Complications of lumbar drainage after thoracoabdominal aortic aneurysm repair.
OBJECTIVE
Paraplegia remains a frequent complication of thoracoabdominal aortic aneurysm (TAAA) repair. Many adjunct therapies have been developed to address this complication. Lumbar drainage is frequently used in an attempt to decrease intrathecal pressure and improve intramedullary perfusion pressure. The effectiveness of this therapy is unclear, and the complications of lumbar drainage used for this indication are unknown. We present a case of intraspinal hematoma with significant neurologic deficit after TAAA repair and review the associated complications of lumbar drains placed for TAAA.


METHODS
The charts of all patients undergoing operations for TAAA repair were reviewed. Patients who underwent perioperative placement of a lumbar drain were included regardless of aneurysm type or etiology. Demographics, Crawford grade, and perioperative parameters and complications were reviewed.


RESULTS
Sixty-five patients underwent TAAA repair with 62 (95%) receiving a preoperative lumbar drain. There were two (3.2%) intraspinal hemorrhagic complications, including one patient with a poor neurologic outcome. No infections or other complications directly related to drainage were identified. Multivariate logistic regression analysis failed to demonstrate a significant association between lumbar drain complications and perioperative and intraoperative parameters such as blood loss or hypotension, level of drain placement, and Crawford grade.


CONCLUSIONS
Lumbar drainage is a frequent adjunct to TAAA repair. However, placement of the drain itself can be associated with significant complications whose aggravating factors may be unidentifiable. Complications resulting from lumbar drainage should be considered in any patient who has postoperative lower extremity neurologic deficits.
Weaver
K D
KD
Department of Surgery, Division of Neurosurgery, University of North Carolina-Chapel Hill School of Medicine, 27599-7212, USA.
Wiseman
D B
DB
Farber
M
M
Ewend
M G
MG
Marston
W
W
Keagy
B A
BA
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006408:Hematoma, Subdural / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D016015:Logistic Models; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010264:Paraplegia / Q000209:etiology* / Q000628:therapy*; D011128:Polyradiculopathy / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome