Spinal Cord Ischemia Following Endovascular Repair of Descending Thoracic Aneurysms And Dissections

Carlos E. Doanyre, MD, Surgery / Division Vasculr Surgery, Harbor / UCLA, Torrance, CA; Tae Song, MD, Torrance, CA; Irwin Walot, MD, Torrance, CA; Rodney A. White, MD, Torrance, CA;

Purpose Open repair of descending thoracoabdominal aneurysms (TAA) and dissections (TAD) are associated with significant risk of spinal cord ischemia. Endoluminal repair of TAA and TAD carries the same risk but appears to occur with a lower incidence. This study reviews the occurrence of spinal cord ischemia after endovascular repair at a single medical center.
Methods CT scans, angiograms and medical records of 140 patients who underwent repair of a descending TAA (n=85), TAD (n=49) or transected aorta (n=6) from October 1998 to May 2004 were reviewed.
Results Seven patients (3 males, 4 females) with an average age of 75.7 years (59-86 years) developed spinal cord ischemia. Five had a TAA and 2 a TAD. Paralysis developed immediately in four, and at 16, 25 and 82 hours in the remaining three.

All were treated with CSF drainage after the onset of paralysis, 2 regained normal function, 2 ambulate with walkers, and 3 remained paralyzed.
Conclusions Paraplegia rate following endovascular repair of TAA and TAD has an incidence of 5%, and is associated with the presence of AAA disease and need of conduits for access. However, permanent paralysis occurred in only 2%.