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 SS15. Collateral Bed Patency Affects Outcomes of Spinal Cord Ischemia (SCI) Following Aortic Endografting

Matthew J. Eagleton, Samir K. Shah, Daniel Petkovsek, Tara Mastracci, Roy K. Greenberg
Vascular Surgery, Cleveland Clinic, Cleveland, OH.
 
OBJECTIVES: This study evaluated factors affecting outcomes from SCI associated with endovascular aortic aneurysm repair.
 
METHODS: 1,251 patients enrolled in an IDE endograft trial (1998-2010) were screened for SCI. A records review supplemented prospective outcomes data. Demographics, collateral bed (hypogastric (HA) and subclavian (SA) artery) patency, presentation and outcomes were evaluated on patients with SCI.
 
RESULTS: SCI occurred in 2.9% (Table 1) of patients. Among SCI patients, SA bypass was performed in 4 (13%) patients, and 2 had intraoperative SA coverage. Preoperative HA occlusion was present in 14 (31%), and an additional 7 had intraoperative HA occlusion. SCI was immediately apparent in 15 (42%) patients. The presence of an occluded SA or HA increased the risk of immediate onset of SCI symptoms compared to those with patent collaterals (73% v. 24%, p=0.021). Of those presenting in a delayed fashion, 9 (43%) had a clear precipitating event prior to SCI onset. Recovery occurred in 24 (67%) patients. Immediate onset was a negative predictor of recovery (p=0.025), as was occlusion of a single collateral bed (p=0.035). Mean follow up was 22±4 months, with 30-day and 1-year survival of 92±4.6% and 56±8.3%. Survival at 3 months was lower in those that did not recover from SCI symptoms (36% v. 92%, p<0.001).
 
CONCLUSIONS: Single collateral bed occlusion predicts immediate onset SCI and lack of recovery, which portends increased mortality. Collateral bed preservation may limit this complication following endovascular AA repair.
AUTHOR DISCLOSURES: M. J. Eagleton: Cook Medical, Consulting fees or other remuneration (payment); R. K. Greenberg: Cook Medical, Consulting fees or other remuneration (payment); T. Mastracci: Cook Medical, Consulting fees or other remuneration (payment); D. Petkovsek: Nothing to disclose; S. K. Shah: Nothing to disclose.
 
Incidence of SCI According to Extent of Endograft Repair
Type of Repair
N (%)
Incidence of SCI
Total
1251 (100%)
36 (2.9%)
AAA
351 (28%)
1 (0.3%)
Juxtarenal AAA
213 (17%)
1 (0.5%)
TAA
194(16%)
10 (5.2%)
TAAA
493 (39%)
24 (4.9%)
SCI - spinal cord ischemia, AAA - abdominal aortic aneurysm, TAA - thoracic aortic aneurysm, TAAA - thoracoabdominal aortic aneurysm​​
 
Posted April 2013

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