Objective: 

To assess outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) of Extent I-III thoracoabdominal aortic aneurysms (TAAAs) without prophylactic cerebrospinal fluid drainage (CSFD).

Background: 

Prophylactic CSFD has been routinely used during endovascular TAAA repair, but concerns about major drain-related complications gave led to revising this paradigm.

Methods: 

We reviewed a multicenter cohort of 541 patients treated for Extent I-III TAAAs by FB-EVAR without prophylactic CSFD. Spinal cord injury (SCI) was graded as ambulatory (paraparesis) or non-ambulatory (paraplegia). Endpoints were any SCI, permanent paraplegia, response to rescue treatment, major drain-related complications, mortality, and patient survival.

Results: 

There were 22 Extent I, 240 Extent II and 279 Extent III TAAAs. Thirty-day mortality was 3%. SCI occurred in 45 patients (8%), paraparesis occurring in 23 (4%) and paraplegia in 22 patients (4%). SCI was more common in patients with Extent I-II compared to Extent III TAAAs (12% vs. 5%, P=0.01). Rescue treatment included permissive hypertension in all patients, with CSFD in 22 (4%). Symptom improvement was noted in 73%. Twelve patients (2%) had permanent paraplegia. Two patients (0.4%) had major drain-related complications. Independent predictors for SCI by multivariate logistic regression were sustained peri-operative hypotension (OR 4.4, 95% CI 1.7-11.1), patent collateral network (OR 0.3, 95% CI 0.1-0.6), and total length of aortic coverage (OR 1.05, CI 95% 1.01-1.10). Patient survival at 3-years was 72±3%.

Conclusion: 

FB-EVAR of Extent I-III TAAAs without CSFD has low mortality and low rates of permanent paraplegia (2%). SCI occurred in 8% of patients, and rescue treatment improved symptoms in 73% of them.

中文翻译：

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评估不进行预防性脑脊液引流的 I-III 级胸腹动脉瘤血管内修复的多中心研究

客观的： 

评估无预防性脑脊液引流 (CSFD) 的 I-III 级胸腹主动脉瘤 (TAAA) 开窗分支主动脉腔内修复 (FB-EVAR) 的结果。

背景： 

预防性 CSFD 已在血管内 TAAA 修复过程中常规使用，但对主要引流相关并发症的担忧导致了对这一范例的修改。

方法： 

我们回顾了一个由 541 名患者组成的多中心队列，这些患者接受 FB-EVAR 治疗，未接受预防性 CSFD，接受 I-III 级 TAAA 治疗。脊髓损伤（SCI）被分级为可行走（截瘫）或不可行走（截瘫）。终点包括任何 SCI、永久性截瘫、抢救治疗的反应、主要引流相关并发症、死亡率和患者生存率。

结果： 

共有 22 个 Extent I、240 个 Extent II 和 279 个 Extent III TAAA。三十天死亡率为 3%。45 名患者 (8%) 发生 SCI，23 名患者 (4%) 发生截瘫，22 名患者 (4%) 发生截瘫。与程度 III 的 TAAA 患者相比，程度 I-II 的患者 SCI 更为常见（12% vs. 5%，P =0.01）。所有患者均接受了允许性高血压的挽救治疗，其中 22 名患者（4%）患有 CSFD。73% 的人症状得到改善。12 名患者 (2%) 患有永久性截瘫。两名患者 (0.4%) 出现严重的引流相关并发症。多变量 Logistic 回归对 SCI 的独立预测因素包括围手术期持续低血压（OR 4.4，95% CI 1.7-11.1）、专利侧支网络（OR 0.3，95% CI 0.1-0.6）和主动脉覆盖总长度（OR 1.05） ，CI 95% 1.01-1.10）。患者 3 年生存率为 72±3%。

结论： 

没有 CSFD 的 I-III 级 TAAA 的 FB-EVAR 死亡率低，永久性截瘫发生率低（2%）。8% 的患者发生 SCI，抢救治疗后 73% 的患者症状得到改善。