Spinal cord protection with a cerebrospinal fluid drain in a patient undergoing thoracic endovascular aortic repair.
Paralysis and paraparesis are dreaded complications of thoracic endovascular aortic repair (TEVAR) that occur with an incidence of 2%-6%. Risks factors include the type of thoracic aortic pathology treated, coverage of the left subclavian artery origin without revascularization, concomitant infrarenal abdominal aortic aneurysm repair, extent of stent graft coverage of the thoracic aorta, and renal failure. Cerebral spinal fluid (CSF) drains have been advocated as one of several protective strategies to prevent spinal cord ischemia. This case discussion briefly addresses the evidence supporting the use of CSF drains in patients undergoing TEVAR and offers an algorithm for managing CSF drains.
Lam
Cuong H
CH
Department of Radiology, Division of Vascular and Interventional Radiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027, USA. cuong.h.lam@kp.org
Vatakencherry
Geogy
G
D000369:Aged, 80 and over; D000465:Algorithms; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects; D004322:Drainage / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D010243:Paralysis / Q000209:etiology / Q000517:prevention & control; D020335:Paraparesis / Q000209:etiology / Q000517:prevention & control; D020760:Spinal Cord Ischemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome