title: Lower extremity weakness is associated with elevated blood and cerebrospinal fluid glucose levels following multibranched endovascular aortic aneurysm repair.
abstract: OBJECTIVE
  Hyperglycemia is associated with worsened clinical outcomes after central nervous system injury. The purpose of this study was to examine the association between lower extremity weakness (LEW) and the glucose levels of blood and cerebrospinal fluid (CSF) in patients undergoing multibranched endovascular aneurysm repair (MBEVAR) of thoracoabdominal and pararenal aortic aneurysms.
  
  
  METHODS
  Blood and CSF samples were collected preoperatively, immediately after aneurysm repair, and on postoperative day 1 in 21 patients undergoing MBEVAR. Data on demographics, operative repair, complications, and outcomes were collected prospectively.
  
  
  RESULTS
  There were 21 patients who underwent successful MBEVAR. Two patients had pre-existing paraplegia from prior open aortic surgery and were excluded from the current analysis. The mean age was 73 ± 8 years, and 15 of 19 (79%) were men. In the postoperative period, 7 of 19 (37%) patients developed LEW. This was temporary in 5 of 19 (26%) patients and permanent in 2 of 19 (11%) patients. The LEW group was older than the non-LEW group (77 ± 6 vs 70 ± 9 years, respectively; P = .10), had a lower preoperative glomerular filtration rate (58.6 ± 18.5 vs 71.4 ± 23.5 mL/min per 1.73 m2; P = .24), and was more likely to be taking a statin (100% vs 67%, respectively; P = .13), but these did not reach statistical significance. There was no significant difference in the prevalence of diabetes mellitus, hypertension, coronary artery disease, lung disease, or peripheral artery disease between the LEW and non-LEW groups. There was also no difference in operative time, blood loss, contrast material volume, or fluoroscopy times between the two groups. Preoperative blood and CSF glucose levels were similar in those with and without LEW. During the postoperative period, glucose values in the blood and CSF were significantly higher in those patients who developed LEW compared with those who did not develop LEW. In all patients with LEW, the elevation in the blood or CSF glucose level preceded the development of LEW. In a multivariable logistic regression model, CSF glucose concentration on postoperative day 1 was significantly and independently associated with the development of LEW (odds ratio, 2.30 [1.03-5.14] per 10 mg/dL increase in CSF glucose; P = .04).
  
  
  CONCLUSIONS
  Elevated blood glucose and CSF glucose levels are associated with postoperative LEW in patients undergoing MBEVAR. The protective effect of euglycemia deserves further study in patients at risk for spinal cord ischemia.
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif. Electronic address: jade.hiramoto@ucsfmedctr.org.
authors.forename: Jade S
authors.initials: JS
authors.lastname: Hiramoto
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
authors.forename: Charlene
authors.initials: C
authors.lastname: Fernandez
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
authors.forename: Warren
authors.initials: W
authors.lastname: Gasper
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
authors.forename: Shant
authors.initials: S
authors.lastname: Vartanian
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
authors.forename: Linda
authors.initials: L
authors.lastname: Reilly
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
authors.forename: Timothy
authors.initials: T
authors.lastname: Chuter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid; D001786:Blood Glucose / Q000378:metabolism*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000134:cerebrospinal fluid / Q000150:complications* / Q000175:diagnosis; D016015:Logistic Models; D035002:Lower Extremity / Q000294:innervation*; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010264:Paraplegia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D005947:Glucose