Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta.
BACKGROUND
We reviewed our experience to investigate the determinants of paraplegia/paraparesis after endovascular stent-graft repair of the thoracic aorta, to assess the influence of the artery of Adamkiewicz (ARM) detected by preoperative magnetic resonance angiography (MRA) and to identify patients at risk.


METHODS
Over a 5-year period (March 2001-June 2006), 149 patients underwent elective endovascular stent-graft repair of the descending thoracic aorta. Patient demographics and perioperative factors relating to the endovascular procedure were evaluated by using univariate statistical analyses. To assess the influence of the ARM in the thoracolumbar region, patients in whom ARM was detected by preoperative MRA were divided into two groups: patients who had occlusion of the intercostal artery for ARM due to stent-graft (group A, n=33) and patients who had patency of the intercostal artery for ARM following stent-graft (group B, n=38).


RESULTS
Five (3.6%) of the 144 patients had paraparesis/paraplegia. Two of these five patients had previously undergone operation for total arch replacement with elephant trunk and one had surgery for descending aortic repair. Univariate analyses identified only prior aortic surgery as a significant risk factor (p=0.04). Paraparesis/paraplegia rates were 10% (three patients) in group A and 0% in group B (p=0.09).


CONCLUSIONS
Prior thoracic aortic replacement was found to be a significant predictor of spinal cord ischemia, and therefore vigilance is needed regarding occlusion of the intercostal artery for ARM detected prior to stent-graft repair.
Kawaharada
Nobuyoshi
N
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan. nobuyosh@sapmed.ac.jp
Morishita
Kiyofumi
K
Kurimoto
Yoshihiko
Y
Hyodoh
Hideki
H
Ito
Toshiro
T
Harada
Ryo
R
Kuwaki
Kenji
K
Higami
Tetsuya
T
D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D020335:Paraparesis / Q000209:etiology*; D010264:Paraplegia / Q000209:etiology*; D011300:Preoperative Care / Q000379:methods; D012307:Risk Factors; D020760:Spinal Cord Ischemia / Q000209:etiology*; D015607:Stents; D014711:Vertebral Artery / Q000473:pathology