37- https://doi.org/10.21037/jtd.2018.10.99
Risk of spinal cord ischemia after thoracic endovascular aortic repair.
Translate Article 
Spinal cord ischemia (SCI) is a recognized grave complication after thoracic endovascular aortic repair (TEVAR). The present study aimed to evaluate the incidence and investigate risk of SCI after TEVAR based on current prophylactic strategies designed against established risk factors. The study retrospectively reviewed a prospectively maintained database to investigate patients who underwent TEVAR successfully between January 2009 and December 2012 in a single cardiovascular center. Detailed assessment of SCI risk was routinely performed for all patients before TEVAR was carried out. Prophylactic measures, including left subclavian artery (LSA) revascularization, blood pressure augmentation and cerebrospinal fluid (CSF) pressure control after TEVAR, were employed in high-risk patients and physical neurological examinations were regularly done to evaluate SCI after TEVAR. Patients were further divided into SCI group and non-SCI group. A total of 650 patients were enrolled in the study. Eleven patients (1.69%) developed SCI after TEVAR. Baseline level of hemoglobin was significantly lower in the SCI group (113.00 vs. 128.50, P=0.023). More patients in the SCI patients in the SCI group underwent TEVAR under general anesthesia (45.5% vs. 17.7%, P=0.033). A significantly higher incidence of post TEVAR hypotension was found in the SCI group (2.7% vs. 27.3%, P=0.004). Logistic regression analysis revealed that post-TEVAR hypotension (OR, 8.379; 95% CI, 1.833-38.304; P=0.006) was strongly associated with development of SCI and high normal baseline hemoglobin was a protective factor (OR, 0.969; CI, 0.942-0.998; P=0.037). The mortality in hospital and mortality at 1 year were not significant different between the SCI and the non-SCI group (0% vs. 1.6% P=1.000; 9.1% vs. 3.0%, P=0.294, respectively). While length of post-TEVAR stay (13.00 vs. 7.00 days, P=0.000) and length of hospital stay (20.00 vs. 13.00 days, P=0.001) were significantly greater in the SCI group. Our study revealed that, based on current prophylactic measures to curtail SCI, including LSA revascularization, blood pressure augmentation and CSF pressure control after TEVAR, post-TEVAR hypotension remains a major and independent risk factor for SCI and high normal baseline hemoglobin level is protective. SCI results in longer post-TEVAR stay and hospital stay, but not associated with increased mortality. Robust precautions should be taken against underlying causes for post-TEVAR hypotension and low level of hemoglobin should be avoided.
- # Spinal Cord Ischemia
- # Thoracic Endovascular Aortic Repair
- # Post Thoracic Endovascular Aortic Repair
- # non-SCI Group
- # Blood Pressure Augmentation
- # Left Subclavian Artery Revascularization
- # High Baseline Hemoglobin
- # Physical Neurological Examinations
- # Low Level Of Hemoglobin
- # Blood Cerebrospinal Fluid
- Abstract
- 1
- 10.1016/j.jvs.2022.03.581
- May 19, 2022
- Journal of Vascular Surgery
Left Subclavian Artery Revascularization May Not Influence the Incidence of Spinal Cord Ischemia in Elective Thoracic Endovascular Aortic Aneurysm Repair
- Abstract
- 10.1016/j.jvs.2023.03.237
- May 23, 2023
- Journal of Vascular Surgery
Open Versus Endovascular Left Subclavian Artery Revascularization Outcomes in Thoracic Endovascular Aortic Repair: A National Study
- Research Article
- 31
- 10.1016/j.avsg.2019.01.005
- Mar 23, 2019
- Annals of Vascular Surgery
Outcome Comparison of TEVAR with and without Left Subclavian Artery Revascularization from Analysis of Nationwide Inpatient Sample Database
- Abstract
- 1
- 10.1016/j.jvs.2023.03.235
- May 23, 2023
- Journal of Vascular Surgery
Factors Associated With Spinal Cord Ischemia After Thoracic, Abdominal, and Thoracoabdominal Endovascular Aortic Repairs
- Research Article
- 1
- 10.1016/j.ejvs.2019.06.602
- Dec 1, 2019
- European Journal of Vascular and Endovascular Surgery
Left Subclavian Artery Revascularization for Thoracic Aortic Stentgrafting: Single Center Experience in 101 Patients
- Research Article
- 5
- 10.1016/j.jvs.2025.02.019
- Jun 1, 2025
- Journal of vascular surgery
Endovascular versus surgical left subclavian artery revascularization with thoracic endovascular aortic repair involving the aortic arch.
