• Vascular Annual Meeting
• Future Meeting Dates
• Past Meeting Information
• Contact Us

Complications of Spinal Fluid Drainage in Thoracoabdominal Aneurysm Repair: A Report of 486 Patients Treated from 1987 to 2008

Martha M. Wynn, Charles W. Acher, Mathew Mell, Girma Tefera, John Hoch.
University of Wisconsin, Madison, Wisc.

OBJECTIVES: Spinal fluid drainage (SFD) has become a standard intervention to reduce paraplegia risk in thoracic (TA) and thoracoabdominal (TAA) aneurysm repair. There has not been a comprehensive study of the risks of SFD and how these risks can be reduced.

METHODS: Using a concurrent database, 648 patients who had TA or TAA repair from 1987 to 2008 were studied. Thoracic endografts have been used for TA since 2005. Four hundred eighty six patients had spinal drains. Spinal fluid pressure (SFP) was reduced to less than 6 mmHg during thoracic aortic occlusion and reperfusion. After surgery SFP was kept less than 10 mmHg until patients were awake with normal leg lift. Until 2000 a 19 gauge epidural catheter (SD) was used. Since 2001 a 16 gauge silastic drain (LD) placed under fluoroscopy has been used, with needle insertion at L3-4 or L2-3 and catheter tip positioned at T9-10. Drains were removed 48 hours after surgery. Spinal and head CTs were performed in patients with bloody spinal fluid during or after surgery. We studied the incidence of spinal fluid bleeding, spinal fluid leak, and the resulting clinical consequences.

RESULTS: The mean age was 67 and 54% were male. Twenty five patients had bloody spinal fluid (5.1%). Seven of the 25 had no CT evidence of intracranial hemorrhage, 14 had intracranial blood without neurologic deficit, and 4 patients with significant intracranial bleeding on CT had neurologic deficits: 1 died from brain herniation, 2 had permanent deficits and 1 recovered fully. Three of these 4 patients had cerebral atrophy with evidence of old subdural hematoma. The incidence of serious complications directly resulting from spinal fluid drainage was 0.8% and mortality was 0.2%. By univariate and multivariate analysis only amount of SFD correlated with bleeding (mean 124 ml vs. 178 ml, p<.0001). Age, sex, blood pressure, drain type, SFP, change in SFP, acuity and Crawford aneurysm type were not significant. No patient had spinal hematoma. Two (0.6%) SD patients and 4 (2.2%) LD patients had spinal fluid leak and headache that required treatment with epidural blood patch.

CONCLUSIONS: Patients with cerebral atrophy or chronic subdural hematoma are at increased risk for complications from SFD. Using strategies to reduce the volume of SFD but still control SFP we have eliminated serious complications for the last 4 years.

AUTHOR DISCLOSURES: M.M. Wynn, None; C.W. Acher, None; M. Mell, None; G. Tefera, None; J. Hoch, None.