title: Short-term outcome of spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms.
abstract: OBJECTIVE
  To analyze the incidence and short-term outcome of SCI after endovascular repair of thoracoabdominal aneurysms (eTAAA).
  
  
  METHODS
  All patients undergoing eTAAA with branched and fenestrated stent grafts between 2008 and 2014 were retrospectively reviewed concerning pre-, intra- and post-operative clinical data and imaging.
  
  
  RESULTS
  Seventy-two patients (53 males, 68 [64-73] years old) underwent eTAAA (51 elective, 21 acute including 7 ruptures). Patients were classified anatomically according to Crawford: type I (n=11), type II (n=26), type III (n=18), and type IV (n=17). Thirty-day mortality was 6.9 % (3.9% for elective, 7.1% for symptomatic and 28.6% for ruptures, including one intra-operative death). Twenty-two of the 71 patients who survived the operation (31.0%) developed SCI: type I (n=2, 20.0%), type II (n=13, 50.0 %), type III (n=3, 16.7%), type IV (n=4, 23.5%). SCI incidence decreased in the latter part of the experience (23.7% vs. 39.4%, p = .201). SCI development was independently associated with Crawford type II TAAA (OR 4.497 (1.331-15.195), p = .016) and higher contrast volume (OR 3.736 [1.054-13.242], p = .041). Fifteen of these 22 patients with SCI showed some improvement of their deficits before hospital discharge. The introduction of a standardized protocol in the last 38 patients aiming at the early diagnosis and treatment of SCI led to more frequent regression of SCI symptoms (100% vs. 46.2%, p = .017) and a higher rate of regaining ambulatory capacity (55.6% vs. 15.4%, p = .027). After the introduction of this protocol, the residual SCI rate at hospital discharge was 13.2% as opposed to 33.3% in the initial group.
  
  
  CONCLUSIONS
  eTAAA has low peri-operative mortality, but SCI incidence is high albeit that it decreased with increasing experience. More extensive repair and use of larger volumes of contrast were associated with higher risk of SCI. Acute repair does not significantly increase SCI risk. A standardized protocol for early diagnosis and treatment of SCI leads to a higher recovery rate with a greater likelihood of regaining ambulatory capacity.
authors: Vascular Center, Department of Haematology and Vascular Diseases, Skåne University Hospital, Malmö, Sweden. Electronic address: nunovdias@gmail.com.
authors: N V
authors: NV
authors: Dias
authors: Vascular Center, Department of Haematology and Vascular Diseases, Skåne University Hospital, Malmö, Sweden.
authors: B
authors: B
authors: Sonesson
authors: Vascular Center, Department of Haematology and Vascular Diseases, Skåne University Hospital, Malmö, Sweden.
authors: T
authors: T
authors: Kristmundsson
authors: Vascular Center, Department of Haematology and Vascular Diseases, Skåne University Hospital, Malmö, Sweden.
authors: H
authors: H
authors: Holm
authors: Vascular Center, Department of Haematology and Vascular Diseases, Skåne University Hospital, Malmö, Sweden.
authors: T
authors: T
authors: Resch
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D020760:Spinal Cord Ischemia / Q000453:epidemiology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Endovascular repair; Spinal cord ischemia; Thoracoabdominal aortic aneurysm