Effect of Lumbar Drainage on the Outcome of Thoracic Endovascular Aortic Repair (TEVAR): Contemporary Results
Background: Despite the utmost development and arousal of new techniques as TEVAR in the management of lethal aortic aneurysms and dissecting aortic aneurysms using, we still need to optimize the results through better spinal cord protection for the possible intercostal arteries especially the Adamqiewckz artery. Here we are focusing on the impact of spinal cord protection on the outcome in cases of TEVAR.
Materials and methods: Between May 2007 and May 2017; in Saudi German Hospital (SGH); Madina Munawarah, KSA and central clinic in Bad Berka; Germany. 41 TEVAR procedures were performed. Medtronic Valiant device with the Captiva delivery system was recently used to manage variety of cases of aortic dissection (6 trauma cases, 27 cases of hypertension induced nonaneurysmal dissection , 6 cases of dissecting aortic aneurysms due to hypertension and 2 cases of descending aortic aneurysm and tortuousity). Some of the cases required vascular intervention for de-branching of the great vessels. All patients were submitted to CT angio (CTA) for whole aorta from the ascending to the pelvic part, trans-sternal 2D echocardiography, abdominal ultrasonography; coagulation profile, kidney and liver profiles. Lumbar drainage was used in all the cases. Medtronic devices were used in all the cases.
Results: All patients were males. Age ranged from 24 to 57 years old. All patients were operated under general anesthesia. There were two mortalities one due to major endoleak and multi-organ failure and the other was due to massive Intracranial Hemorrhage (ICH). Three cases of permanent paraplegia early after the procedure. Three cases of renal failure and one impaired kidney functions. One patient had CSF leak. One case had local infection at the lumbar catheter site and one case of meningitis.
Conclusions: Lumbar drainage procedure is an easy but not complications-free procedure. Because of the seriousness of its complications, it is recommended to avoid in TEVAR procedures, as the paraplegia complication due to cord ischemia for which we used the lumbar drainage was unavoidable by the lumbar drainage as it was related mainly to the anatomical site of the aortic injury and its extent or to the area covered by the endograft. There was a mortality of ICH (mostly related to the lumbar drainage).