Khoynezhad Ali, Donayre Carlos E, Bui Hao, Kopchok George E, Walot Irwin, White Rodney A
Section of Cardiovascular and Thoracic Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198-2315, USA.
Ann Thorac Surg. 2007 Feb;83(2):S882-9; discussion S890-2. doi: 10.1016/j.athoracsur.2006.10.090.
Stroke and spinal cord injury (SCI) remain the most devastating complications of thoracic endovascular aortic repair (TEVAR). The risk factors associated with these complications are poorly understood. The aim of this study was to analyze the risk factors associated with neurologic deficits after TEVAR.
From 1998 to 2005, 153 patients underwent 184 TEVARs. Computed tomography scans, angiograms, and medical records were reviewed. TEVAR was completed in all but 3 patients. The underlying pathologies included descending thoracic aortic aneurysm in 91, acute type B aortic dissection in 25, chronic type B aortic dissection in 42, aortic transection in 12, and penetrating aortic ulcer in 14.
Stroke developed in 8 patients, and SCI developed in another 8 patients (4 immediate, 4 delayed paraplegia/paraparesis). The procedure-associated stroke and SCI rate was 4.3% (8/184). Univariate statistical analysis revealed increased postoperative stroke with obesity, significant intraoperative blood loss, and evidence of peripheral vascular embolization/thrombosis. Aneurysmal pathology, iliac conduit, and hypogastric artery coverage were highly associated with postoperative SCI after TEVAR. Early and late mortality were 9.8% (n = 18) and 19% (n = 35) in a 16-month average period of follow-up.
The incidence of stroke and SCI after TEVAR was 4.3% (8/184). The risk factors associated with postoperative stroke were obesity, intraoperative blood loss, and vascular embolization. Aneurysm as an underlying pathology, the use of an iliac conduit, and coverage of the hypogastric artery were all associated with SCI. These risk factors for SCI may be markers of tenuous collateral blood supply to the spinal cord.
中风和脊髓损伤（SCI）仍然是胸主动脉腔内修复术（TEVAR）最严重的并发症。与这些并发症相关的危险因素尚不清楚。本研究的目的是分析TEVAR术后与神经功能缺损相关的危险因素。
1998年至2005年，153例患者接受了184次TEVAR手术。回顾了计算机断层扫描、血管造影和病历。除3例患者外，所有患者均完成了TEVAR手术。潜在病理包括降主动脉瘤91例、急性B型主动脉夹层25例、慢性B型主动脉夹层42例、主动脉横断12例和穿透性主动脉溃疡14例。
8例患者发生中风，另外8例患者发生SCI（4例立即发生，4例延迟性截瘫/轻瘫）。与手术相关的中风和SCI发生率为4.3%（8/184）。单因素统计分析显示，肥胖、术中大量失血以及外周血管栓塞/血栓形成的证据会增加术后中风的发生率。动脉瘤病理、髂血管导管和下腹动脉覆盖与TEVAR术后SCI高度相关。在平均16个月的随访期内，早期和晚期死亡率分别为9.8%（n = 18）和19%（n = 35）。
TEVAR术后中风和SCI的发生率为4.3%（8/184）。与术后中风相关的危险因素是肥胖、术中失血和血管栓塞。作为潜在病理的动脉瘤、髂血管导管的使用以及下腹动脉的覆盖均与SCI相关。这些SCI的危险因素可能是脊髓侧支血供薄弱的标志。
