Walter Corinna, Hirsch Kornelia, Heil Sabine, Taher Fadi, Falkensammer Jürgen, Gustorff Burkhard, Assadian Afshin
Department of Vascular and Endovascular Surgery, Klinik Ottakring, Wiener Gesundheitsverbund, Wien, Austria.
Anesthesiology, Intensive Care and Pain Medicine, Klinik Ottakring, Wiener Gesundheitsverbund, Wien, Austria.
J Endovasc Ther. 2024 Dec 26:15266028241309252. doi: 10.1177/15266028241309252.
This study offers a retrospective assessment of a single-center experience using cerebrospinal fluid catheters to reduce the risk of perioperative spinal cord injury in patients undergoing single-staged complex endovascular juxtarenal or thoracoabdominal aortic aneurysm repair.
A total of 97 patients were included. On average, 70.7%±14.4% of the aortic segment between the left subclavian artery and the aortic bifurcation was covered during the procedures. Of the 53 patients receiving cerebrospinal fluid drainage, 77.4% were prophylactic and 22.6% were in symptomatic patients. The overall spinal cord injury rate was 12.4%, with 8.3% experiencing transient spinal cord injury with immediate improvement after cerebrospinal fluid drainage, and 4.1% of patients suffering permanent spinal cord injury: 2 (2.1%) with minor deficits and 2 (2.1%) with paraplegia. The mean intraoperatively administered heparin dosage was 7500 international units, and an additional intravenous bolus of acetylsalicylic acid was given in 69 cases (71.1%), whereas the cerebrospinal fluid drain was in situ.
The evaluation of the employed in-house protocol for single-staged complex endovascular juxtarenal and thoracoabdominal aortic aneurysm repair, focusing on cerebrospinal fluid catheter management in conjunction with necessary anticoagulant and antiplatelet medication, indicated that the use of a cerebrospinal fluid catheter is a feasible approach for spinal cord injury risk reduction in selected high-risk patients.
This study highlights the effectiveness of cerebrospinal fluid drainage (CSFD) in reducing spinal cord injury (SCI) rates from 12.4% to 4.1% during single-staged complex endovascular repair of juxtarenal and thoracoabdominal aortic aneurysms. Implementing CSFD within a standardized protocol achieved a 99.7% target visceral and renal vessel patency without major CSFD-related bleeding complications. These findings emphasize CSFD as a feasible and effective tool for SCI prevention in selected high-risk patients. While supporting on-demand catheter placement, this study underscores the potential of selective prophylactic CSFD use, contributing to safer, evidence-based strategies in managing high-risk aortic repairs.
本研究对单中心使用脑脊液导管降低接受单阶段复杂血管腔内近肾或胸腹主动脉瘤修复患者围手术期脊髓损伤风险的经验进行回顾性评估。
共纳入97例患者。手术过程中，左锁骨下动脉与主动脉分叉之间的主动脉段平均覆盖70.7%±14.4%。在接受脑脊液引流的53例患者中，77.4%为预防性引流，22.6%为有症状患者。总体脊髓损伤率为12.4%，其中8.3%经历短暂性脊髓损伤，脑脊液引流后立即改善，4.1%的患者遭受永久性脊髓损伤：2例（2.1%）有轻度功能缺损，2例（2.1%）截瘫。术中平均肝素用量为7500国际单位，69例（71.1%）在脑脊液引流管在位时额外静脉推注乙酰水杨酸。
对单阶段复杂血管腔内近肾和胸腹主动脉瘤修复所采用的内部方案进行评估，重点是脑脊液导管管理以及必要的抗凝和抗血小板药物治疗，结果表明，对于选定的高危患者，使用脑脊液导管是降低脊髓损伤风险的可行方法。
本研究强调了脑脊液引流（CSFD）在单阶段复杂血管腔内修复近肾和胸腹主动脉瘤时将脊髓损伤（SCI）率从12.4%降至4.1%的有效性。在标准化方案中实施CSFD实现了99.7%的目标内脏和肾血管通畅率，且无重大CSFD相关出血并发症。这些发现强调CSFD是选定高危患者预防SCI的可行且有效工具。在支持按需放置导管的同时，本研究强调了选择性预防性使用CSFD的潜力，有助于制定更安全、基于证据的高危主动脉修复管理策略。
