title: The incidence of spinal cord ischaemia following thoracic and thoracoabdominal aortic endovascular intervention.
abstract: OBJECTIVE
  To determine the incidence and risk factors for spinal cord ischaemia (SCI) following thoracic and thoracoabdominal aortic intervention.
  
  
  METHODS
  A prospective database of all thoracic and thoracoabdominal aortic interventions between 2001 and 2009 was used to investigate the incidence of SCI. All elective and emergency cases for all indications were included. Logistic regression was used to investigate which factors were associated with SCI.
  
  
  RESULTS
  235 patients underwent thoracic aortic stent grafting; 111(47%) thoracic aortic stent-grafts alone, with an additional 14(6%) branched or fenestrated thoracic grafts, 30(13%) arch hybrid procedures and 80(34%) visceral hybrid surgical and endovascular procedures. The global incidence of SCI for all procedures was 23/235 (9.8%) and this included emergency indications (ruptured TAAA and acute complex dissections) but the incidence varied considerably between types of procedures. Of the 23 cases, death occurred in 4 patients but recovery of function was seen in 6. Thus, permanent paraplegia occurred in 13/235 (5.5%) patients. Of the nine pre-specified factors investigated for association with SCI, only percentage of aortic coverage was significantly associated with the incidence of SCI; adjusted odds ratio per 10% increase in aorta covered=1.78[95% CI 1.18-2.71], p=0.007. The procedures in patients who developed SCI took longer (463.5 versus 307.2 minutes) and utilised more stents (4 versus 2).
  
  
  CONCLUSIONS
  SCI following thoracic and thoracoabdominal aortic endovascular intervention is associated with the proportion of aorta covered. The degree of risk varies between different types of procedure and this should be carefully considered in both selection and consenting of patients.
authors.affiliation: Department of Vascular Surgery, Regional Vascular Unit, St Mary's Hospital, Imperial College NHS Trust, London, United Kingdom.
authors.forename: S L
authors.initials: SL
authors.lastname: Drinkwater
authors.forename: A
authors.initials: A
authors.lastname: Goebells
authors.forename: A
authors.initials: A
authors.lastname: Haydar
authors.forename: P
authors.initials: P
authors.lastname: Bourke
authors.forename: L
authors.initials: L
authors.lastname: Brown
authors.forename: M
authors.initials: M
authors.lastname: Hamady
authors.forename: R G J
authors.initials: RG
authors.lastname: Gibbs
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008131:London; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020760:Spinal Cord Ischemia / Q000209:etiology* / Q000401:mortality; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome