Retrospective Risk Factor Analysis of Spinal Cord Ischemia after Thoracic Endovascular Aneurysm Repair

Abstract Thoracic endovascular aneurysm repair carries a risk of spinal cord ischemia(SCI), similar to open repair. We conducted a retrospective study of the incidence and outcome of SCI after thoracic endovascular aneurysm repair (TEVAR). From March 2007 to September 2012, 96 patients underwent TEVAR at Saitama Cardiovascular and Respiratory Center. A loss of lower extremity motor evoked potentials (MEP) or lower extremity strength was treated emergently to maintain a mean arterial blood pressure ≥ 70-80 mmHg. For the protection of spinal cord, combined use of naloxone and cerebrospinal fluid drainage (≤ 13 mmHg) was employed. 4 (4.2%) of the 96 patients had paraplegia. One had lower extremity strength loss after extubation and 3 developed delayed-onset paraparesis/paraplegia. Afterward 2 (50%) of them were dead. SCI patients were more likely to be elderly (78 ± 5.5 vs 70 ± 7.1 years; P = 0.0476). A trend toward an increase in SCI was noted in women (25.0% vs 2.2%; P = 0.0338), and in length of aortic coverage (25.9 ± 2.6 cm vs 16.2 ± 5.6 cm; P = 0.008). Early detection and intervention to improve spinal cord perfusion may benefit patients at risk for SCI.