| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
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.
This article has been cited by other articles:
|
|
 |
|
  B. W. Ullery, G. J. Wang, D. Low, and A. T. Cheung Neurological Complications of Thoracic Endovascular Aortic Repair Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2011; 15(4): 123 - 140. [Abstract] [PDF]
|
|
|
|
 |
|
 S. M. Rehman, J. A. Vecht, R. Perera, R. Jalil, S. Saso, J. R. Anderson, L. K. von Segesser, and T. Athanasiou How to manage the left subclavian artery during endovascular stenting of the thoracic aorta Eur J Cardiothorac Surg, April 1, 2011; 39(4): 507 - 518. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Fehrenbacher, H. Siderys, C. Terry, J. Kuhn, and J. S. Corvera Early and late results of descending thoracic and thoracoabdominal aortic aneurysm open repair with deep hypothermia and circulatory arrest J. Thorac. Cardiovasc. Surg., December 1, 2010; 140(6_suppl): S154 - S160. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Fedorow, M. C. Moon, W. A. C. Mutch, and H. P. Grocott Review Articles: Lumbar Cerebrospinal Fluid Drainage for Thoracoabdominal Aortic Surgery: Rationale and Practical Considerations for Management Anesth. Analg., July 1, 2010; 111(1): 46 - 58. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 American College of Cardiology Foundation, American Heart Association Task Force on Practice, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interve, Society of Interventional Radiology, Society of Thoracic Surgeons, Society for Vascular Medicine, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease J. Am. Coll. Cardiol., April 6, 2010; 55(14): e27 - e129. [Full Text] [PDF]
|
|
|
|
 |
|
 WRITING GROUP MEMBERS, L. F. Hiratzka, G. L. Bakris, J. A. Beckman, R. M. Bersin, V. F. Carr, D. E. Casey Jr, K. A. Eagle, L. K. Hermann, E. M. Isselbacher, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine Circulation, April 6, 2010; 121(13): e266 - e369. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Mariscalco, G. Piffaretti, M. Tozzi, A. Bacuzzi, G. Carrafiello, A. Sala, and P. Castelli Predictive Factors for Cerebrovascular Accidents After Thoracic Endovascular Aortic Repair Ann. Thorac. Surg., December 1, 2009; 88(6): 1877 - 1881. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Preventza, G. H Wheatley III, J. Williams, V. Ramaiah, J. Rodriguez-Lopez, and E. B Diethrich Identifying Paraplegia Risk Associated with Thoracic Endografting Asian Cardiovasc Thorac Ann, December 1, 2009; 17(6): 568 - 572. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Khoynezhad, C. E. Donayre, B. O. Omari, G. E. Kopchok, I. Walot, and R. A. White Midterm results of endovascular treatment of complicated acute type B aortic dissection J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 625 - 631. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Sandrelli, P. Cioffi, and M. Fabbrocini Alternative Approach for Endovascular Treatment of Aortic Aneurysms Ann. Thorac. Surg., May 1, 2009; 87(5): 1584 - 1585. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Feezor, T. D. Martin, P. J. Hess Jr, M. J. Daniels, T. M. Beaver, C. T. Klodell, and W. A. Lee Extent of Aortic Coverage and Incidence of Spinal Cord Ischemia After Thoracic Endovascular Aneurysm Repair Ann. Thorac. Surg., December 1, 2008; 86(6): 1809 - 1814. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Khoynezhad Stroke Rate After Thoracic Endovascular Aortic Repair May Not Be Equal Among Various Aortic Pathologies Ann. Thorac. Surg., December 1, 2008; 86(6): 2023 - 2023. [Full Text] [PDF]
|
|
|
|
|
|
J. T. Gutsche and A. T. Cheung Reply. Ann. Thorac. Surg., December 1, 2008; 86(6): 2023 - 2024. [Full Text] [PDF]
|
|
|
|
|
|
M. D. Peterson, G. H. Wheatley III, J. Kpodonu, J. P. Williams, V. G. Ramaiah, J. A. Rodriguez-Lopez, and E. B. Diethrich Treatment of type II endoleaks associated with left subclavian artery coverage during thoracic aortic stent grafting. J. Thorac. Cardiovasc. Surg., November 1, 2008; 136(5): 1193 - 1199. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Dunning, J. E. Martin, H. Shennib, and D. C. Cheng Is it safe to cover the left subclavian artery when placing an endovascular stent in the descending thoracic aorta? Interact CardioVasc Thorac Surg, August 1, 2008; 7(4): 690 - 697. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Khoynezhad, C. E. Donayre, J. Smith, G. E. Kopchok, I. Walot, and R. A. White Risk factors for early and late mortality after thoracic endovascular aortic repair. J. Thorac. Cardiovasc. Surg., May 1, 2008; 135(5): 1103 - 1109.e4. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Swee and M. D. Dake Endovascular Management of Thoracic Dissections Circulation, March 18, 2008; 117(11): 1460 - 1473. [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Moon, J. Pablo Morales, and R. K. Greenberg Complicated Acute Type B Dissection and Endovascular Repair: Indications and Pitfalls Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2007; 19(2): 146 - 159. [Abstract] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
