Gustavo S. Oderich1, Carlos Timaran2, Mark Farber3, William Quinones-Baldrich4, Guillermo Escobar5, Peter Gloviczki1, Roy K. Greenberg6, James Black7, Sharif Ellozy8, Edward Woo9, Michael Singh10, Mark Fillinger11, Jason Lee12, Hasan H. Dosluoglu13
1Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN; 2University of Texas SouthWestern, Dallas, TX; 3University of North Carolina, Chapel Hill, NC; 4University of California Los Angeles, Los Angeles, CA; 5University of Michigan, Ann Arbor, MI; 6The Cleveland Clinic, Cleveland, OH; 7Johns Hopkins Medical Center, Baltimore, MD; 8Mount Sinai School of Medicine ̶ New York, NY; 9University of Pennsylvania Medical Center, Philadelphia, PA; 10University of Rochester Medical Center, Rochester, NY; 11Dartmouth-Hitchcock Medical Center, Lebanon, NH; 12Stanford University Medical Center, Stanford, CA; 13State University of New York Buffalo, Buffalo, NY.
OBJECTIVES: To describe the incidence, predictive factors and outcomes of spinal cord injuries (SCI) in patients treated for thoracoabdominal aortic aneurysms (TAAAs) with abdominal debranching and aortic stent grafts (ADSG).
METHODS: We reviewed the clinical data of 159 consecutive patients treated for TAAAs with ADSG between 1999-2010. Extent of aortic disease was defined by Crawford TAAA classification (types I-IV) and percent length of aortic coverage. Predictive factors for SCI were identified using univariate and multivariate logistic regression analysis.
RESULTS: There were 81 male and 78 female patients with mean age of 70±9 years. TAAA classification was type I in 13 patients, type II in 52, type III in 63 and type IV in 31. ADGS required reconstruction of 512 vessels (3.2/ patient) and coverage of 73±19% of the aorta. Twenty-two patients (14%) developed SCI, which was immediate in 10 (6 paraplegia, 4 paraparesis), late in 12 (2 paraplegia, 10 paraparesis), and associated with recovery in 10. Thirty-day mortality was 16% (22/159) for the entire cohort and 18% (4/22) for patients with SCI (p=0.8). Patients with SCI had higher rates (p<0.05) of any morbidity (95% vs. 37%), respiratory complications (67% vs. 42%) and ischemic colitis (14% vs. 4%). By univariate analysis, factors associated with higher rates (p<0.05) of SCI were length of aortic coverage, type II TAAA, aneurysm rupture, Society for Vascular Surgery (SVS) renal scores and iliac artery occlusive disease. Independent predictors (p<0.01) were type II TAAA (OR 2.7, 95% CI 1.8-3.9) and aneurysm rupture (OR 2.52; 95% CI 1.00-6.33; p<004). Patient survival at 3-years was significantly decreased in patients with SCI compared to those who did not have this complication (66% vs. 31%, p<0.01).
CONCLUSIONS: SCI occurs in 14% of patients treated for TAAAs with ADSG and is associated with extent of aortic disease and aneurysm rupture. Patients with SCI have higher morbidity rates and decreased long-term survival.
AUTHOR DISCLOSURES: J. Black, Nothing to disclose; H. H. Dosluoglu, Nothing to disclose; S. Ellozy, Nothing to disclose; G. Escobar, Nothing to disclose; M. Farber, Nothing to disclose; M. Fillinger, Nothing to disclose; P. Gloviczki, Nothing to disclose; R. K. Greenberg, Nothing to disclose; J. Lee, Nothing to disclose; G. S. Oderich, Nothing to disclose; W. Quinones-Baldrich, Nothing to disclose; M. Singh, Nothing to disclose; C. Timaran, Nothing to disclose; E. Woo, Nothing to disclose.
Posted April 2012