Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair

Stefano Zoli, Fabian Roder, Christian D. Etz, Robert M. Brenner, Carol A. Bodian, Hung Mo Lin, Gabriele Di Luozzo, Randall B. Griepp

Research output: Contribution to journalArticle

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Abstract

Background: Endovascular repair of descending thoracic and thoracoabdominal aortic aneurysms is an appealing alternative to the standard surgical approach, but precludes revascularization of segmental arteries (SAs). For safer surgical and endovascular repairs, an accurate prediction of the risk of paraplegia in relation to the extent of SA sacrifice is needed. Methods: From January 1994 to October 2008, 609 patients (mean age, 63 ± 14 years) underwent surgical descending thoracic or thoracoabdominal aortic aneurysm repair without SA reimplantation. Three hundred seventy-six patients (62%) were male; 159 (26%) had urgent or emergent operation; 199 (33%) had previous aortic surgery. Somatosensory- or motor-evoked potential monitoring and cerebrospinal fluid drainage were routinely performed. Results: Hospital mortality was 10.7% (65 patients). Spinal cord injury (SCI) occurred in 3.4% (21 patients). The extent of resectionexpressed as the number of SAs sacrificed (p = 0.007)and the need for visceral artery reimplantation (p = 0.03) were independent risk factors for paraplegia. Further analysis identified four risk groups (p <0.0001): fewer than 8 SAs sacrificed (group A, SCI = 1.2%); sacrifice of 8 to 12 SAs with proximal origin in the upper thorax (group B, SCI = 3.7%); 8 to 12 SAs sacrificed beginning in the lower thorax (group C, SCI = 15.4%); and 13 or more SAs sacrificed (group D, SCI = 12.5%). This four-group model more accurately predicts SCI risk than the Crawford classification (goodness of fit c statistic: 0.748 versus 0.640). Conclusions: The extent of SA sacrifice is the most powerful predictor of paraplegia risk. For aneurysms of moderate extent, a more distal location involving the abdominal aorta increases the risk of spinal cord injury. Sacrifice of fewer than 8 SAs is associated with a very low paraplegia risk regardless of location.

Original languageEnglish
Pages (from-to)1237-1244
Number of pages8
JournalAnnals of Thoracic Surgery
Volume90
Issue number4
DOIs
Publication statusPublished - 2010

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Paraplegia
Aneurysm
Thorax
Arteries
Spinal Cord Injuries
Thoracic Aortic Aneurysm
Replantation
Motor Evoked Potentials
Abdominal Aorta
Hospital Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Zoli, S., Roder, F., Etz, C. D., Brenner, R. M., Bodian, C. A., Lin, H. M., ... Griepp, R. B. (2010). Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair. Annals of Thoracic Surgery, 90(4), 1237-1244. https://doi.org/10.1016/j.athoracsur.2010.04.091

Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair. / Zoli, Stefano; Roder, Fabian; Etz, Christian D.; Brenner, Robert M.; Bodian, Carol A.; Lin, Hung Mo; Di Luozzo, Gabriele; Griepp, Randall B.

In: Annals of Thoracic Surgery, Vol. 90, No. 4, 2010, p. 1237-1244.

Research output: Contribution to journalArticle

Zoli, S, Roder, F, Etz, CD, Brenner, RM, Bodian, CA, Lin, HM, Di Luozzo, G & Griepp, RB 2010, 'Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair', Annals of Thoracic Surgery, vol. 90, no. 4, pp. 1237-1244. https://doi.org/10.1016/j.athoracsur.2010.04.091
Zoli, Stefano ; Roder, Fabian ; Etz, Christian D. ; Brenner, Robert M. ; Bodian, Carol A. ; Lin, Hung Mo ; Di Luozzo, Gabriele ; Griepp, Randall B. / Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair. In: Annals of Thoracic Surgery. 2010 ; Vol. 90, No. 4. pp. 1237-1244.
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title = "Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair",
abstract = "Background: Endovascular repair of descending thoracic and thoracoabdominal aortic aneurysms is an appealing alternative to the standard surgical approach, but precludes revascularization of segmental arteries (SAs). For safer surgical and endovascular repairs, an accurate prediction of the risk of paraplegia in relation to the extent of SA sacrifice is needed. Methods: From January 1994 to October 2008, 609 patients (mean age, 63 ± 14 years) underwent surgical descending thoracic or thoracoabdominal aortic aneurysm repair without SA reimplantation. Three hundred seventy-six patients (62{\%}) were male; 159 (26{\%}) had urgent or emergent operation; 199 (33{\%}) had previous aortic surgery. Somatosensory- or motor-evoked potential monitoring and cerebrospinal fluid drainage were routinely performed. Results: Hospital mortality was 10.7{\%} (65 patients). Spinal cord injury (SCI) occurred in 3.4{\%} (21 patients). The extent of resectionexpressed as the number of SAs sacrificed (p = 0.007)and the need for visceral artery reimplantation (p = 0.03) were independent risk factors for paraplegia. Further analysis identified four risk groups (p <0.0001): fewer than 8 SAs sacrificed (group A, SCI = 1.2{\%}); sacrifice of 8 to 12 SAs with proximal origin in the upper thorax (group B, SCI = 3.7{\%}); 8 to 12 SAs sacrificed beginning in the lower thorax (group C, SCI = 15.4{\%}); and 13 or more SAs sacrificed (group D, SCI = 12.5{\%}). This four-group model more accurately predicts SCI risk than the Crawford classification (goodness of fit c statistic: 0.748 versus 0.640). Conclusions: The extent of SA sacrifice is the most powerful predictor of paraplegia risk. For aneurysms of moderate extent, a more distal location involving the abdominal aorta increases the risk of spinal cord injury. Sacrifice of fewer than 8 SAs is associated with a very low paraplegia risk regardless of location.",
author = "Stefano Zoli and Fabian Roder and Etz, {Christian D.} and Brenner, {Robert M.} and Bodian, {Carol A.} and Lin, {Hung Mo} and {Di Luozzo}, Gabriele and Griepp, {Randall B.}",
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T1 - Predicting the risk of paraplegia after thoracic and thoracoabdominal aneurysm repair

