Clinical Research Article
Spinal cord ischemia after thoracic endovascular aortic repair: a report of four cases and review of literatures
Zhang Meng, Zhou Min, Qiao Tong
Published 2016-11-30
Cite as Chin J Vasc Surg, 2016, 01(3): 175-180. DOI: 10.3760/cma.j.issn.2096-1863.2016.03.011
Abstract
ObjectiveTo analyse and explore the etiology of spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) and the therapeutic efficacy of cerebrospinal fluid drainage (CSFD) .
MethodsA retrospective analysis was made on 4 patients who developed SCI after TEVAR.
ResultsThe length of aorta covered was 38% and the left subclavian artery (LSA) was covered in patient one. The proximal landing zone was Z2 and the distal landing zone was T8. Patient one presented lower extremity weakness 9 hours following the repair and then his systolic pressure was controlled over 115 mmHg and CSFD was not deployed. Patient one could not walk independently at discharge. Patient two had 74% coverage of aorta and the LSA was open. The stent was deployed between Z3 and T12. Patient two developed immediate SCI after anesthesia awareness. His systolic pressure was controlled between 150-160 mmHg and CSFD was timely utilized. Patient two was able to walk independently at discharge. The length of aorta covered was 37% and the LSA was covered in patient three. The stent’s landing zone was Z2 and T8 and he had lower extremity weakness10 hours after repair. His systolic pressure was controlled between 150-160 mmHg and CSFD was timely utilized. Patient two was able to walk independently at discharge. The LSA of patient four was open. The proximal landing zone was T7 and the distal landing zone was T12. Patient four developed SCI 21 hours after anesthesia awareness. Then his systolic pressure was controlled over 100 mmHg and CSFD was not deployed. Patient four could walk independentlyat discharge.
ConclusionSCI after TEVAR is the result of multiple factors. Patients with extensive aortic lesions might need staged repair. Adamkiewicz artery should be identified to avoid covering this artery. The blood supply of spinal cord is suddenly decrease once the stent is deployed, which could lead to spinal shock. Spinal shock could result in the refractory hypotension, which deteriorate SCI. The argument of mean arterial pressure and CSFD could prevent permanent paraplegia and CSFD play an irreplaceable role.
Key words:
Thoracic endovascular aortic repair; Spinal cord ischemia; Cerebrospinal fluid drainage; Prognosis
Contributor Information
Zhang Meng
Department of Vascular Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
Zhou Min
Qiao Tong
