Cerebrospinal Fluid Drain-Related Complications in Patients Undergoing Open and Endovascular Repairs of Thoracic and Thoracoabdominal Aortic Pathologies: A Systematic Review and Meta-Analysis

Abstract

Search of electronic databases of PubMed and Scopus for randomized controlled trials, prospective studies, and retrospective studies in all languages from 1990 to 2017. Thirty-four studies including 4714 patients were analyzed examining the results of cerebrospinal drainage (CSF) drainage performed as an adjunct for endovascular or open repair of thoracic or thoracoabdominal aneurysm repair. The pooled event rate of CSF drainage was 6.5% overall: 2% for minor complications (puncture-site bleeding, bloody spinal fluid, CSF leak not requiring intervention, hypotension, drain fracture left in place, occluded/dislodged catheters), 3.7% for moderate complications (spinal headache, CSF leak requiring intervention, drain fracture), and 2.5% for severe complications (epidural hematoma, intracranial hemorrhage, subarachnoid hemorrhage, meningitis, catheter/drainage-related neurological deficit). The drainage-related mortality-pooled event rate was 0.9%. There was no difference in complication rates between open and endovascular approaches or between different CSF drainage protocols. The complication rate for CSF drainage is approximately 6% with severe complications occurring in 2.5% of patients. These results help define a more accurate risk-benefit ratio