Spinal cord ischemia during endovascular repair of the thoracic aorta

Abstract

Background and objectives: This work aims to analyze the incidence of medullary ischemia (MI) and identify the factors contributing to its development during endovascular repair of the descending thoracic aorta in patients requiring complete coverage. Material and methods: A retrospective study. Between April 1999 and December 2014, 176 thoracic aortic endovascular repairs were performed. Sixty-two patients (48 male and 14 female) were treated with thoracic stents from the aortic arch to the celiac trunk due to thoracoabdominal aneurysms (n = 13), aortic dissections (n = 42), intramural hematomas (n = 4), post-traumatic pseudoaneurysms (n = 2) and aortic ulcers (n = 1). All procedures were performed under general anesthesia with strict invasive blood pressure control. Cerebrospinal fluid drainage was performed in 5 patients. Results: The success rate of stent placement was 96.7%, and mortality was 4.84%. The incidence of spinal cord ischemia was 4.84% (3 patients, one in the immediate postoperative period and two during follow-up). Permanent paraplegia was observed in 1.6%. Overall survival (Kaplan-Meier) at 1, 3, and 6 years was 76%, 69.1%, and 64.32%, respectively. Conclusions: thoracic aortic coverage is an effective procedure with a high probability of success. Our study identified a previous procedure on the abdominal aorta and a thromboembolic aortic event as risk factors for developing medullary ischemia in patients requiring complete coverage of the thoracic aorta. In this study, full coverage of the thoracic aorta and left subclavian artery alone are not predictors of paraplegia.