Optimization of factors for the prevention of spinal cord ischemia in thoracic endovascular aortic repair.

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Citation: Vascular. 30(2):199-205, 2022 Apr.PMID: 33853456Institution: MedStar Heart & Vascular Institute | MedStar Union Memorial Hospital | MedStar Washington Hospital CenterDepartment: Surgery/Vascular Surgery | Vascular Surgery Integrated ResidencyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Aneurysm, Thoracic | *Blood Vessel Prosthesis Implantation | *Endovascular Procedures | *Spinal Cord Ischemia | Aorta, Thoracic/dg [Diagnostic Imaging] | Aorta, Thoracic/su [Surgery] | Aortic Aneurysm, Thoracic/co [Complications] | Aortic Aneurysm, Thoracic/dg [Diagnostic Imaging] | Aortic Aneurysm, Thoracic/su [Surgery] | Blood Vessel Prosthesis Implantation/ae [Adverse Effects] | Blood Vessel Prosthesis Implantation/mt [Methods] | Endovascular Procedures/ae [Adverse Effects] | Endovascular Procedures/mt [Methods] | Humans | Retrospective Studies | Risk Factors | Spinal Cord Ischemia/di [Diagnosis] | Spinal Cord Ischemia/ep [Epidemiology] | Spinal Cord Ischemia/et [Etiology] | Time Factors | Treatment OutcomeYear: 2022ISSN:
  • 1708-5381
Name of journal: VascularAbstract: 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.All authors: Abramowitz SD, Alfawaz AA, Dearing JA, Fatima J, Kiguchi MM, Maloni KC, Reynolds KB, Rossi MJ, Sulzinski MC, Vallabhaneni R, Woo EYOriginally published: Vascular. :17085381211007623, 2021 Apr 14Fiscal year: FY2021Digital Object Identifier: ORCID: Date added to catalog: 2021-06-07
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Journal Article MedStar Authors Catalog Article 33853456 Available 33853456

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.

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