Thorac Cardiovasc Surg 2019; 67(05): 379-384
DOI: 10.1055/s-0038-1642611
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Benefits and Risks of Prophylactic Cerebrospinal Fluid Catheter and Evoked Potential Monitoring in Symptomatic Spinal Cord Ischemia Low-Risk Thoracic Endovascular Aortic Repair

Sven Maier
1  Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany
2  Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Maria Shcherbakova
1  Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany
2  Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Friedhelm Beyersdorf
1  Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany
2  Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Christoph Benk
1  Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany
2  Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Fabian Alexander Kari
1  Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany
2  Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Matthias Siepe
1  Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany
2  Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Martin Czerny
1  Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany
2  Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Bartosz Rylski
1  Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany
2  Faculty of Medicine, University of Freiburg, Freiburg, Germany
› Author Affiliations
Further Information

Publication History

11 December 2017

09 March 2018

Publication Date:
01 May 2018 (online)

Abstract

Background To assess risks and benefits of a standardized strategy to prevent symptomatic spinal cord ischemia (SSCI) after thoracic endovascular repair (TEVAR) using routine cerebrospinal fluid (CSF) catheter placement and evoked potential (EP) monitoring.

Methods One hundred and ninety-five patients underwent 223 SSCI low-risk TEVAR procedures between 1998 and 2014. CSF catheter was used to measure CSF pressure and drain CSF if necessary throughout the procedure and up to 24 hours thereafter. EPs were used to monitor spinal cord integrity throughout the procedure.

Results Underlying pathologies included descending thoracic aortic aneurysm in 115 (52%), type B aortic dissection in 85 (38%), traumatic aortic rupture in 16 (7%), and others in 7 (3%) patients. CSF catheter was inserted before TEVAR in 116 procedures (52%). Active CSF draining was required in 29 patients (25%). The CSF catheter caused no major and 11 (10%) minor complications. EP were monitored during 88 (40%) procedures. We observed a reduction in the amplitude, prolonged latencies, or complete signal loss in nine procedures. There were no EP monitoring-related complications. SSCI incidence was higher in patients without CSF drainage (0.8% vs 4.7%, p = 0.031).

Conclusion Use of CSF drainage is associated with a significant lower incidence of SSCI after SSCI low-risk TEVAR than nonuse, whereas the complication rate associated with CSF drainage insertion or removal is very low. Routine EP monitoring is a useful tool to detect immediate arterial inflow obstruction to the spinal cord. The combination of these two methods serves as a safe and reliable standardized strategy in reducing the incidence of SSCI to a minimum.