scholarly journals Preoperative Risk Score Model to Characterize Predictors of Spinal Cord Ischemia Following Thoracic Endovascular Aortic Repair

2016 ◽  
Vol 64 (3) ◽  
pp. 832
Author(s):  
Albeir Mousa ◽  
Mike Broce ◽  
Michael Yacoub ◽  
Andrew Sticco ◽  
Mina Baskharoun ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Risk Score ◽  
Spinal Cord Ischemia ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Preoperative Risk ◽  
Aortic Repair ◽  
Score Model

scholarly journals New Preoperative Spinal Cord Ischemia Risk Stratification Model for Patients Undergoing Thoracic Endovascular Aortic Repair

2020 ◽  
Vol 54 (6) ◽  
pp. 487-496
Author(s):  
Albeir Y. Mousa ◽  
Ramez Morcos ◽  
Mike Broce ◽  
Mark C. Bates ◽  
Ali F. AbuRahma
Keyword(s):  
Spinal Cord ◽  
Risk Score ◽  
Spinal Cord Ischemia ◽  
High Volume ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Inhospital Mortality ◽  
Aortic Repair ◽  
Patient Consent ◽  
Score Model

Purpose: Our objective was to determine significant predictors of spinal cord ischemia (SCI) following Thoracic Endovascular Aortic Repair (TEVAR) and to further develop a simple and clinically orientated risk score model. Methods: A retrospective review of data from the Society of Vascular Surgery/Vascular Quality Initiative national data set was performed for all patients undergoing TEVAR from January, 2014 to June 2018. Preoperative demographics, procedure-related variables, and clinical details related to SCI were examined. A SCI risk score was developed utilizing a multivariable logistic regression model. Results: For the 7889 patients in the final analysis who underwent TEVAR during the study period, the mean age was 67.6 ± 13.9, range 18 to 90 years, and the majority was male (65%). Postoperative outcomes included stroke (3.0%), myocardial infarction (2.9%), inhospital mortality (5.4%), transient SCI (1.5%), and permanent SCI (2.1%). Nearly half of the overall cases were performed in high volume centers. Predictors of increased risk for SCI included age by decade (odds ratio [OR]: 1.2), celiac coverage (OR: 1.5), current smoker (OR: 1.6), dialysis (OR: 1.9), 3 or more aortic implanted devices (OR: 1.7), emergent or urgent surgery (OR: 1.5), adjunct aorta-related procedure (OR: 2.5), adjunct not related (OR: 2.6), total estimated length of aortic device (19-31 cm, OR: 1.9 and ≥32 cm, OR: 3.0), ASA class 4 or 5 (OR: 1.6), and procedure time ≥154 minutes (OR: 1.8). Two predictors decreased the risk of SCI, cases from high-volume centers (OR: 0.6) and eGFR ≥ 60 (OR: 0.6). To evaluate the risk score model, probabilities of SCI from the original regression, raw score, and raw score categories resulted in area under the curve statistics of 0.792, 0.786, and 0.738, respectively. Conclusions: Spinal cord ischemia remains one of the most feared complications of TEVAR. Incidence of SCI in this large series of patients with TEVAR was 3.6% with nearly 60% being permanent. The proposed model provides an assessment tool to guide clinical decisions, patient consent process, risk-assessment, and procedural strategy.

Hypogastric Artery Stenting for Chronic Intermittent Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair

2020 ◽  
Vol 27 (5) ◽  
pp. 801-804
Author(s):  
Catharina Gronert ◽  
Nikolaos Tsilimparis ◽  
Giuseppe Panuccio ◽  
Ahmed Eleshra ◽  
Fiona Rohlffs ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Ischemia ◽  
Thoracic Endovascular Aortic Repair ◽  
Neurological Symptoms ◽  
Endovascular Aortic Repair ◽  
Hypogastric Artery ◽  
Lower Extremity Weakness ◽  
Aortic Repair ◽  
The Right

Purpose: To report a case of chronic intermittent spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) and its successful treatment using hypogastric artery stenting. Case Report: A 79-year-old patient presented in May 2013 with a thoracic aortic aneurysm (TAA) and a contained rupture. He urgently underwent TEVAR that covered 274 mm of descending thoracic aorta without immediate postoperative signs of acute SCI. At 3-month follow-up, he reported repeating incidents of sudden lower extremity weakness leading to a fall with a humerus fracture. A neurological consultation revealed the tentative diagnosis of intermittent SCI caused by TEVAR and initially recommended a conservative approach. During the following year there was no clinical improvement of the symptoms. Computed tomography angiography showed a high-grade stenosis of the right hypogastric artery, which was stented in November 2014 to improve the collateral network of spinal cord perfusion. Following treatment, the patient had no further neurological symptoms; at 32 months after the reintervention, the imaging follow-up documented a patent stent and continued exclusion of the TAA. Conclusion: Intermittent neurological symptoms after TEVAR should be suspected as chronic intermittent SCI. The improvement of collateral networks of the spinal cord by revascularization of the hypogastric artery is a viable treatment option.

scholarly journals National Incidence, Mortality Outcomes, and Predictors of Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair

2019 ◽  
Vol 69 (1) ◽  
pp. e15-e16 ◽  
Author(s):  
Salvatore T. Scali ◽  
Kristina A. Giles ◽  
Grace J. Wang ◽  
Thomas S. Huber ◽  
Gilbert R. Upchurch ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Ischemia ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

scholarly journals PC072. Impact of Functional Recovery and Prediction of Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair in the Vascular Quality Initiative

2016 ◽  
Vol 63 (6) ◽  
pp. 174S-175S
Author(s):  
Liza Flory P. Laquian ◽  
Salvatore Scali ◽  
Robert Feezor ◽  
Javairiah Fatima ◽  
Kristina A. Giles ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Functional Recovery ◽  
Spinal Cord Ischemia ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

scholarly journals Risk of spinal cord ischemia after thoracic endovascular aortic repair

2018 ◽  
Vol 10 (11) ◽  
pp. 6088-6096 ◽  
Author(s):  
Ling Xue ◽  
Songyuan Luo ◽  
Huanyu Ding ◽  
Yi Zhu ◽  
Yuan Liu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Ischemia ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

National incidence, mortality outcomes, and predictors of spinal cord ischemia after thoracic endovascular aortic repair

2020 ◽  
Vol 72 (1) ◽  
pp. 92-104 ◽  
Author(s):  
Salvatore T. Scali ◽  
Kristina A. Giles ◽  
Grace J. Wang ◽  
Paul Kubilis ◽  
Dan Neal ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Ischemia ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair
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