TY  - BOOK
AU  - Abramowitz, Steven D
AU  - Alfawaz, Abdullah A
AU  - Dearing, Joshua A
AU  - Fatima, Javairiah
AU  - Kiguchi, Misaki M
AU  - Maloni, Krystal C
AU  - Rossi, Matthew
AU  - Vallabhaneni, Raghuveer
AU  - Woo, Edward Y
TI  - Optimization of factors for the prevention of spinal cord ischemia in thoracic endovascular aortic repair
SN  - 1708-5381
PY  - 2022///
KW  - *Aortic Aneurysm, Thoracic
KW  - *Blood Vessel Prosthesis Implantation
KW  - *Endovascular Procedures
KW  - *Spinal Cord Ischemia
KW  - Aorta, Thoracic/dg [Diagnostic Imaging]
KW  - Aorta, Thoracic/su [Surgery]
KW  - Aortic Aneurysm, Thoracic/co [Complications]
KW  - Aortic Aneurysm, Thoracic/dg [Diagnostic Imaging]
KW  - Aortic Aneurysm, Thoracic/su [Surgery]
KW  - Blood Vessel Prosthesis Implantation/ae [Adverse Effects]
KW  - Blood Vessel Prosthesis Implantation/mt [Methods]
KW  - Endovascular Procedures/ae [Adverse Effects]
KW  - Endovascular Procedures/mt [Methods]
KW  - Humans
KW  - Retrospective Studies
KW  - Risk Factors
KW  - Spinal Cord Ischemia/di [Diagnosis]
KW  - Spinal Cord Ischemia/ep [Epidemiology]
KW  - Spinal Cord Ischemia/et [Etiology]
KW  - Time Factors
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - MedStar Union Memorial Hospital
KW  - MedStar Washington Hospital Center
KW  - Surgery/Vascular Surgery
KW  - Vascular Surgery Integrated Residency
KW  - Journal Article
N2  - CONCLUSION: Incidence of spinal cord ischemia in our cohort was low at 1.5% (2/130). Individual and bundled interventions for the prevention of spinal cord ischemia were unable to demonstrate a statistically significant effect given the low rate. Nonetheless, we advocate for a proactive approach for the prevention of spinal cord ischemia given our experience in this complex population; METHODS: Using CPT codes 33880 and 33881, all TEVAR procedures performed at a single tertiary care center from January 2017 to December 2018 were examined. Patients who had concomitant ascending aortic repairs or a TEVAR for traumatic indications were excluded from analysis, leaving 130 TEVAR procedures. Comorbid conditions, procedural characteristics, extent of coverage, peri-procedural management strategies, and post-operative outcomes were collected and analyzed retrospectively; OBJECTIVES: Spinal cord ischemia following thoracic endovascular aortic repair (TEVAR) is a devastating complication. This study seeks to demonstrate how a standardized protocol to prevent spinal cord ischemia affects incidence in patients undergoing TEVAR; RESULTS: One hundred thirty patients undergoing TEVAR were examined for four perioperative variables: postoperative hemoglobin greater than 10 g/dL, subclavian revascularization, preoperative spinal drain placement, and somatosensory evoked potential monitoring (SSEP). All conditions were met in 46.2% (60/130) of procedures; 37.8% (28/74) in emergent/urgent cases and 61.5% (32/52) in elective cases. Of patients who required subclavian coverage, 87.1% (54/62) underwent subclavian revascularization; 70.8% (92/130) of patients received spinal drains preoperatively; 68.5% (89/130) of patients had SSEP monitoring; 73.8% (93/130) of patients obtained a postoperative hemoglobin of >10 g/dL. Out of all patients, two (1.5%) developed spinal cord ischemia
UR  - https://dx.doi.org/10.1177/17085381211007623
ER  -