Extended Aortic Coverage in Thoracic Aortic Endovascular Repair is not associated with Spinal Cord Ischemia

P0133 

Abstract Submission 

George Chachati (1), James Brown (2), Sarah Yousef (3), Nishant Agrawal (2), Shwetabh Tarun (3), Kristian Punu (4), Derek Serna-Gallegos (5), Ibrahim Sultan (5)

(1) UPMC Central PA, Harrisburg, PA, (2) UPMC, Pittsburgh, PA, (3) University of Pittsburgh, Pittsburgh, PA, (4) N/A, N/A, (5) University of Pittsburgh Medical Center, Pittsburgh, PA

George Chachati    -  Contact Me
UPMC Central PA

James Brown    -  Contact Me
UPMC

Sarah Yousef    -  Contact Me
University of Pittsburgh

Nishant Agrawal    -  Contact Me
UPMC

Shwetabh Tarun    -  Contact Me
University of Pittsburgh

Kristian Punu    -  Contact Me
N/A

Derek Serna-Gallegos    -  Contact Me
University of Pittsburgh Medical Center

*Ibrahim Sultan    -  Contact Me
University of Pittsburgh Medical Center

George Chachati    -  Contact Me
UPMC Central PA

Objective: Spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) continues to be a debilitating complication occurring in 10% of patients. Studies have shown that extended aortic coverage is a risk factor for SCI. This study evaluates if extended aortic length coverage is a significant risk factor for spinal cord ischemia.

Methods: This study retrospectively reviewed 277 consecutive patients who underwent TEVAR successfully between 2006 and 2021 at a single institution. Patients with TEVAR were classified into two groups: greater or less than 205mm of thoracic aortic coverage. Analysis of variance was conducted comparing these variables and associated aortic coverage.

Results: A total of 269 patients underwent successful TEVAR. Of those, 127 (47.2%) had greater than 205mm of thoracic aorta covered while 142 (52.8%) did not. Patients who had greater aortic coverage were more likely to be smokers (p< 0.01) and have previous strokes (p< 0.05). Patients who received extended coverage were more likely to receive a pre-operative lumbar drain (p< 0.01). Extended aortic coverage was not associated with higher risk of spinal cord ischemia compared to standard aortic coverage (4.7% vs 4.2%, p=0.84). On sub-analysis of descending thoracic aneurysms, rapid growth (>10mm/yr) [9.15% vs 23.62%, p=0.0012] and urgency (24-48 hrs of presentation) [23.94% vs 35.43%, p=0.038] were noted to be statistically higher in the extended aortic cohort group Type II endoleaks were seen more in extended aortic coverage (p< 0.01).

Conclusion: Extended aortic coverage (compared with the standard approach) was not associated with higher risk of spinal cord ischemia; however, this may have been mitigated by this population's higher prevalence of prophylactic lumbar drainage.

Spinal Cord Protection