Lumbar Cerebrospinal Fluid Drainage in Endovascular Aortic Repair - Reference Centre Experience

Spinal cord ischemia (SCI) and the resulting paraplegia are one of the most feared postoperative complications after thoraco-abdominal aortic surgery, with an incidence 4,3-8,0% after thoracic endovascular aortic repair (TEVAR), increasing patients morbi-mortality. Lumbar cerebrospinal fluid (CSF) drainage catheter is recommended as preventive measure in high risk patients.

To evaluate the efficiency and safety of CSF drainage catheter as preventive or therapeutic measure in endovascular aortic repair (EAR).

Retrospective study in 19 patients submitted to TEVAR or fEVAR (fenestrated endovascular aneurism repair), in whom CSF drainage catheter was used, between January 2010 and March 2017. Collected data regarding demographic, perioperative patients characteristics, neurologic symptoms (NS) and other complications. All patients were submitted to general anesthesia (GA) as result of complexity and length of surgery. Known risk factors (RF) for SCI were taken into account.

19 patients, 89,5% (n=17) male, mean age of 66±9 years. 63,2% were classified as ASA III and 36,8% as ASA IV. 9 patients submitted to TEVAR (47,4%); the remaining were submitted to fEVAR. 73,7 % were programed procedures. There were intraoperative complications in 3 patients: iliac artery (IA) rupture in 2 patients, laceration of the axillary artery in 1 patient, all required surgical repair. All catheters were placed in awake patients, before GA induction, and were left in place 2,5 days. 7 patients needed drainage because of CSF pressure>10mmHg intra- or postoperatively. 3 patients developed early symptoms of SCI (decreased mobility and strength of legs). Complete recovery occurred in all patients, except one who recovered just partially. 1 patient developed late NS: paraparesia on 40th postoperative day (POD) as result of spinal stroke. 30 days mortality was 10,5% (n=2), due to cardiorespiratory arrest- 1 by hypovolemic shock (on 3rd POD), 1 by unknown cause (14th POD).

This study was limited by the small sample size. CSF drainage catheter was an efficient measure in prevention and treatment of SCI in this sample, since there was no case of complications due to SCI. CSF drainage seems to be an effective technique in preventing SCI. Further studies are required to determine the effectiveness and compare the different methods available for the prevention of SCI complications.