AU - Zoli, Stefano

AU - Roder, Fabian

AU - Etz, Christian D.

AU - Brenner, Robert M.

AU - Bodian, Carol A.

AU - Lin, Hung Mo

AU - Di Luozzo, Gabriele

AU - Griepp, Randall B.

PY - 2010

Y1 - 2010

N2 - Background: Endovascular repair of descending thoracic and thoracoabdominal aortic aneurysms is an appealing alternative to the standard surgical approach, but precludes revascularization of segmental arteries (SAs). For safer surgical and endovascular repairs, an accurate prediction of the risk of paraplegia in relation to the extent of SA sacrifice is needed. Methods: From January 1994 to October 2008, 609 patients (mean age, 63 ± 14 years) underwent surgical descending thoracic or thoracoabdominal aortic aneurysm repair without SA reimplantation. Three hundred seventy-six patients (62%) were male; 159 (26%) had urgent or emergent operation; 199 (33%) had previous aortic surgery. Somatosensory- or motor-evoked potential monitoring and cerebrospinal fluid drainage were routinely performed. Results: Hospital mortality was 10.7% (65 patients). Spinal cord injury (SCI) occurred in 3.4% (21 patients). The extent of resectionexpressed as the number of SAs sacrificed (p = 0.007)and the need for visceral artery reimplantation (p = 0.03) were independent risk factors for paraplegia. Further analysis identified four risk groups (p <0.0001): fewer than 8 SAs sacrificed (group A, SCI = 1.2%); sacrifice of 8 to 12 SAs with proximal origin in the upper thorax (group B, SCI = 3.7%); 8 to 12 SAs sacrificed beginning in the lower thorax (group C, SCI = 15.4%); and 13 or more SAs sacrificed (group D, SCI = 12.5%). This four-group model more accurately predicts SCI risk than the Crawford classification (goodness of fit c statistic: 0.748 versus 0.640). Conclusions: The extent of SA sacrifice is the most powerful predictor of paraplegia risk. For aneurysms of moderate extent, a more distal location involving the abdominal aorta increases the risk of spinal cord injury. Sacrifice of fewer than 8 SAs is associated with a very low paraplegia risk regardless of location.

AB - Background: Endovascular repair of descending thoracic and thoracoabdominal aortic aneurysms is an appealing alternative to the standard surgical approach, but precludes revascularization of segmental arteries (SAs). For safer surgical and endovascular repairs, an accurate prediction of the risk of paraplegia in relation to the extent of SA sacrifice is needed. Methods: From January 1994 to October 2008, 609 patients (mean age, 63 ± 14 years) underwent surgical descending thoracic or thoracoabdominal aortic aneurysm repair without SA reimplantation. Three hundred seventy-six patients (62%) were male; 159 (26%) had urgent or emergent operation; 199 (33%) had previous aortic surgery. Somatosensory- or motor-evoked potential monitoring and cerebrospinal fluid drainage were routinely performed. Results: Hospital mortality was 10.7% (65 patients). Spinal cord injury (SCI) occurred in 3.4% (21 patients). The extent of resectionexpressed as the number of SAs sacrificed (p = 0.007)and the need for visceral artery reimplantation (p = 0.03) were independent risk factors for paraplegia. Further analysis identified four risk groups (p <0.0001): fewer than 8 SAs sacrificed (group A, SCI = 1.2%); sacrifice of 8 to 12 SAs with proximal origin in the upper thorax (group B, SCI = 3.7%); 8 to 12 SAs sacrificed beginning in the lower thorax (group C, SCI = 15.4%); and 13 or more SAs sacrificed (group D, SCI = 12.5%). This four-group model more accurately predicts SCI risk than the Crawford classification (goodness of fit c statistic: 0.748 versus 0.640). Conclusions: The extent of SA sacrifice is the most powerful predictor of paraplegia risk. For aneurysms of moderate extent, a more distal location involving the abdominal aorta increases the risk of spinal cord injury. Sacrifice of fewer than 8 SAs is associated with a very low paraplegia risk regardless of location.

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