Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta.
OBJECTIVE
The study aims to identify risk constellations for symptomatic spinal cord malperfusion in patients undergoing extensive stent-graft coverage of the thoracic aorta.


METHODS
From 1997 through 2009, 26 patients (mean age 70 years) underwent extensive stent-graft coverage of the thoracic aorta. Indications for stent-graft placement were atherosclerotic aneurysms (n=18) and penetrating atherosclerotic ulcers (PAUs) (n=8). In 16 patients, a re-routing procedure was required to gain sufficient proximal landing zone length. Cerebrospinal fluid (CSF) drainage was not routinely applied owing to the necessity of maintaining continuing anti-platelet therapy due to severe cardiovascular co-morbidities.


RESULTS
Technical success was 100%. Five patients developed symptomatic spinal cord malperfusion. All symptomatic patients had impaired spinal cord blood supply by acute or chronic occlusion of at least two major blood-supplying vascular territories of the spinal cord. Secondary CSF drainage improved neurologic symptoms in all patients without causing any anti-platelet therapy-related collateral injury.


CONCLUSIONS
Extensive stent-graft coverage of the entire thoracic aorta can be performed with a high rate of success. If collateral blood supply to the spinal cord is maintained, occlusion of the intercostal arteries does not cause symptomatic malperfusion. However, if acute or chronic occlusion of the subclavian, lumbar or hypogastric arteries is present, likelihood of symptomatic malperfusion dramatically increases.
Gottardi
Roman
R
Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria.
Dumfarth
Julia
J
Holfeld
Johannes
J
Schoder
Maria
M
Funovics
Martin
M
Laufer
Guenther
G
Grimm
Michael
M
Czerny
Martin
M
D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery; D050197:Atherosclerosis / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D003097:Collateral Circulation; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000098:blood supply*; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome; D014456:Ulcer / Q000601:surgery