Risk factors of neurologic deficit after thoracic aortic endografting.
BACKGROUND
Stroke and spinal cord injury (SCI) remain the most devastating complications of thoracic endovascular aortic repair (TEVAR). The risk factors associated with these complications are poorly understood. The aim of this study was to analyze the risk factors associated with neurologic deficits after TEVAR.


METHODS
From 1998 to 2005, 153 patients underwent 184 TEVARs. Computed tomography scans, angiograms, and medical records were reviewed. TEVAR was completed in all but 3 patients. The underlying pathologies included descending thoracic aortic aneurysm in 91, acute type B aortic dissection in 25, chronic type B aortic dissection in 42, aortic transection in 12, and penetrating aortic ulcer in 14.


RESULTS
Stroke developed in 8 patients, and SCI developed in another 8 patients (4 immediate, 4 delayed paraplegia/paraparesis). The procedure-associated stroke and SCI rate was 4.3% (8/184). Univariate statistical analysis revealed increased postoperative stroke with obesity, significant intraoperative blood loss, and evidence of peripheral vascular embolization/thrombosis. Aneurysmal pathology, iliac conduit, and hypogastric artery coverage were highly associated with postoperative SCI after TEVAR. Early and late mortality were 9.8% (n = 18) and 19% (n = 35) in a 16-month average period of follow-up.


CONCLUSIONS
The incidence of stroke and SCI after TEVAR was 4.3% (8/184). The risk factors associated with postoperative stroke were obesity, intraoperative blood loss, and vascular embolization. Aneurysm as an underlying pathology, the use of an iliac conduit, and coverage of the hypogastric artery were all associated with SCI. These risk factors for SCI may be markers of tenuous collateral blood supply to the spinal cord.
Khoynezhad
Ali
A
Section of Cardiovascular and Thoracic Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198-2315, USA. akhoynezhad@unmc.edu
Donayre
Carlos E
CE
Bui
Hao
H
Kopchok
George E
GE
Walot
Irwin
I
White
Rodney A
RA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery; D001013:Aorta, Thoracic / Q000293:injuries / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000150:complications / Q000601:surgery*; D016063:Blood Loss, Surgical; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000209:etiology*; D020521:Stroke / Q000209:etiology*; D014456:Ulcer / Q000601:surgery; D014950:Wounds, Penetrating / Q000150:complications / Q000601:surgery