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Original Articles: Adult Cardiac

Extent of Aortic Coverage and Incidence of Spinal Cord Ischemia After Thoracic Endovascular Aneurysm Repair

^a Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Florida
^b Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
^c Division of Biostatistics, Department of Epidemiology and Biostatistics, University of Florida, Gainesville, Florida

Accepted for publication September 4, 2008.

^_* Address correspondence to Dr Lee, Division of Vascular Surgery and Endovascular Therapy, 1600 SW Archer Rd, Ste NG-45, PO Box 100286, Gainesville, FL 32610-0286 (Email: anthony.lee{at}surgery.ufl.edu).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: Risk factors for spinal cord ischemia (SCI) after thoracic endovascular aneurysm repair (TEVAR) remain unclear. Aortic coverage was examined as a risk factor for SCI using quantitative three-dimensional computed tomography angiography (CTA) analysis.

Methods: The medical records, radiographic imaging studies, and a prospectively maintained database of all TEVAR procedures performed during a 7-year period were retrospectively reviewed. Preoperative anatomic dimensions and postoperative graft path lengths were measured from CTAs using curved planar and orthogonal multiplanar reformations along centerline paths. SCI was defined as transient or permanent lower extremity neurologic deficit without associated intracerebral hemispheric events.

Results: Of 326 TEVAR cases, 241 patients (74%) had satisfactory imaging. Thirty-three (10%) had SCI. These patients were older (72.7 ± 10.6 vs 64.7 ± 15.8 years, p = 0.005) and had longer intraoperative procedure times (137 ± 65 vs 113 ± 68 minutes, p = 0.05). Despite similar total lengths of native thoracic aorta (295.0 ± 36.3 vs 283.1 ± 39.8 mm, p = 0.17), patients with permanent SCI had a greater absolute (260.5 ± 40.9 vs 195.8 ± 81.6 mm, p = 0.002) and proportionate (88.8% ± 12.1% vs 67.6% ± 24.0%, p = 0.001) length of aortic coverage. The average length of uncovered aorta proximal to the celiac artery in patients with SCI was 17.3 ± 21.8 mm vs 63.1 ± 62.9 mm in patients without SCI (p = 0.0006). Neither the patency of the hypogastric arteries nor left subclavian artery was associated with SCI.

Conclusions: The extent and distal location (relative to the celiac artery) of aortic coverage were associated with an increased risk of SCI. Prophylactic measures for spinal cord protection should be considered in patients whose thoracic aortas require extensive coverage.

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