bleeding in the 5 patients who had bloody drain output or in 1 patient who developed an epidural hematoma. Conclusion Prophylactic CSF drainage was associated with low paraplegia and drain-related complication rates. These data further support the safety of prophylactic CSF drainage in patients undergoing TEVAR with a high risk for ischemic spinal cord injury. |
Databáze: | OpenAIRE |
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