Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Ann Thorac Surg. 2013 Jun;95(6):1968-74; discussion 1974-5. doi: 10.1016/j.athoracsur.2013.03.016. Epub 2013 Apr 28.
The optimal use of lumbar cerebrospinal fluid drainage for the prevention of spinal cord ischemia (SCI) with thoracic endovascular aortic repair (TEVAR) remains unclear. Here, we report our experience with selective preoperative lumbar drain placement with TEVAR.
Between May 2002 and January 12, 381 TEVAR procedures were performed at a single referral institution. Preoperative lumbar drains were placed selectively in patients considered high-risk for SCI due to planned long-segment aortic coverage with a history of prior aortic intervention or planned hybrid Crawford extent I to III thoracoabdominal aortic aneurysm repair.
Preoperative lumbar drains were placed in 81 patients (21%); of these, drain placement in 38 (47%) was for procedures involving long-segment descending thoracic aortic coverage in the setting of prior descending thoracic or infrarenal aortic repair, and in 43 (53%) was for hybrid thoracoabdominal aortic aneurysm repair. SCI occurred in 12 patients (14.8%) who received a preoperative lumbar drain, transient in 6 (7.4%) and permanent in 6 (7.4%), whereas SCI occurred in 13 patients (4.3%) who did not receive a preoperative lumbar drain, 12 transient (4.0%) and 1 permanent (0.3%). A lumbar drain complication occurred in 9 drain patients (11.1%), although none resulted in permanent disability. Age, postoperative hypotension, and the number of endografts implanted were independently associated with SCI. Preoperative lumbar drain placement was not associated with reduced SCI.
Restricted use of preoperative lumbar drains for patients at high-risk of SCI undergoing TEVAR appears safe and leads to low rates of SCI in nondrained patients. However, the utility of preoperative lumbar drains in preventing SCI with TEVAR remains questionable and should be weighed against the risk of drain complications.
在胸主动脉腔内修复术（TEVAR）中，为预防脊髓缺血（SCI）而使用腰椎脑脊液引流的最佳方法尚不清楚。在此，我们报告了我们在 TEVAR 中选择性使用术前腰椎引流的经验。
在一家转诊机构，于 2002 年 5 月至 2023 年 1 月 12 日期间，共进行了 381 例 TEVAR 手术。对于由于计划进行长节段主动脉覆盖且有既往主动脉介入或计划进行杂交 Crawford Ⅰ至Ⅲ型胸腹主动脉瘤修复史而被认为存在 SCI 高风险的患者，选择性地在术前放置腰椎引流管。
81 例患者（21%）接受了术前腰椎引流；其中 38 例（47%）的引流是为了在先前的胸降主动脉或肾下主动脉修复的情况下进行长节段降主动脉覆盖的手术，43 例（53%）的引流是为了进行杂交胸腹主动脉瘤修复。在接受术前腰椎引流的 12 例患者（14.8%）中发生了 SCI，其中 6 例（7.4%）为暂时性，6 例（7.4%）为永久性，而在未接受术前腰椎引流的 13 例患者（4.3%）中，SCI 发生了 12 例（4.0%）为暂时性，1 例（0.3%）为永久性。在 9 例引流患者中（11.1%）发生了腰椎引流管并发症，尽管没有导致永久性残疾。年龄、术后低血压和植入的内移植物数量与 SCI 独立相关。术前腰椎引流放置与 SCI 发生率降低无关。
对于高危 SCI 患者，在行 TEVAR 前有选择地使用腰椎引流是安全的，并且在未进行引流的患者中 SCI 发生率较低。然而，TEVAR 中使用术前腰椎引流预防 SCI 的效用仍存在疑问，应权衡引流管并发症的风险。
