Spinal cord ischemia after simultaneous and sequential treatment of multilevel aortic disease.
OBJECTIVE
The aim of the present study is to report a risk analysis for spinal cord injury in a recent cohort of patients with simultaneous and sequential treatment of multilevel aortic disease.


METHODS
We performed a multicenter study with a retrospective data analysis. Simultaneous treatment refers to descending thoracic and infrarenal aortic lesions treated during the same operation, and sequential treatment refers to separate operations. All descending replacements were managed with endovascular repair.


RESULTS
Of 4320 patients, multilevel aortic disease was detected in 77 (1.8%). Simultaneous repair was performed in 32 patients (41.5%), and a sequential repair was performed in 45 patients (58.4%). Postoperative spinal cord injury developed in 6 patients (7.8%). At multivariable analysis, the distance of the distal aortic neck from the celiac trunk was the only independent predictor of postoperative spinal cord injury (odds ratio, 0.75; 95% confidence interval, 0.56-0.99; P=.046); open surgical repair of the abdominal aortic disease was associated with a higher risk of spinal cord injury but did not reach statistical significance (odds ratio, 0.16; 95% confidence interval, 0.02-1.06; P=.057). Actuarial survival estimates at 1, 2, and 5 years after the procedure were 80%±5%, 68%±6%, and 63%±7%, respectively. Spinal cord injury did not impair survival (P=.885).


CONCLUSIONS
In our experience, the risk of spinal cord injury is still substantial at 8% in patients with multilevel aortic disease. The distance of the distal landing zone from the celiac trunk is a significant predictor of spinal cord ischemia.
Vascular Surgery, Department of Surgery and Morphological Sciences Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy. Electronic address: gabriele.piffaretti@uninsubria.it.
Gabriele
G
Piffaretti
Vascular Surgery, Department of Surgery, Spedali Civili Hospital, University of Brescia School of Medicine, Brescia, Italy.
Stefano
S
Bonardelli
Vascular Surgery, Cardiovascular Department, Poliambulanza Foundation, Brescia, Italy.
Raffaello
R
Bellosta
Cardiac Surgery, Department of Surgery and Morphological Sciences Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy.
Giovanni
G
Mariscalco
Thoracic Aortic Research Center, IRCCS Policlinio San Donato, San Donato Milanese, Milan, Italy.
Chiara
C
Lomazzi
Thoracic Aortic Research Center, IRCCS Policlinio San Donato, San Donato Milanese, Milan, Italy.
Jip L
JL
Tolenaar
Vascular Surgery, Department of Surgery, Spedali Civili Hospital, University of Brescia School of Medicine, Brescia, Italy.
Camilla
C
Zanotti
Vascular Surgery, Department of Surgery, Spedali Civili Hospital, University of Brescia School of Medicine, Brescia, Italy.
Cristina
C
Guadrini
Vascular Surgery, Cardiovascular Department, Poliambulanza Foundation, Brescia, Italy.
Antonio
A
Sarcina
Vascular Surgery, Department of Surgery and Morphological Sciences Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy.
Patrizio
P
Castelli
Thoracic Aortic Research Center, IRCCS Policlinio San Donato, San Donato Milanese, Milan, Italy.
Santi
S
Trimarchi
D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020760:Spinal Cord Ischemia / Q000209:etiology*; D014057:Tomography, X-Ray Computed