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Ann Thorac Surg 2007;83:S882-S889
© 2007 The Society of Thoracic Surgeons
a Section of Cardiovascular and Thoracic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
b Divisions of Vascular and Endovascular Surgery, Harbor-UCLA Medical Center, Torrance, California
c Division of Interventional Radiology, Harbor-UCLA Medical Center, Torrance, California
* Address correspondence to Dr Khoynezhad, Section of Cardiovascular and Thoracic Surgery, University of Nebraska Medical Center, 982315 Nebraska Medical Center, Omaha, NE 68198-2315. (Email: akhoynezhad{at}unmc.edu).
Presented at Aortic Surgery Symposium X, New York, NY, April 27–28, 2006.
BACKGROUND: Stroke and spinal cord injury (SCI) remain the most devastating complications of thoracic endovascular aortic repair (TEVAR). The risk factors associated with these complications are poorly understood. The aim of this study was to analyze the risk factors associated with neurologic deficits after TEVAR.
METHODS: From 1998 to 2005, 153 patients underwent 184 TEVARs. Computed tomography scans, angiograms, and medical records were reviewed. TEVAR was completed in all but 3 patients. The underlying pathologies included descending thoracic aortic aneurysm in 91, acute type B aortic dissection in 25, chronic type B aortic dissection in 42, aortic transection in 12, and penetrating aortic ulcer in 14.
RESULTS: Stroke developed in 8 patients, and SCI developed in another 8 patients (4 immediate, 4 delayed paraplegia/paraparesis). The procedure-associated stroke and SCI rate was 4.3% (8/184). Univariate statistical analysis revealed increased postoperative stroke with obesity, significant intraoperative blood loss, and evidence of peripheral vascular embolization/thrombosis. Aneurysmal pathology, iliac conduit, and hypogastric artery coverage were highly associated with postoperative SCI after TEVAR. Early and late mortality were 9.8% (n = 18) and 19% (n = 35) in a 16-month average period of follow-up.
CONCLUSIONS: The incidence of stroke and SCI after TEVAR was 4.3% (8/184). The risk factors associated with postoperative stroke were obesity, intraoperative blood loss, and vascular embolization. Aneurysm as an underlying pathology, the use of an iliac conduit, and coverage of the hypogastric artery were all associated with SCI. These risk factors for SCI may be markers of tenuous collateral blood supply to the spinal cord.
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