- Research Article
- 6
- 10.1016/j.jvs.2010.03.010
- Jun 10, 2010
- Journal of Vascular Surgery
Endovascular repair of extent I thoracoabdominal aneurysms with landing zone extension into the aortic arch and mesenteric portion of the abdominal aorta
- Research Article
- 10.1016/j.ejvs.2019.09.184
- Dec 1, 2019
- European Journal of Vascular and Endovascular Surgery
Stroke Following Thoracic Endovascular Aortic Repair and the Impact of Left Subclavian Artery Management
- Research Article
- 62
- 10.1016/j.ejvs.2018.07.018
- Aug 16, 2018
- European Journal of Vascular and Endovascular Surgery
Effect of Left Subclavian Artery Revascularisation in Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-analysis
- Research Article
- 99
- 10.1177/1526602816651417
- Jul 9, 2016
- Journal of Endovascular Therapy
Purpose: To examine the role of left subclavian artery (LSA) revascularization in thoracic endovascular aortic repair (TEVAR) with LSA coverage. Methods: A systematic search was conducted to identify all studies providing comparative outcomes with or without LSA revascularization for LSA occlusion during TEVAR. The search included MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov , ISRCTN Register, and bibliographic reference lists. The primary outcome parameters were perioperative stroke, spinal cord ischemia (SCI), and mortality. Combined overall effect sizes were calculated using fixed effect or random effects models; results are reported as the odds ratio (OR) and 95% confidence interval (CI). Results: Five observational studies reporting a total of 1161 patients were identified; 444 patients underwent LSA revascularization and the remaining 717 patients did not. LSA revascularization was associated with a similar risk of stroke (OR 0.70, 95% CI 0.43 to 1.14, p=0.15), SCI (OR 0.56, 95% CI 0.28 to 1.10, p=0.09), and mortality (OR 0.87, 95% CI 0.55 to 1.39, p=0.56) compared with no LSA revascularization. Conclusion: LSA revascularization was not found to significantly reduce neurologic complications or mortality in patients undergoing TEVAR with coverage of the LSA origin. Randomized clinical trials are required to elucidate the role of routine or selective LSA revascularization in these cases.
- Front Matter
- 9
- 10.1016/j.jvs.2010.06.140
- Aug 21, 2010
- Journal of Vascular Surgery
Regulatory TEVAR clinical trials
- Research Article
- 39
- 10.1016/j.athoracsur.2020.04.101
- Jun 12, 2020
- The Annals of Thoracic Surgery
Permissive Hypertension and Collateral Revascularization May Allow Avoidance of Cerebrospinal Fluid Drainage in Thoracic Endovascular Aortic Repair
- Research Article
- 12
- 10.1016/j.jvir.2010.05.011
- Aug 4, 2010
- Journal of Vascular and Interventional Radiology
Spinal Cord Protection with a Cerebrospinal Fluid Drain in a Patient Undergoing Thoracic Endovascular Aortic Repair
- Research Article
- 10.21608/ejhm.2025.473206
- Oct 1, 2025
- The Egyptian Journal of Hospital Medicine
Background: Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment for different thoracic aortic diseases for its safety and minimally invasive nature. In some cases, secure graft fixation requires coverage of the left subclavian artery, which may increase the risk of spinal cord ischemia, stroke and upper limb ischemia but prophylactic left subclavian artery (LSA) revascularization may reduce these complications. Methods: The study aimed to determine whether LSA revascularization reduces the risk of major neurologic or ischemic complications defined as any ischemic stroke, spinal cord ischemia, or ipsilateral upper-limb ischemia requiring intervention within 30 days after zone-2 thoracic endovascular aortic repair (TEVAR). To address this, we analyzed a retrospectively assembled observational cohort derived from prospectively collected data on adults (≥18 years) who underwent zone-2 TEVAR with either LSA revascularization or deliberate LSA coverage without revascularization across three vascular surgery centers: Mansoura University Hospital, and Egypt Healthcare Hospitals in Portsaid and Ismailia. The study period extended from January 2022 to January 2025, enabling comprehensive capture of contemporary management practices and early postoperative outcomes. Results: A significant difference was observed between the LSA revascularization and non-LSA groups only in the use of spinal drains, which were required in 5 patients (85.7%) in the non-LSA group (P<0.05). No significant differences were found between the groups regarding mortality, stroke/TIA, contrast-induced nephropathy, ICU stay, or total hospital stay (P>0.05), indicating comparable perioperative outcomes overall. Conclusion: LSA revascularization during zone-2 TEVAR appeared to be a safe and effective strategy, demonstrating similar rates of major adverse events including death, cerebrovascular complications and renal impairment when compared to non-revascularized patients. These findings support the role of LSA revascularization as a protective measure without increasing perioperative risk
- Research Article
- 111
- 10.1016/j.jvs.2012.06.101
- Sep 26, 2012
- Journal of Vascular Surgery
Left subclavian artery coverage during thoracic endovascular aortic aneurysm repair does not mandate revascularization
Save Important notes in documents
Highlight text to save as a note, or write notes directly
You can also access these Documents in Paperpal, our AI writing tool
Powered by our AI Writing Assistant
