Mechanisms of symptomatic spinal cord ischemia after TEVAR: Insights from the European Registry of Endovascular Aortic Repair Complications (EuREC)

Martin Czerny, Holger Eggebrecht, Gottfried Sodeck, Fabio Verzini, Piergiorgio Cao, Gabriele Maritati, Vicente Riambau, Friedhelm Beyersdorf, Bartosz Rylski, Martin Funovics, Christian Loewe, Jürg Schmidli, Piergiorgio Tozzi, Ernst Weigang, Toru Kuratani, Ugolino Livi, Giampiero Esposito, Santi Trimarchi, Jos C. Van Den Berg, Weiguo FuRoberto Chiesa, Germano Melissano, Luca Bertoglio, Lars Lonn, Ingrid Schuster, Michael Grimm

Research output: Contribution to journalArticle

Abstract

Purpose: To test the hypothesis that simultaneous closure of at least 2 independent vascular territories supplying the spinal cord and/or prolonged hypotension may be associated with symptomatic spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR). Methods: A pattern matching algorithm was used to develop a risk model for symptomatic SCI using a prospective 63-patient single-center cohort to test the positive predictive value (PPV) of prolonged intraoperative hypotension and/or simultaneous closure of at least 2 of 4 the vascular territories supplying the spinal cord (left subclavian, intercostal, lumbar, and hypogastric arteries). This risk model was then applied to data extracted from the multicenter European Registry on Endovascular Aortic Repair Complications (EuREC). Between 2002 and 2010, the 19 centers participating in EuREC reported 38 (1.7%) cases of symptomatic spinal cord ischemia among the 2235 patients in the database. Results: In the single-center cohort, direct correlations were seen between the occurrence of symptomatic SCI and both prolonged intraoperative hypotension (PPV 1.00, 95%CI 0.22 to 1.00, p=0.04) and simultaneous closure of at least 2 independent spinal cord vascular territories (PPV 0.67, 95% CI 0.24 to 0.91, p=0.005). Previous closure of a single vascular territory was not associated with an increased risk of symptomatic spinal cord ischemia (PPV 0.07, 95% CI 0.01 to 0.16, p=0.56). The combination of prolonged hypotension and simultaneous closure of at least 2 territories exhibited the strongest association (PPV 0.75, 95%CI 0.38 to 0.75, p

Original languageEnglish
Pages (from-to)37-43
Number of pages7
JournalJournal of Endovascular Therapy
Volume19
Issue number1
DOIs
Publication statusPublished - 2012

Keywords

  • Complication
  • Hypoperfusion
  • Hypotension
  • Intercostal arteries
  • Left subclavian artery
  • Paraparesis
  • Paraplegia
  • Risk model
  • Spinal cord ischemia
  • Stent-graft
  • Thoracic aorta
  • Thoracic endovascular aortic repair

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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    Czerny, M., Eggebrecht, H., Sodeck, G., Verzini, F., Cao, P., Maritati, G., Riambau, V., Beyersdorf, F., Rylski, B., Funovics, M., Loewe, C., Schmidli, J., Tozzi, P., Weigang, E., Kuratani, T., Livi, U., Esposito, G., Trimarchi, S., Van Den Berg, J. C., ... Grimm, M. (2012). Mechanisms of symptomatic spinal cord ischemia after TEVAR: Insights from the European Registry of Endovascular Aortic Repair Complications (EuREC). Journal of Endovascular Therapy, 19(1), 37-43. https://doi.org/10.1583/11-3578.1