Spinal Cord Ischemia After Thoracoabdominal Aortic Aneurysms Endovascular Repair: From the Italian Multicenter Fenestrated/Branched Endovascular Aneurysm Repair Registry
| العنوان: | Spinal Cord Ischemia After Thoracoabdominal Aortic Aneurysms Endovascular Repair: From the Italian Multicenter Fenestrated/Branched Endovascular Aneurysm Repair Registry |
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| المؤلفون: | Enrico Rinaldi, Andrea Melloni, Enrico Gallitto, Aaron Fargion, Giacomo Isernia, Andrea Kahlberg, Luca Bertoglio, Gianluca Faggioli, Massimo Lenti, Carlo Pratesi, Mauro Gargiulo, Germano Melissano, Roberto Chiesa, Baccani Luigi, Bertoglio Luca, Chiesa Roberto, Faggioli Gianluca, Fargion Aaron, Fenelli Cecilia, Gallitto Enrico, Gargiulo Mauro, Isernia Giacomo, Lenti Massimo, Logiacco Antonino, Kahlberg Andrea, Mascoli Chiara, Melissano Germano, Melloni Andrea, Pini Rodolfo, Pratesi Carlo, Rinaldi Enrico, Simonte Gioele, Speziali Sara |
| المساهمون: | Rinaldi, E., Melloni, A., Gallitto, E., Fargion, A., Isernia, G., Kahlberg, A., Bertoglio, L., Faggioli, G., Lenti, M., Pratesi, C., Gargiulo, M., Melissano, G., Chiesa, R. |
| المصدر: | Journal of Endovascular Therapy. 30:281-288 |
| بيانات النشر: | SAGE Publications, 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | B-EVAR, branched, endovascular aortic aneurysm repair, F-EVAR, fenestrated, paraplegia, spinal cord ischemia, TAAA, Radiology, Nuclear Medicine and imaging, Surgery, Cardiology and Cardiovascular Medicine |
| الوصف: | Purpose: The aim of this study is to report an Italian multicenter experience analyzing the incidence and the risk factors associated with spinal cord ischemia (SCI) in a large cohort of thoracoabdominal aortic aneurysms (TAAAs) treated by fenestrated-branched endovascular aneurysm repair (F-/B-EVAR). Materials and Methods: All consecutive patients undergoing F-/B-EVAR in 4 Italian university centers between 2008 and 2019 were prospectively recorded and retrospectively analyzed. Spinal cord ischemia, 30 day/in-hospital adverse events, and mortality were assessed as early outcomes. Risk factors for SCI were determined by multivariable analysis. Results: A total of 351 patients received F-/B-EVAR for a TAAA. Twenty-eight (8.0%) patients died within 30 postoperative days or during the hospitalization. Regarding SCI, 47 patients (13.4%) developed neurological symptoms related to spinal cord impaired perfusion. Among them, 17 (4.8%) had a major permanent impairment. The multivariable analysis identified that SCI was associated with Crawford extent I to III (odds ratio [OR]: 20.90, p=0.004, 95% confidence interval [CI]=2.69–162.57), and with endovascular procedures performed for ruptured TAAA (OR: 5.74, p=0.010, 95% CI=1.53–21.57). Spinal cord ischemia was also significantly associated with a grade 3 bleeding during the visceral stage (OR: 4.34, p=0.005, 95% CI=1.55–12.16) and a grade 2 renal insufficiency at 30 days (OR: 7.45, p=0.002, 95% CI=2.12–26.18). Conclusion: The present study indicates that SCI is still an open issue after extent I to III TAAA endovascular repair, while its incidence in extent IV TAAA and pararenal/juxtarenal aneurysms is rare. Thoracoabdominal aortic aneurysms extension, urgent TAAA repair for rupture, severe bleeding, and 30 day renal insufficiency have been identified as significant risk factors for SCI. In the presence of such factors, adjunctive strategies may be considered to reduce SCI rates, while in low-risk patients invasive or potentially-risky maneuvers might not be justified. |
| تدمد: | 1545-1550 1526-6028 |
| DOI: | 10.1177/15266028221081074 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0ef83bc5c305de784b56e2a8cdb44c6d https://doi.org/10.1177/15266028221081074 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....0ef83bc5c305de784b56e2a8cdb44c6d |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15451550 15266028 |
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| DOI: | 10.1177/15266028221081074 |