Spinal cord injury is not negligible after TEVAR for lower descending aorta.
OBJECTIVE
To clarify the incidence of spinal cord injury (SCI) after thoracic endovascular aneurysm repair (TEVAR), we investigate the intercostal/lumbar arteries that supply the Adamkiewicz artery (ICA-AKA).


METHODS
Among 81 patients subjected to TEVAR, we retrospectively reviewed the clinical records of 50 patients (range: 57-86 (median age: 77) years, 41 males) who underwent TEVAR for part of or the whole distal descending aorta (T7 to L2) after identification of ICA-AKA by magnetic resonance angiography (MRA) or computed tomography angiography (CTA).


RESULTS
The 50 patients were classified into group A: 17 patients whose patent ICA-AKA was not covered, group B: 24 patients whose ICA-AKA was covered and group C: nine patients in whom no patent ICA-AKA was identified. Only three patients in group B suffered paraplegia and of them two recovered full ambulation. The estimated incidence of permanent and transient paraplegia was 3.7% in all TEVAR patients, 6.0% when part of or the entire distal aorta was covered and 12.5% when the patent ICA-AKA was covered. The length of aortic coverage in patients with paraplegia was >300 mm.


CONCLUSIONS
Paraplegia after TEVAR occurred in one of eight patients in whom the stent graft covered ICA-AKA. Long coverage of the aorta including the ICA-AKA was critical. To prevent this serious complication, identification of the ICA-AKA is crucial.
Matsuda
H
H
Department of Cardiovascular Surgery, National Cardiovascular Center, Suita/Osaka, Japan. hitmat@hsp.ncvc.go.jp
Fukuda
T
T
Iritani
O
O
Nakazawa
T
T
Tanaka
H
H
Sasaki
H
H
Minatoya
K
K
Ogino
H
H
D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply*; D013119:Spinal Cord Injuries / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome