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Early experience with automatic pressure-controlled cerebrospinal fluid drainage during thoracic endovascular aortic repair

Purpose: to report initial experience with automatic pressure-controlled cerebrospinal fluid drainage (CSFD) during thoracic endovascular aortic repair (TEVAR). Methods: A prospective nonrandomized study enrolled 30 consecutive patients (median age 68 years, range 42-89; 18 men) who underwent TEVAR...

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Hauptverfasser: Kotelis, Drosos (VerfasserIn) , Müller, Thomas (VerfasserIn) , Bischoff, Moritz (VerfasserIn) , Böckler, Dittmar (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: April 10, 2015
In: Journal of endovascular therapy
Year: 2015, Jahrgang: 22, Heft: 3, Pages: 368-372
ISSN:1545-1550
DOI:10.1177/1526602815579904
Online-Zugang:Verlag, Volltext: http://dx.doi.org/10.1177/1526602815579904
Verlag, Volltext: http://journals.sagepub.com/doi/abs/10.1177/1526602815579904
Volltext
Verfasserangaben:Drosos Kotelis, MD, Claudio Bianchini, MD, Bence Kovacs, MD, Thomas Müller, MD, Moritz Bischoff, MD, and Dittmar Böckler, MD

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520 |a Purpose: to report initial experience with automatic pressure-controlled cerebrospinal fluid drainage (CSFD) during thoracic endovascular aortic repair (TEVAR). Methods: A prospective nonrandomized study enrolled 30 consecutive patients (median age 68 years, range 42-89; 18 men) who underwent TEVAR between March 2012 and July 2013 and were considered to be at high risk for postoperative spinal cord ischemia (SCI), fulfilling 2 of the following criteria: stent-graft length >20 cm, left subclavian artery coverage, and previous infrarenal aortic repair. All patients received perioperative CSFD via the LiquoGuard system. The protocol aimed for a CSF pressure of 10 mm Hg and duration of CSFD of 3 or 7 days in asymptomatic or symptomatic patients, respectively. Muscle strength of the lower extremities was assessed with the Oxford muscle strength grading scale. Results: Completion of the CSFD protocol was achieved in 26 (87%) of 30 patients. CSFD was prematurely stopped due to catheter dislocation in 1 patient and bloody spinal fluid in 3 patients. CSFD was performed for a median of 3 days (range 1-7). Median total CSFD volume was 714 mL (range 13-2369), with a median 192 mL drained per 24 hours. The SCI rate was 3% (1/30). CSFD-related complications were observed in 33% of the patients: 1 fatal intracranial hemorrhage, 3 bloody spinal fluid episodes, 3 persistent CSF leaks requiring epidural blood patch, and 3 post lumbar puncture headaches. Mortality during a median follow-up of 16 months (range 10-25) was 3% (1/30). Conclusion: Prophylactic CSFD was associated with a low SCI rate in a high-risk patient collective undergoing TEVAR. Monitoring and drainage by an automatic modus was feasible, reproducible, and reliable but associated with relevant drainage-associated complications. 
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