title: Spinal cord injury after endovascular treatment for thoracoabdominal aneurysm or dissection.
abstract: OBJECTIVE
  Postoperative spinal cord injury (SCI) is a devastating complication of surgical repair for thoracoabdominal aortic aneurysm or dissection (TAAD), despite the complex reconstruction of inter-costal or lumbar arteries involved in the surgery. As an alternative technique, endovascular thoracoabdominal aneurysm repair (EVTAR) with visceral artery reconstruction has been accepted as a treatment option for severe comorbid patients of TAAD, because there is a permissible frequency of SCI after EVTAR in spite of no reconstruction of inter-costal or lumbar arteries. We report the results of EVTAR at our hospital with a focus on spinal cord injury.
  
  
  METHODS
  We analyzed data from 54 consecutive patients with TAAD (mean age, 74 ± 9.6 years; 42 men) who underwent EVTAR at our hospital between February 2007 and February 2014. Three types of EVTAR technique were used: fenestrated and/or branched stent graft implantation in 39 patients, a hybrid technique (bypass grafts to visceral arteries and straight stent graft implantation) in 10 patients, and intentional coverage of the coeliac artery and straight stent graft implantation in 5 patients. In all patients, mean systemic blood pressure was maintained at ≥80 mmHg. Opioid use was avoided in the perioperative period.
  
  
  RESULTS
  According to the Crawford classification, the graft coverage extent was 9% (5/54) in type I, 11% (6/54) in type II, 39% (21/54) in type III, 22%(12/54) in type IV and 19% (10/54) in type V. In most patients (74%, 40/54), cerebrospinal fluid drainage was done intraoperatively and 1 day postoperatively. Hospital mortality was 5.6% (3/54). No patient developed SCI in the perioperative period. However, in the follow-up period 2 patients developed paraplegia as a consequence of shock caused by an aortic event.
  
  
  CONCLUSIONS
  With close attention to spinal cord protection, EVTAR may be associated with only a low incidence of SCI in the perioperative period. Therefore, EVTAR is expected to become a promising treatment option for appropriately selected patients with TAAD.
authors.affiliation: Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Japan mkato3@gmail.com.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Motoki
authors.affiliation: Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Isaji
authors.affiliation: Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kawai
authors.affiliation: Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Japan.
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Ohkubo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D015607:Stents; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Branched stent graft; Endovascular aneurysm repair; Fenestrated stent graft; Spinal cord injury; Thoracoabdominal aortic aneurysm or dissection