Cochrane Collaborative Review Group on Peripheral Vascular Diseases: Review Abstracts

Abstract

The following abstracts are part of an ongoing series of articles produced by the Cochrane Collaborative Review Group on Peripheral Vascular Diseases, which is part of The Cochrane Collaboration. The reviews are published in full on The Cochrane Library, a quarterly electronic journal available on CD-ROM and via the internet. The electronic format allows Cochrane reviews to accommodate new data as they become available, making the library a consistently up-to-date source of information over time. Certain abstracts appearing on The Cochrane Library may be presented in a simpler, less scientific format than the abstract presented here to permit greater accessibility to the public. However, the substance of both versions is the same. Cochrane reviews are now indexed on MEDLINE. If you are interested in conducting a Cochrane review or contributing to the activities of the Cochrane Collaborative Review Group on Peripheral Vascular Diseases, please contact: Professor FGR Fowkes Cochrane Collaborative Review Group on Peripheral Vascular Diseases Public Health Sciences University of Edinburgh Teviot Place Edinburgh EH8 9AG, UK Tel.: +44 131 650 3220 Fax: +44 131 650 6904. Any comments or criticisms on Cochrane reviews/abstracts should be made through the comments/criticisms facility on The Cochrane Library, or by contacting the group at the above address. Abstract. Cerebrospinal fluid drainage for thoracic and throacoabdominal aortic aneurysm surgery. Khan SN, Stansby G First Published: The Cochrane Library Issue 1, 2004 During aortic aneurysm surgery, cross-clamping can lead to inadequate blood supply to the spinal cord resulting in neurological deficit. Cerebrospinal fluid drainage (CSFD) may increase the perfusion pressure to the spinal cord and hence reduce the risk of ischaemic spinal cord injury. To determine the effect of CSFD during thoracic and thoracoabdominal aortic aneurysm (TAAA) surgery on the risk of developing spinal cord injury. The reviewers searched the Cochrane Peripheral Vascular Diseases Group trials register (last searched July 2004), the Cochrane Central Register of Controlled Trials (CENTRAL) database (last searched The Cochrane Library Issue 2, 2004). Reference lists of relevant articles and recent conference proceedings were scanned. Randomised controlled trials involving CSFD during thoracic and TAAA surgery. Both reviewers assessed the quality of trials independently. SNK extracted data and GS verified the data. Three trials with a total of 287 participants operated on for type I or II TAAA were included. In the first trial of 98 participants, neurological deficits in the lower extremities occurred in 14 (30%) in CSFD group and 17 (33%) controls. The deficit was observed within 24 h of the operation in 21 (68%), and from 3 to 22 days in 10 (32%) participants. CSFD did not have a significant benefit in preventing ischaemic injury to the spinal cord. The second trial of 33 participants used a combination of CSFD and intrathecal papaverine. It showed a statistically significant reduction in the rate of postoperative neurological deficit (P 0.039), compared to controls. Analysis was undertaken after only one third of the estimated sample size had entered the trial. In the third trial TAAA repair was performed on 145 participants. CSFD was initiated during the operation and continued for 48 h after surgery. Paraplegia or paraparesis occurred in 9 of 74 participants (12.2%) in the control group versus 2 of 82 participants (2.7%) receiving CSFD (P 0.03). Overall, CSFD resulted in an 80% reduction in the relative risk of postoperative deficits. Meta-analysis showed an odds ratio (OR) of 0.48 (95% confidence interval (CI) 0.25 to 0.92). For CSFD-only trials, OR was 0.57 (95% CI 0.28 to 1.17) and for intention-to-treat analysis in CSFD-only studies, the OR remained unchanged. There are limited data supporting the role of CSFD in thoracic and thoracoabdominal aneurysm surgery for prevention of neurological injury. Further clinical and experimental studies are indicated.