title: Early experience with automatic pressure-controlled cerebrospinal fluid drainage during thoracic endovascular aortic repair.
abstract: OBJECTIVE
  To report initial experience with automatic pressure-controlled cerebrospinal fluid drainage (CSFD) during thoracic endovascular aortic repair (TEVAR).
  
  
  METHODS
  A prospective nonrandomized study enrolled 30 consecutive patients (median age 68 years, range 42-89; 18 men) who underwent TEVAR between March 2012 and July 2013 and were considered to be at high risk for postoperative spinal cord ischemia (SCI), fulfilling 2 of the following criteria: stent-graft length >20 cm, left subclavian artery coverage, and previous infrarenal aortic repair. All patients received perioperative CSFD via the LiquoGuard system. The protocol aimed for a CSF pressure of 10 mm Hg and duration of CSFD of 3 or 7 days in asymptomatic or symptomatic patients, respectively. Muscle strength of the lower extremities was assessed with the Oxford muscle strength grading scale.
  
  
  RESULTS
  Completion of the CSFD protocol was achieved in 26 (87%) of 30 patients. CSFD was prematurely stopped due to catheter dislocation in 1 patient and bloody spinal fluid in 3 patients. CSFD was performed for a median of 3 days (range 1-7). Median total CSFD volume was 714 mL (range 13-2369), with a median 192 mL drained per 24 hours. The SCI rate was 3% (1/30). CSFD-related complications were observed in 33% of the patients: 1 fatal intracranial hemorrhage, 3 bloody spinal fluid episodes, 3 persistent CSF leaks requiring epidural blood patch, and 3 post lumbar puncture headaches. Mortality during a median follow-up of 16 months (range 10-25) was 3% (1/30).
  
  
  CONCLUSIONS
  Prophylactic CSFD was associated with a low SCI rate in a high-risk patient collective undergoing TEVAR. Monitoring and drainage by an automatic modus was feasible, reproducible, and reliable but associated with relevant drainage-associated complications.
authors: Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany drosos.kotelis@med.uni-heidelberg.de.
authors: Drosos
authors: D
authors: Kotelis
authors: Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors: Claudio
authors: C
authors: Bianchini
authors: Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors: Bence
authors: B
authors: Kovacs
authors: Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
authors: Thomas
authors: T
authors: Müller
authors: Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors: Moritz
authors: M
authors: Bischoff
authors: Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors: Dittmar
authors: D
authors: Böckler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001331:Automation; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D015170:Cerebrospinal Fluid Pressure; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D020760:Spinal Cord Ischemia / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013129:Spinal Puncture; D015607:Stents; D013997:Time Factors; D014160:Transducers, Pressure; D016896:Treatment Outcome
keywords: automatic fluid drainage; cerebrospinal fluid drainage; cerebrospinal fluid pressure; complications; pressure-controlled fluid drainage; thoracic endovascular aortic repair