SPINAL CORD ISCHEMIA (SCI) after thoracoabdominal aortic repair is a well-known complication
of both open and endovascular surgery, with reported rates as high as 5%-to-21% after
open repair.
1
Resultant morbidity, including paraparesis and paraplegia, are devastating, and a
fair amount of research has gone into developing strategies for mitigating SCI-related
complications. Cerebrospinal fluid drainage (CSFD) with the placement of lumbar drains
(LDs) is considered the current recommendation for both prevention and treatment of
SCI in high-risk patients.
2
,3
While there is some controversy over the utility of CSFD for endovascular repairs,
it is still a widely accepted practice that is performed frequently for patients at
high risk of developing SCI postrepair.
- Hiratzka LF
- Bakris GL
- Beckman JA
- et al.
2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management
of patients with thoracic aortic disease: a report of the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines, American
Association for Thoracic Surgery, American College of Radiology, American Stroke Association,
Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography
and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,
and Society for Vascular Medicine.
Circulation. 2010; 121: e266-e369
4
Protocols regarding the placement of LDs can vary by institution, whereby some centers
may routinely use imaging guidance for the procedure. In this review, the authors
examine the specifics of using fluoroscopic guidance for the preoperative placement
of LDs in patients who are at a high risk of developing SCI after thoracoabdominal
aortic repair. It is the authors’ belief that the universal use of fluoroscopic guidance
is unnecessary, potentially harmful, confers additional expense, and is unsupported
by the current body of evidence.Key Words
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Published online: September 29, 2022
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