Open stent-grafting for aortic arch aneurysm is associated with increased risk of paraplegia.
BACKGROUND
Open surgery using the endovascular stent-graft is a novel technique that lessens the invasiveness of surgery for the aortic arch. However, the outcome of this procedure remains uncertain.


METHODS
Between November 1996 and July 2000, a total of 19 patients underwent open surgery using an endovascular stent-graft for thoracic aortic aneurysms. There were 15 men (78.9%) and 4 women (21.1%). Patient age ranged from 29 to 82 years (mean 69.3 years, median 74 years). Atherosclerotic thoracic aortic aneurysms were present in 17 patients (89.4%) and aortic dissection in 2 patients (10.5%).


RESULTS
Two patients (10.5%) died in the hospital and 4 patients (21.1%) presented with paraplegia postoperatively. Among the 4 patients with postoperative paraplegia, 1 case was complicated with intraoperative aortic dissection. The other 3 patients with paraplegia had spinal cord ischemic time of more than 60 minutes and intraoperative body weight gain of more than 4 kg. Of these 3 patients, hemodynamic instability after cardiopulmonary bypass was observed in 1 patient and cholesterin embolus in the anterior spinal artery was found at autopsy in another. On univariate analysis, age greater than 75 years was the only risk factor associated with paraplegia (p < 0.05). Autopsy findings for the 2 patients showed that the Adamkiewicz arteries were not blocked by the stent-graft in either patient.


CONCLUSIONS
Intraoperative aortic dissection, embolization of the intercostal arteries, long ischemic time of the spinal cord, and excessive weight gain during operation may have been associated with the high incidence of paraplegia after open surgery using the endovascular stent-graft.
Department of Cardiothoracic Surgery, University of Tokyo, Japan. tmiyairi-tky@umin.ac.jp
Takeshi
T
Miyairi
Yutaka
Y
Kotsuka
Masahiko
M
Ezure
Minoru
M
Ono
Tetsuro
T
Morota
Hiroshi
H
Kubota
Ko
K
Shibata
Katsuhito
K
Ueno
Shinichi
S
Takamoto
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology*; D012307:Risk Factors; D015607:Stents; D013997:Time Factors