Spinal cord ischemia after TEVAR in patients with abdominal aortic aneurysms

Objective: To examine the incidence of and the anatomic factors that may contribute to spinal cord ischemia (SCI) in patients with a history of abdominal aortic aneurysms (AAA) after thoracic endovascular aortic repair (TEVAR). Methods: The medical records, computed tomography (CT) angiograms, and a prospectively maintained clinical database of all TEVAR patients at a single institution between 2000 and 2007 were reviewed. Select preoperative demographics, thoracoabdominal aortoiliac anatomy, intraoperative procedural variables, and postoperative outcomes were examined. Univariate and multivariate analyses were performed and odds ratio estimates were reported with 95% confidence intervals. Results: Of the 261 patients who underwent TEVAR, 27 developed SCI (10%). Thirteen (48%) of these 27 patients were completely reversed with spinal drainage, and 14 (52%) were permanent. Patients with SCI tended to be older (P=.006), male (P=.049), and required more emergent procedures (P=.051) performed under general anesthesia (P=.004). Interestingly, while prior AAA repair (50/261, 19%) alone was not associated with SCI (P=.44), a history of either repaired or unrepaired AAA (101/261, 39%) was a predictor of SCI on multivariate analysis (odds ratio [OR] = 4.35 [1.43, 14.3], P=.10), independent of thoracic aortic coverage (P=.001) and lumbar artery patency (P=.008), both of which were also associated with SCI. Conclusion: Although the causes of SCI after TEVAR are multifactorial, abdominal aortic anatomy appears to be associated with development of this complication. Patients with either prior AAA repair or those with unrepaired AAA appear to be at increased risk for SCI. (J Vase Surg 2009;49:302-7.)