Risk factors for spinal cord ischaemia after thoracic endovascular aortic repair

OBJECTIVES: Spinal cord ischaemia (SCI) is a serious complication of thoracic endovascular aortic repair (TEVAR). The purpose of this study was to assess the incidence, risk factors, clinical manifestations of SCI after TEVAR and which type of patients could benefit from cerebrospinal fluid drainage. METHODS: A retrospective review was conducted for 175 patients who underwent TEVAR from January 2008 to July 2014. All patients were divided into groups with and without SCI, and they were compared to identify significant risk factors for SCI. RESULTS: The incidence of SCI after TEVAR including paraplegia and paraparesis was 6.9%. SCI usually occurred within 24 h, but delayed SCI was observed after 5 days in 1 patient. In all patients with SCI, we tried to increase the blood pressure to improve spinal perfusion. Three patients recovered completely, and the 6 patients with some remaining neurological deficit included 3 with motion against gravity and bladder dysfunction and the 3 remaining patients with only bladder dysfunction. Three patients did not recover. In our study, significant risk factors for SCI were as follows: rupture, shaggy aorta, chronic obstructive pulmonary disease, 1-stage procedure, the coverage of more than 9 segments, the coverage from Th8 to Th12, minimum of postoperative haemoglobin and the number of postoperative patent segmental arteries. CONCLUSIONS: Sufficient perioperative care should be given to high-risk patients who have endografts that cover more than 9 segments and endografts that cover segments from Th8 to Th12. Adequate haemoglobin levels and mean arterial pressure are needed to provide sufficient spinal cord perfusion.