Spinal Cord Ischemia Following Simultaneous Evar And Tevar For Concomitant Thoracic And Abdominal Aortic Aneurysms
Allan M. Conway, MD1, Rohan Sampat2, Nhan T. Nguyen Tran1, Deanna Schreiber-Gregory, MS1, Donna Bahroloomi, MD1, Khalil Qato, MD1, Gary Giangola, MD1, Alfio Carroccio, MD1.
1Lenox Hill Hospital, New York, NY, USA, 2Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
OBJECTIVES: In patients with abdominal aortic aneurysms, 10-20% have concomitant thoracic aortic pathologies. These are typically managed with staged endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) due to a perceived higher risk of spinal cord ischemia from a simultaneous intervention. We aimed to determine the outcomes of patients undergoing simultaneous EVAR and TEVAR for concomitant aneurysms. METHODS: A retrospective cohort study was performed using the Vascular Quality Initiative registry from December 2003 to January 2021. Patients undergoing same-day EVAR and TEVAR were included and analyzed in accordance with the Society for Vascular Surgery reporting standards. Primary outcomes were technical success and spinal cord ischemia. RESULTS: Simultaneous EVAR and TEVAR was performed in 25 patients. Mean age was 72.2 years (±10.6), and 20 (80.0%) patients were male. Two (4.0%) patients were symptomatic and four (16.0%) presented with rupture. Maximum infrarenal and thoracic aortic diameter was 60.9mm (±17.1) and 60.5mm (±19.0) respectively. Infrarenal aortic neck length was 16.5mm (±10.1), and diameter was 27.2mm (±3.1). Median procedure time was 185.0 minutes (IQR, 117.8-251.3), fluoroscopy time 32.7 minutes (IQR, 21.8-63.1), and contrast volume 165 ml (IQR, 115-207). There were three (12.0%) Type Ia endoleaks and three (12.0%) Type II endoleaks in EVAR’s, with one (4.0%) Type Ia and one (4.0%) Type II endoleak in TEVARs. In-hospital mortality occurred in three (12.0%) patients (one elective, two ruptures). Spinal cord ischemia occurred in one (4.0%) patient. This patient had a symptomatic aneurysm. Thoracic coverage extended from Zone 4 to Zone 5 and an emergent spinal drain was placed postoperatively. Symptoms were present on discharge. There was one (4.0%) conversion to open repair which occurred in a ruptured aneurysm. Technical success was achieved in 19 (76.0%) patients, however when excluding ruptured aneurysms, was achieved in 17 (81.0%) patients. Follow-up data was available for 19 (76.0%) patients at a mean of 439.2 (±135.4) days postoperatively. A total of 3 (12.0%) patients died during the late mortality period, at a mean of 509.0 (±503.7) days. Mean change in abdominal and thoracic aortic sac diameter was -4.3mm (±9.9) and 1.9mm (±18.7) respectively. CONCLUSIONS: Simultaneous EVAR and TEVAR for concomitant abdominal and thoracic aortic aneurysms can be performed with low rates of spinal cord ischemia. Short- and mid-term outcomes are acceptable.
Back to 2022 ePosters