Kenneth DeSart, Salvatore T. Scali, Michael Hong, Robert J. Feezor, Thomas S. Huber, Adam W. Beck
University of Florida, Gainesville, FL.
OBJECTIVES: SCI is a devastating complication of TEVAR with varying degrees of disability. Here we review the outcomes of patients with SCI after TEVAR.
METHODS: Patients with SCI after TEVAR, defined by any lower extremity neuro deficit over baseline, were evaluated. A database query and chart review/phone interviews with patients/family were used to determine outcomes and functional status after discharge. Patients were analyzed based on functional recovery and timing of their CSF drain placement(prophylactic or post-op for symptoms).
RESULTS: Six-hundred nine TEVARs were performed in the study period, and 57 patients developed SCI (9.4%). In-hospital mortality with SCI was 7.0%. 54 patients (95%) had a CSF drain placed with the majority placed post-op (54%). Complete data were available for 34 patients (60%) of whom 27(47%) were alive at follow-up [median 11.8mos]. Of these 34 patients, 26 (76%) had functional improvement, with 12 (35%) reporting return to baseline. Survival was worse in patients with no functional improvement (NI) when compared to patients with improvement(WI). Median survival for WI patients was 56mos compared to 3mos (p<.001) in NI patients. No difference in functional improvement or mortality was noted when comparing patients with prophylactic vs. post-op drains.
CONCLUSIONS: SCI can be a devastating complication after TEVAR and patients without functional improvement have a dismal prognosis. Measures to decrease the rate of SCI and/or mitigate its severity are needed. Timing of drain placement does not appear to have an impact on functional recovery.
AUTHOR DISCLOSURES: A. W. Beck, Nothing to disclose; K. DeSart, Nothing to disclose; R. J. Feezor, Nothing to disclose; M. Hong, Nothing to disclose; T. S. Huber, Nothing to disclose; S. T. Scali, Nothing to disclose.
Posted April 2012