PER THE SOCIETY for Vascular Surgery clinical guidelines, use of cerebrospinal fluid
drains (CSFDs) should be considered for appropriately-selected patients undergoing
extensive aortic repair.
1
Use of CSFDs enhances spinal cord perfusion pressure, thus ameliorating the detrimental
effects in vulnerable watershed regions caused by the surgical reduction in blood
supply, and thereby preventing devastating spinal cord ischemia (SCI). It is important
to note that patients who experience SCI after aortic repairs have significantly worse
long-term survival than those without this complication. More importantly, patients
who have a return of neurologic function after SCI can anticipate similar life expectancy
compared to those without SCI. There is plenty of evidence suggesting that prophylactic
use of CSFDs in selected high-risk patients undergoing aortic repairs reduces the
incidence of postoperative SCI.
2
A recent meta-analysis that included 3,561 patients from 34 studies, demonstrated
a lower incidence of SCI when CSFDs were placed routinely, as opposed to use only
in patients meeting specified criteria.
3
Hence, the use of CSFDs will be warranted in selected patients undergoing aortic
repairs who are at a high risk of SCI.
4
Although CSFDs are an essential tool in the prevention of SCI caused by the surgery,
CSFD placement is not without risk. Rong et al. published a meta-analysis that included
4,714 patients across 34 studies who underwent open and endovascular aortic repairs
with CSFDs.
5
This analysis focused on CSFD-related complications, with a 6.5% rate of pooled events,
2.5% of which represented severe complications, including epidural hematoma, intracranial
hemorrhage, subarachnoid hemorrhage, meningitis, and/or catheter-related neurologic
deficit. Risk factors for increased technical difficulty or even failed CSFD placement
included atypical anatomy, such as from prior lumbar spine surgery, osteoarthritis
or scoliosis, and poor surface landmarks, as can occur with a higher body mass index.
6
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Published online: September 29, 2022
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