Mousa Albeir Y, Morcos Ramez, Broce Mike, Bates Mark C, AbuRahma Ali F
Department of Surgery, Robert C. Byrd Health Sciences Center/West Virginia University, Charleston Area Medical Center, Vascular Center of Excellence, WV, USA.
Charles E. Schmidt College of Medicine Florida Atlantic University, Boca Raton, FL, USA.
Vasc Endovascular Surg. 2020 Aug;54(6):487-496. doi: 10.1177/1538574420929135. Epub 2020 Jun 4.
Our objective was to determine significant predictors of spinal cord ischemia (SCI) following Thoracic Endovascular Aortic Repair (TEVAR) and to further develop a simple and clinically orientated risk score model.
A retrospective review of data from the Society of Vascular Surgery/Vascular Quality Initiative national data set was performed for all patients undergoing TEVAR from January, 2014 to June 2018. Preoperative demographics, procedure-related variables, and clinical details related to SCI were examined. A SCI risk score was developed utilizing a multivariable logistic regression model.
For the 7889 patients in the final analysis who underwent TEVAR during the study period, the mean age was 67.6 ± 13.9, range 18 to 90 years, and the majority was male (65%). Postoperative outcomes included stroke (3.0%), myocardial infarction (2.9%), inhospital mortality (5.4%), transient SCI (1.5%), and permanent SCI (2.1%). Nearly half of the overall cases were performed in high volume centers. Predictors of increased risk for SCI included age by decade (odds ratio [OR]: 1.2), celiac coverage (OR: 1.5), current smoker (OR: 1.6), dialysis (OR: 1.9), 3 or more aortic implanted devices (OR: 1.7), emergent or urgent surgery (OR: 1.5), adjunct aorta-related procedure (OR: 2.5), adjunct not related (OR: 2.6), total estimated length of aortic device (19-31 cm, OR: 1.9 and ≥32 cm, OR: 3.0), ASA class 4 or 5 (OR: 1.6), and procedure time ≥154 minutes (OR: 1.8). Two predictors decreased the risk of SCI, cases from high-volume centers (OR: 0.6) and eGFR ≥ 60 (OR: 0.6). To evaluate the risk score model, probabilities of SCI from the original regression, raw score, and raw score categories resulted in area under the curve statistics of 0.792, 0.786, and 0.738, respectively.
Spinal cord ischemia remains one of the most feared complications of TEVAR. Incidence of SCI in this large series of patients with TEVAR was 3.6% with nearly 60% being permanent. The proposed model provides an assessment tool to guide clinical decisions, patient consent process, risk-assessment, and procedural strategy.
我们的目标是确定胸主动脉腔内修复术（TEVAR）后脊髓缺血（SCI）的重要预测因素，并进一步开发一个简单且以临床为导向的风险评分模型。
对2014年1月至2018年6月期间接受TEVAR的所有患者，回顾性分析血管外科学会/血管质量倡议国家数据集的数据。检查术前人口统计学、手术相关变量以及与SCI相关的临床细节。利用多变量逻辑回归模型开发SCI风险评分。
在最终分析的7889例研究期间接受TEVAR的患者中，平均年龄为67.6±13.9岁，范围为18至90岁，大多数为男性（65%）。术后结果包括中风（3.0%）、心肌梗死（2.9%）、住院死亡率（5.4%）、短暂性SCI（1.5%）和永久性SCI（2.1%）。近一半的病例在高容量中心进行。SCI风险增加的预测因素包括每增加十岁的年龄（比值比[OR]：1.2）、腹腔动脉覆盖（OR：1.5）、当前吸烟者（OR：1.6）、透析（OR：1.9）、3个或更多主动脉植入装置（OR：1.7）、急诊或紧急手术（OR：1.5）、辅助性主动脉相关手术（OR：2.5）、辅助性非相关手术（OR：2.6）、主动脉装置总估计长度（19 - 至31厘米，OR：1.9；≥32厘米，OR：3.0）、美国麻醉医师协会（ASA）分级4或5级（OR：1.6）以及手术时间≥154分钟（OR：1.8）。两个预测因素降低了SCI风险，来自高容量中心的病例（OR：0.6）和估算肾小球滤过率（eGFR）≥60（OR：0.6）。为评估风险评分模型，原始回归、原始评分和原始评分类别得出的SCI概率，曲线下面积统计值分别为0.792、0.786和0.738。
脊髓缺血仍然是TEVAR最令人担忧的并发症之一。在这一大系列接受TEVAR的患者中，SCI发生率为3.6%，近60%为永久性。所提出的模型提供了一种评估工具，以指导临床决策、患者知情同意过程、风险评估和手术策略。
