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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
REVIEWS THORACIC AND ABDOMINAL AORTIC ANEURYSMS CHALLENGES
Italian Journal of Vascular and Endovascular Surgery 2007 September;14(3):221-9
Spinal cord injury and stroke following thoracic endovascular aortic repair: a risk analysis and review of the literature
Khoynezhad A., Upadhyaya P., Kruse M. J.
Section of Cardiovascular and Thoracic Surgery University of Nebraska Medical Center, Omaha, NE, USA
Thoracic endovascular aortic repair (TEVAR) is a promising treatment modality for various thoracic aortic pathologies. Although long-term follow-up studies on durability of the stent grafts are yet to be established, the advantages in the short-term include shorter hospital stay, avoidance of lengthy invasive procedures, and decreased anesthesia time. It has allowed treatment of elderly patients with coexisting comorbidities who otherwise would be difficult candidates for open surgery. However, specific complications such as spinal cord injury and stroke still exist. The aim of this study is to review the literature on neurologic deficit after TEVAR along with the results of an internal survey of risk factors of TEVAR. A detailed literature search was performed along with internal review and risk analysis of spinal cord injury and stroke after TEVAR. TEVAR is associated with significant risk of paraplegia, paraparesis and stroke. The overall incidence of spinal cord injury seems to be reduced when compared to open repair, while the incidence of stroke is not significantly less than open repair. The pathogenesis of spinal cord injury and stroke after TEVAR are discussed. A number of risk factors were identified that are associated with increased spinal cord injury and stroke after TEVAR. Furthermore, strategies that may reduce incidence of neurological complications after TEVAR were discussed.