Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta

• Published in: European journal of cardio-thoracic surgery 2007-06, Vol.31 (6), p.998-1003
• Main Authors: Kawaharada, Nobuyoshi, Morishita, Kiyofumi, Kurimoto, Yoshihiko, Hyodoh, Hideki, Ito, Toshiro, Harada, Ryo, Kuwaki, Kenji, Higami, Tetsuya
• Format: Article
• Language: English
• Subjects: Aged; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - surgery; Biological and medical sciences; Blood Vessel Prosthesis Implantation - adverse effects; Cerebrospinal fluid. Meninges. Spinal cord; Female; Humans; Magnetic Resonance Angiography - methods; Male; Medical sciences; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Paraparesis - etiology; Paraplegia; Paraplegia - etiology; Preoperative Care - methods; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk Factors; Spinal cord ischemia; Spinal Cord Ischemia - etiology; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; The artery of Adamkiewicz (ARM); Thoracic aortic aneurysm; Vertebral Artery - pathology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2007.01.069

Background: We reviewed our experience to investigate the determinants of paraplegia/paraparesis after endovascular stent-graft repair of the thoracic aorta, to assess the influence of the artery of Adamkiewicz (ARM) detected by preoperative magnetic resonance angiography (MRA) and to identify patients at risk. Methods: Over a 5-year period (March 2001–June 2006), 149 patients underwent elective endovascular stent-graft repair of the descending thoracic aorta. Patient demographics and perioperative factors relating to the endovascular procedure were evaluated by using univariate statistical analyses. To assess the influence of the ARM in the thoracolumbar region, patients in whom ARM was detected by preoperative MRA were divided into two groups: patients who had occlusion of the intercostal artery for ARM due to stent-graft (group A, n = 33) and patients who had patency of the intercostal artery for ARM following stent-graft (group B, n = 38). Results: Five (3.6%) of the 144 patients had paraparesis/paraplegia. Two of these five patients had previously undergone operation for total arch replacement with elephant trunk and one had surgery for descending aortic repair. Univariate analyses identified only prior aortic surgery as a significant risk factor (p = 0.04). Paraparesis/paraplegia rates were 10% (three patients) in group A and 0% in group B (p = 0.09). Conclusion: Prior thoracic aortic replacement was found to be a significant predictor of spinal cord ischemia, and therefore vigilance is needed regarding occlusion of the intercostal artery for ARM detected prior to stent-graft repair.