Retrospective analysis of Paralysis/Paraparesis post-aortic aneurysm endovascular repair

ABSTRACT

Objective

Spinal cord ischemia (SCI) is a potentially devastating complication of thoracic and thoraco-abdominal endovascular aortic repair (TEVAR and TAEVAR) that can result in varying degrees of short-term and permanent disability. This study was undertaken to evaluate the incidence, investigate the risk factors of SCI, and describe the clinical outcomes, reversibility, long-term functional impact, and influence on survival of SCI

Methods

This study employed a retrospective design to investigate patients who underwent TEVAR and TAEVAR successfully within the past 11 years between January 2012 and June 2022 in a single center. The analysis focused on factors such as incidence, personal history, and detailed assessment of medical and surgical risk factors. Data was retrieved from medical records. SCI was defined by any new lower neurologic deficit not attributable to another cause and diagnosed through clinical examination immediately after emergence from anesthesia and frequently postoperatively, as well as during follow-up outpatient clinic visits.

Results

A total of 137 patients were enrolled in the study. Among them, 15 patients developed lower limb paralysis with an incidence of 10.95%, three patients (20.1%) developed paralysis immediately postoperatively, and five patients (33.3%) developed paralysis on day 1 postoperatively (33.3%). Furthermore, the remaining patients experienced delayed onset paralysis, with the most recent case occurring 26 days after the operation. In terms of reversibility, nine patients had complete reversal of their motor and sensory symptoms to the baseline preoperative status. Two patients experienced a partial reversal of their symptoms, and four patients had persistent symptoms without any improvement. Data showed that 12 out of 81 patients (14.8%) who had functioning spinal drains developed paralysis. The duration of the procedure was the most significant risk factor for paralysis. Patients with a mean duration of 270 min had a higher risk of paralysis.

Conclusion

Prediction of paralysis post-TEVAR and TAEVAR remains challenging, with data analysis indicating that the duration of the procedure is the sole statistically significant variable to consider.

KEYWORDS:

• Spinal cord injury
• paralysis
• TEVAR
• lumbar drains
• risk factors
• duration of the procedure

List of abbreviation

CHF	=	Congestive heart failure
COPD	=	Chronic obstructive pulmonary disease
GFR	=	Glomerular filtration rate
HB	=	Hemoglobin
IHD	=	Ischemic heart disease
MAP	=	Mean arterial pressure
TAEVAR	=	Thoraco-abdominal endovascular aortic repair
TEVAR	=	Thoracic endovascular aortic repair

Acknowledgments

We express our gratitude to all subjects involved in the current study.

Disclosure statement

The authors report no competing interests to declare.