Use of lumbar cerebrospinal fluid drainage in thoracoabdominal aortic aneurysm repairs

Thoracoabdominal aortic aneurysm repairs present many challenges, and the complication of paraplegia remains a concern for both the surgeon and the nurse caring for the patient in the postoperative period. Paraplegia can occur secondary to spinal cord ischemia from prolonged aortic clamping during the repair of the descending thoracic aorta. Paraplegia is a devastating complication for the patient and family. Multiple adjunct techniques have been instituted to prevent reduced spinal cord perfusion during and after the operation, including the use of shunts and cardiopulmonary bypass, femoral artery-femoral vein bypass, left atrial-femoral artery bypass, and selective revascularization of the dominant intercostal artery. Other methods, such as somatosensory evoked potential monitoring during the operation and regional spinal hypothermia techniques, have not reduced the incidence of paraplegia. Improved outcomes have been seen with the use of methods to reduce cerebrospinal fluid (CSF) pressure. One such method is the use of external CSF drainage during the operation, followed by use of a lumbar drain system for as long as 72 hours after the operation. This system setup uses a transducer to monitor CSF pressure and a drip chamber to drain CSF to maintain a normal pressure. This article describes thoracoabdominal aneurysms, surgical techniques to repair the aneurysm, and the use of external CSF drainage and related nursing care measures.