title: Identifying paraplegia risk associated with thoracic endografting.
abstract: Endografting, like open surgical repair of the thoracic aorta, can be complicated by paraplegia. We reviewed our thoracic endografting experience regarding the incidence and treatment of spinal cord neurologic events. Between February 2000 and July 2008, 346 patients underwent endoluminal grafting of the descending thoracic aorta. Indications for intervention included atherosclerotic aneurysms (45.9%), acute and chronic dissections (31.5%), miscellaneous lesions (13.6%), and penetrating aortic ulcers (8.9%). Ten women and 4 men (4.0%), with a mean age of 71.3 years, developed either paraparesis (1.7%) or paraplegia (2.3%). Nine (64.3%) of these patients had an aneurysm, 4 (28.6%) had acute or chronic type B aortic dissection, and 1 (7.1%) had a penetrating aortic ulcer; 3 (21.4%) of them had previously undergone open abdominal aortic aneurysm repair, and 13 (92.9%) required coverage of more than 20 cm of the aorta. Cerebrospinal fluid drainage was instituted in 7/8 paraplegic patients. Eight (57.1%) of the 14 patients recovered fully, 2 (14.3%) experienced partial recovery, and 4 (28.6%) had significant neurological deficits. Paraplegia following thoracic endografting appears to be associated with female sex, long-segment coverage of the thoracic aorta, and aneurysmal disease.
authors.affiliation: Department of Cardiovascular and Endovascular Surgery Arizona Heart Institute Phoenix, AZ, USA. opsmile01@aol.com
authors.forename: Ourania
authors.initials: O
authors.lastname: Preventza
authors.forename: Grayson H
authors.initials: GH
authors.lastname: Wheatley
authors.forename: James
authors.initials: J
authors.lastname: Williams
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Ramaiah
authors.forename: Julio
authors.initials: J
authors.lastname: Rodriguez-Lopez
authors.forename: Edward B
authors.initials: EB
authors.lastname: Diethrich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001130:Arizona / Q000453:epidemiology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D019992:Databases as Topic; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020335:Paraparesis / Q000453:epidemiology / Q000209:etiology*; D010264:Paraplegia / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020760:Spinal Cord Ischemia / Q000453:epidemiology / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014456:Ulcer / Q000601:surgery; D055815:Young Adult