Optimization of factors for the prevention of spinal cord ischemia in thoracic endovascular aortic repair. (April 2022)

• Record Type: Journal Article
• Authors: Sulzinski, Michelle C; Rossi, Matthew John; Alfawaz, Abdullah A; Reynolds, Kyle B; Maloni, Krystal C; Kiguchi, Misaki M; Dearing, Joshua A; Abramowitz, Steven D; Vallabhaneni, Raghuveer; Woo, Edward Y; Fatima, Javairiah
• Is Part Of: Vascular. Volume 30:Number 2(2022)
• Page Start: 199
• Page End: 205
• Publication Date: 2022-04
• Subjects: Spinal cord ischemia -- spinal cord ischemia prevention -- TEVAR -- thoracic aneurysm -- dissection; 616.13
• DOI: 10.1177/17085381211007623
• Languages: English
• ISSNs: 1708-5381

Abstract

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.