Martin Daniel J, Martin Tomas D, Hess Philip J, Daniels Michael J, Feezor Robert J, Lee W Anthony
Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Florida, USA.
J Vasc Surg. 2009 Feb;49(2):302-6; discussion 306-7. doi: 10.1016/j.jvs.2008.08.119. Epub 2008 Nov 22.
To examine the incidence of and the anatomic factors that may contribute to spinal cord ischemia (SCI) in patients with a history of abdominal aortic aneurysms (AAA) after thoracic endovascular aortic repair (TEVAR).
The medical records, computed tomography (CT) angiograms, and a prospectively maintained clinical database of all TEVAR patients at a single institution between 2000 and 2007 were reviewed. Select preoperative demographics, thoracoabdominal aortoiliac anatomy, intraoperative procedural variables, and postoperative outcomes were examined. Univariate and multivariate analyses were performed and odds ratio estimates were reported with 95% confidence intervals.
Of the 261 patients who underwent TEVAR, 27 developed SCI (10%). Thirteen (48%) of these 27 patients were completely reversed with spinal drainage, and 14 (52%) were permanent. Patients with SCI tended to be older (P = .006), male (P = .049), and required more emergent procedures (P = .051) performed under general anesthesia (P = .004). Interestingly, while prior AAA repair (50/261, 19%) alone was not associated with SCI (P = .44), a history of either repaired or unrepaired AAA (101/261, 39%) was a predictor of SCI on multivariate analysis (odds ratio [OR] = 4.35 [1.43, 14.3], P = .10), independent of thoracic aortic coverage (P = .001) and lumbar artery patency (P = .008), both of which were also associated with SCI.
Although the causes of SCI after TEVAR are multifactorial, abdominal aortic anatomy appears to be associated with development of this complication. Patients with either prior AAA repair or those with unrepaired AAA appear to be at increased risk for SCI.
研究胸主动脉腔内修复术（TEVAR）治疗腹主动脉瘤（AAA）患者后脊髓缺血（SCI）的发生率及可能导致脊髓缺血的解剖学因素。
回顾了2000年至2007年期间一家机构所有接受TEVAR治疗患者的病历、计算机断层扫描（CT）血管造影以及前瞻性维护的临床数据库。检查了术前的人口统计学特征、胸腹主动脉髂部解剖结构、术中操作变量和术后结果。进行了单因素和多因素分析，并报告了优势比估计值及95%置信区间。
在接受TEVAR治疗的261例患者中，27例发生了SCI（10%）。这27例患者中有13例（48%）通过脊髓引流完全恢复，14例（52%）为永久性损伤。发生SCI的患者往往年龄较大（P = 0.006）、为男性（P = 0.049），且在全身麻醉下进行的急诊手术较多（P = 0.051）（P = 0.004）。有趣的是，虽然单纯既往AAA修复术（50/261，19%）与SCI无关（P = 0.44），但在多因素分析中，既往有AAA修复史或未修复史（101/261，39%）是SCI的一个预测因素（优势比[OR] = 4.35 [1.43, 14.3]，P = 0.10），独立于胸主动脉覆盖范围（P = 0.001）和腰动脉通畅情况（P = 0.008），而这两者也与SCI有关。
虽然TEVAR术后SCI的原因是多因素的，但腹主动脉解剖结构似乎与这种并发症的发生有关。既往有AAA修复史或未修复AAA的患者发生SCI的风险似乎增加。
