Protocol implementation of selective postoperative lumbar spinal drainage after thoracic aortic endograft

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Surgery

Background:

• Spinal cord ischemia (SCI) is a risk following thoracic endovascular aortic repair (TEVAR).
• No established protocol exists for managing SCI after TEVAR using lumbar drainage.
• This study evaluates an institutional protocol for selective lumbar drainage in SCI patients post-TEVAR.

Purpose of the Study:

• To analyze the efficacy of selective postoperative lumbar spinal drainage for SCI after TEVAR.
• To identify risk factors associated with SCI development post-TEVAR.
• To assess the impact of lumbar drainage on neurologic recovery and survival in SCI patients.

Main Methods:

• Review of a prospectively maintained registry of TEVAR procedures (January 2000-June 2010).
• Comparison of patients who developed SCI versus those who did not.
• Analysis of outcomes in SCI patients who received selective lumbar drainage, categorized by symptom resolution.

Main Results:

• 16.0% of 266 TEVAR procedures resulted in SCI.
• Significant risk factors for SCI included longer aortic coverage, infrarenal aortic pathology, and history of stroke.
• Of 10 SCI patients treated with lumbar drainage, 30% had complete resolution, 40% partial, and 30% no resolution. Complete responders survived, while non-responders died within one year.

Conclusions:

• Selective postoperative lumbar drainage is a safe approach for SCI following TEVAR.
• This protocol may reduce permanent neurologic deficits in SCI patients.
• Patients experiencing SCI after TEVAR have diminished overall survival rates.