Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy.
J Endovasc Ther. 2023 Jun;30(3):323-335. doi: 10.1177/15266028221082008. Epub 2022 Mar 14.
Spinal cord ischemia (SCI) is still a feared complication for patients suffering from thoracoabdominal aortic aneurysm (TAAA) who undergo endovascular treatment. The aims of this work are to review the available literature on different reperfusion methods of the aneurysm sac, and to analyze whether the different reperfusion methods, also in combination with other factors, are effective in reducing SCI risk and if the impact varies with the patient's age.
PubMed/MEDLINE library was searched for studies published until November 2020 concerning TAAA, endovascular repair, and SCI preventive measures. Systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses criteria. Primary outcome consisted of correlation between endovascular repair techniques (type A: single step; type B: staged approach with reperfusion branches; type C: staged sequential approach with positioning of the thoracic component). A logistic-weighted regression for each event (SCI, transient, and permanent) was then performed with type of treatment, age, and interaction between them as input factors. Finally, another logistic-weighted regression was performed to analyze the other relevant factors for which observations are available together with the endovascular technique.
Data from 53 studies with a total of 3095 patients were analyzed. Type A, type B, and type C endovascular strategies were adopted in 75%, 13%, and 12% of studied patients, respectively. Data showed that both type B and type C treatments are associated with lower risk of SCI, with a higher reduction of type C with respect to type B, although this positive trend is limited for elder patients. Moreover, a greater aortic diameter, a reduced aneurysm extent, and the absence of cerebrospinal fluid drainage positioning contribute to lower the risk of SCI. Concerning permanent SCI, both type B and type C are effective in reducing percentages for all ages, with type C treatment more beneficial for younger patients and type B for elder ones.
According to the anatomy and the endovascular repair feasibility criteria, staged endovascular treatment appears to offer relevant advantages over single-step treatment in reducing the risk of SCI, regardless of the reperfusion method adopted.
脊髓缺血（SCI）仍然是接受血管内治疗的胸主动脉腹主动脉瘤（TAAA）患者所担心的并发症。本研究的目的是回顾不同的瘤囊再灌注方法的相关文献，并分析不同的再灌注方法（也与其他因素结合）是否有效降低 SCI 风险，以及这种影响是否因患者年龄而异。
检索了截至 2020 年 11 月发表的关于 TAAA、血管内修复和 SCI 预防措施的研究。根据系统评价和荟萃分析的首选报告项目进行了系统评价和荟萃分析。主要结果包括血管内修复技术（A型：一步法；B 型：再灌注分支的分期方法；C 型：带有胸段组件定位的分期序贯方法）之间的相关性。然后，使用治疗类型、年龄以及它们之间的相互作用作为输入因素，对每种事件（SCI、短暂性和永久性）进行逻辑加权回归。最后，对其他与血管内技术一起观察到的相关因素进行了另一个逻辑加权回归分析。
对 53 项研究共 3095 例患者的数据进行了分析。A型、B 型和 C 型血管内策略分别在研究患者中的 75%、13%和 12%中采用。结果表明，B 型和 C 型治疗均与 SCI 风险降低相关，C 型与 B 型相比，降低风险的幅度更高，但对于老年患者，这种积极趋势受到限制。此外，更大的主动脉直径、更小的瘤囊范围和没有脑脊液引流定位有助于降低 SCI 风险。关于永久性 SCI，B 型和 C 型治疗对所有年龄组都有效降低百分比，C 型治疗对年轻患者更有益，B 型治疗对老年患者更有益。
根据解剖结构和血管内修复可行性标准，分期血管内治疗似乎比单步治疗更能降低 SCI 的风险，无论采用何种再灌注方法。
