title: Complications of spinal fluid drainage in thoracic and thoracoabdominal aortic aneurysm surgery in 724 patients treated from 1987 to 2013.
abstract: OBJECTIVE
  To study complications from spinal fluid drainage in open thoracic/thoracoabdominal and thoracic endovascular aortic aneurysm repairs to define risks of spinal fluid drainage.
  
  
  METHODS
  Retrospective, prospectively maintained, institutionally approved database.
  
  
  METHODS
  Single institution university center.
  
  
  METHODS
  724 patients treated from 1987 to 2013 INTERVENTIONS: The authors drained spinal fluid to a pressure≤6 mmHg during thoracic aortic occlusion/reperfusion in open and ≤8 mmHg after stent deployment in endovascular procedures. Low pressure was maintained until leg strength was documented. If bloody fluid appeared, drainage was stopped. Head computed tomography (CT) and, if indicated, spine CT and magnetic resonance imaging (MRI) were performed for bloody spinal fluid or neurologic deficit.
  
  
  RESULTS
  Spinal fluid drainage was studied for bloody fluid, CT/MRI-identified intracranial and spinal bleeding, neurologic deficit, and death. Seventy-three patients (10.1%) had bloody fluid; 38 (5.2%) had intracranial blood on CT. One patient had spinal epidural hematoma. Higher volume of fluid drained and higher central venous pressure during proximal clamping were associated with intracranial blood. Most patients with intracranial blood were asymptomatic. Six patients had neurologic deficits: of the 6, 3 died (0.4%), 1 (0.1%) had permanent hemiparesis, and 2 recovered. Three of the six deficits were delayed, associated with heparin anticoagulation.
  
  
  CONCLUSIONS
  10% of patients had bloody spinal fluid; half of these had intracranial bleeding, which was almost always asymptomatic. In these patients, immediately stopping drainage and correcting coagulopathy may decrease the risk of serious complications. Neurologic deficit from spinal fluid drainage is uncommon (0.8%), but has high morbidity and mortality.
authors.affiliation: Departments of Anesthesiology. Electronic address: mmwynn@facstaff.wisc.edu.
authors.forename: Martha M
authors.initials: MM
authors.lastname: Wynn
authors.affiliation: Departments of Anesthesiology.
authors.forename: Joshua
authors.initials: J
authors.lastname: Sebranek
authors.affiliation: Departments of Anesthesiology.
authors.forename: Erich
authors.initials: E
authors.lastname: Marks
authors.affiliation: Surgery, University of Wisconsin School of Medicine and Public Health, Madison WI.
authors.forename: Travis
authors.initials: T
authors.lastname: Engelbert
authors.affiliation: Surgery, University of Wisconsin School of Medicine and Public Health, Madison WI.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Acher
mesh_terms: D000328:Adult; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000453:epidemiology / Q000601:surgery*; D015170:Cerebrospinal Fluid Pressure; D004322:Drainage / Q000009:adverse effects* / Q000639:trends; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013129:Spinal Puncture / Q000009:adverse effects* / Q000639:trends
keywords: TEVAR; paraplegia; spinal fluid drainage; thoracic aortic aneurysm; thoracoabdominal aortic aneurysm