Prospective Assessment of a Protocol Using Neuromonitoring, Early Limb Reperfusion, and Selective Temporary Aneurysm Sac Perfusion to Prevent Spinal Cord Injury During Fenestrated-branched Endovascular Aortic Repair
| Autor: | Emanuel R. Tenorio, Ernest M Hoffman, Gustavo S. Oderich, Jussi M. Kärkkäinen, Bernardo C. Mendes, Randall R. DeMartino, Péter Banga, Maurício Serra Ribeiro |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Blood Vessel Prosthesis Implantation 03 medical and health sciences 0302 clinical medicine Aneurysm Quality of life Risk Factors medicine Humans Prevention Protocol Prospective Studies Spinal cord injury Spinal Cord Injuries Retrospective Studies Paraplegia Aortic Aneurysm Thoracic business.industry Endovascular Procedures Odds ratio medicine.disease Confidence interval Blood Vessel Prosthesis Surgery Perfusion Treatment Outcome 030220 oncology & carcinogenesis Reperfusion Quality of Life 030211 gastroenterology & hepatology business Complication |
| Zdroj: | Annals of Surgery. 276:e1028-e1034 |
| ISSN: | 0003-4932 |
| DOI: | 10.1097/sla.0000000000004624 |
| Popis: | Objective The aim of this study was to analyze the outcomes of a standardized protocol using routine CSFD, neuromonitoring, LL reperfusion, and selective TASP to prevent SCI during F-BEVAR. Background SCI is to be the most devastating complication for the patient, family, and surgeon, with impact on patient's quality of life and long-term prognosis. An optimal standardized protocol may be used to improve outcomes. Methods Patients enrolled in a prospective, nonrandomized single-center study between 2013 and 2018. A SCI prevention protocol was used for TAAAs or complex abdominal aneurysms with ≥5-cm supraceliac coverage including CSFD, neuromonitoring, LL reperfusion, and selective TASP. End-points included mortality and rates of SCI. Results SCI prevention protocol was used in 170 of 232 patients (73%) treated by F-BEVAR. Ninety-one patients (55%) had changes in neuromonitoring, which improved with maneuvers in all except for 9 patients (10%) who had TASP. There was one 30-day or in-hospital mortality (0.4%). Ten patients (4%) developed SCIs including in 1% (1/79) of patients with normal neuromonitoring and 10% (9/91) of those who had decline in neuromonitoring (P = 0.02). Permanent paraplegia occurred in 2 patients (1%). Factors associated with SCI included total operating time (odds ratio 1.5, 95% confidence interval 1.1-2.2, P = 0.02) and persistent changes in neuromonitoring requiring TASP (odds ratio 15.7, 95% confidence interval 2.9-86.2, P = 0.001). Conclusion This prospective nonrandomized study using a standardized strategy to prevent SCI was associated with low incidence of the SCI during F-BEVAR. Permanent paraplegia occurred in 1%. |
| Databáze: | OpenAIRE |
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