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PVSS10. TEVAR Following Prior Abdominal Aortic Aneurysm Surgery: What Is the Risk of Neurological Deficit?

Felix J.V. Schlösser, Alan Dardik, Peter H. Lin, Eric L.G. Verhoeven, Joost J.A. van Herwaarden, Hence J.M. Verhagen, Frans L. Moll, Paul J. Gagne, Bart E. Muhs.
Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.

OBJECTIVES: Evidence regarding the impact of prior abdominal aortic aneurysm (AAA) repair on the risk of neurological deficit after thoracic endovascular aortic aneurysm repair (TEVAR) is lacking. The EUROSTAR registry reported an overall risk of paraplegia or paraparesis of 2.5% following TEVAR but did not differentiate between patients with and without prior AAA repair. The purpose of this study was to characterize the risk of TEVAR related neurological deficit in patients who previously underwent infrarenal AAA surgery.

METHODS: All patients with a history of prior infrarenal AAA repair (open and endovascular) who subsequently underwent TEVAR were selected from six different institutions and included in our cohort. Neurological deficit was defined by temporary or permanent paraplegia or paraparesis. The number of patients with neurological deficit was collected by consulting the treating physicians and documented in a database. The collected patient data were pooled and an overall risk of neurological deficit was calculated for patients with a history of prior infrarenal AAA repair undergoing TEVAR.

RESULTS: 69 patients underwent TEVAR after prior AAA repair and were included in our study. The risk of development of temporary or permanent neurological deficit was 13.0% (9 of 69 patients). The risk of permanent neurologic deficit was 7.2% (5 of 69 patients).

CONCLUSIONS: Prior infrarenal AAA repair is associated with a five-fold increased risk of neurological deficit after TEVAR compared to those patients without prior AAA surgery based on historical controls. This high risk of neurological deficit in patients with a history of infrarenal AAA repair compared to patients without prior infrarenal AAA repair suggests a higher threshold for surgical intervention may be more appropriate. If the diameter and rupture risk are large and TEVAR is indicated, best available pre-operative care should be offered to protect the neurological function of this specific group of patients with prior AAA repair.