Perioperative Drainage of Cerebrospinal Fluid for Endovascular Aortic Surgery

Spinal cord ischemia (SCI) is a feared complication following thoracic endovascular aortic aneurysm repair (TEVAR). European Society for Vascular Surgery guidelines suggest lumbar drainage of cerebrospinal fluid (CSF) in high-risk patients. The institutional protocol proposes as indications for CSF drainage: coverage of Adamkiewicz artery origin (T9-T12), aortic length of coverage >15 cm, compromise of collateral arteries (left subclavian or internal iliac occlusion) and symptomatic SCI. The aim of this study is to demonstrate CSF drainage efficacy and safety in the prevention or treatment of TEVAR-related SCI.

Patients submitted to TEVAR with perioperative CSF drainage between May 2015 and April 2017 at our hospital were prospectively included. The primary outcome consisted of prevention or regression of neurological symptoms (efficacy). Other complications were recorded as secondary outcomes (safety).

Nine patients, aged between 63 and 75 years, were included. Eight surgeries were elective and one was emergent. Eight lumbar catheters were placed before surgery and one in the postoperative period due to SCI symptomatology that reverted after CSF drainage. Of those placed preoperatively, 2 developed postoperative SCI symptoms that alleviated with increased drainage or haemoglobin optimization. All patients were submitted to general anaesthesia. The patient treated in the emergent setting progressed with multiorgan dysfunction and death 24 hours after surgery. There were no other complications.

In this group of patients, CSF drainage was safe and effective in the prevention and treatment of TEVAR-related SCI.