title: Spinal cord injury is not negligible after TEVAR for lower descending aorta.
abstract: 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.
authors: Department of Cardiovascular Surgery, National Cardiovascular Center, Suita/Osaka, Japan. hitmat@hsp.ncvc.go.jp
authors: H
authors: H
authors: Matsuda
authors: T
authors: T
authors: Fukuda
authors: O
authors: O
authors: Iritani
authors: T
authors: T
authors: Nakazawa
authors: H
authors: H
authors: Tanaka
authors: H
authors: H
authors: Sasaki
authors: K
authors: K
authors: Minatoya
authors: H
authors: H
authors: Ogino
mesh_terms: 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