![]() RISK OF PARAPLEGIA AFTER TREATMENT OF ACUTE AND CHRONIC TBAD In contrast, the aneurysmal aorta is promptly sealed after TEVAR with rapid sac thrombosis and cessation of flow through the intercostal arteries before requisite collaterals have developed. Another factor that may contribute to lower SCI rates in TBAD is that some false lumen perfusion often persists after TEVAR, either maintaining perfusion through the intercostal arteries or allowing time for collateralization. The lower burden of mural atheroma and thrombus in TBAD presents a lower risk for atheroembolism after manipulation in the aorta. The reasons for these reported disparities are likely multifactorial. 8Fourteen patients in this cohort experienced SCI postoperatively: 11 (3.8%) in the aneurysm group and three (1.4%) in the dissection group. 6,7The EUROSTAR registry reported outcomes from 606 patients who underwent TEVAR, of whom 291 were treated for aneurysmal disease and 215 for TBAD. Published literature to date suggests that SCI rates after TEVAR for TBAD are lower than for TEVAR carried out to repair thoracic aneurysms, with rates of 4% reported for the former and up to 10% for the latter. 5 COMPARATIVE PARAPLEGIA RATES AFTER TEVAR FOR TBAD AND ANEURYSMAL DISEASE Patients who develop paraplegia after TEVAR have a poor long-term functional outlook and significantly reduced life expectancy. As such, the extent of aorta covered during thoracic endovascular aortic repair (TEVAR), patency of the left subclavian artery (LSA) and internal iliac arteries, and perioperative blood pressure are just some of the factors that affect the periprocedural risk of SCI. 4Disruption of the blood flow from any of these territories reduces perfusion to spinal cord neural tissue, increasing the risk of SCI. The blood supply of the spinal cord arises via a variety of different vascular territories, including the intercostal, lumbar, left subclavian, and internal iliac arteries. 3Ī complex interplay of factors impacts the likelihood of SCI complicating endovascular repair of TBAD. Systematic reviews have suggested SCI rates of up to 4% for undifferentiated patients undergoing endovascular repair of TBAD 1,2 however, significantly higher rates have been reported, especially in case series dealing with acute presentations. Although spinal cord ischemia (SCI) can manifest as a de novo sequela of TBAD at presentation, it is encountered more frequently as a complication of both endovascular and open TBAD repair. ![]() Paraplegia is a devastating and unpredictable clinical syndrome that remains an important consideration in the management of type B aortic dissection (TBAD). ![]() A review of this devastating complication including incidence rates after TEVAR for TBAD and the roles of left subclavian artery revascularization, aortic coverage, and cerebrospinal fluid drainage.īY KEAGAN WERNER-GIBBINGS, MS, FRACS, AND BIJAN MODARAI, P h D, FRCS
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |