Fluoroscopic-guided Lumbar Subarachnoid Drain Placement: A Technical Report

Spinal cord ischemia is a serious complication associated with major endovascular and open aortic repairs. Placement of prophylactic lumbar subarachnoid drains to prevent spinal cord ischemia is a common practice. Traditionally, anesthesiologists placed these drains using landmark techniques or consulted radiologists for fluoroscopic guidance for challenging drain placements. To overcome logistical challenges and improve success rates, vascular anesthesiologists at the authors' institution began routinely using fluoroscopy for lumbar drain placements in 2018. Over 6 years, this dedicated group of anesthesiologists refined an approach and developed protocols that reduced traumatic placements and case cancellations. Fluoroscopic guidance was especially useful in patients with complex anatomies (ie, prior spine surgery, anatomical variances, and obesity). This article shares institutional experiences and technical insights gained from creating a system that enabled anesthesiologists at the authors' institution to perform fluoroscopic-guided lumbar drain placements for a variety of vascular and cardiac surgeries. With over 175 successful placements, this experience emphasizes the value of real-time imaging for obtaining accurate needle and catheter placement, reducing adverse outcomes, and streamlining integration into operating room flow. This report serves as a guide for other institutions aiming to establish similar programs.