Multicenter Study to Evaluate Endovascular Repair of Extent I-III Thoracoabdominal Aneurysms Without Prophylactic Cerebrospinal Fluid Drainage.

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dc.contributor.authorMarcondes, Giulianna B
dc.contributor.authorCirillo-Penn, Nolan C
dc.contributor.authorTenorio, Emanuel R
dc.contributor.authorAdam, Donald J
dc.contributor.authorTimaran, Carlos
dc.contributor.authorAustermann, Martin J
dc.contributor.authorBertoglio, Luca
dc.contributor.authorJakimowicz, Tomasz
dc.contributor.authorPiazza, Michele
dc.contributor.authorJuszczak, Maciej T
dc.contributor.authorScott, Carla K
dc.contributor.authorBerekoven, Bärbel
dc.contributor.authorChiesa, Roberto
dc.contributor.authorLima, Guilherme B B
dc.contributor.authorJama, Katarzyna
dc.contributor.authorSquizzato, Francesco
dc.contributor.authorClaridge, Martin
dc.contributor.authorMendes, Bernardo C
dc.contributor.authorOderich, Gustavo S
dc.contributor.departmentVascular and General Surgeryen_US
dc.contributor.roleMedical and Dentalen_US
dc.contributor.trustauthorAdam, Donald, J
dc.date.accessioned2023-09-26T09:59:10Z
dc.date.available2023-09-26T09:59:10Z
dc.date.issued2022-08-04
dc.description.abstractObjective: 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 have 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 nonambulatory (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 with 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 perioperative hypotension [odds ratio (OR): 4.4, 95% confidence interval (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, 95% CI: 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.en_US
dc.identifier.citationMarcondes GB, Cirillo-Penn NC, Tenorio ER, Adam DJ, Timaran C, Austermann MJ, Bertoglio L, Jakimowicz T, Piazza M, Juszczak MT, Scott CK, Berekoven B, Chiesa R, Lima GBB, Jama K, Squizzato F, Claridge M, Mendes BC, Oderich GS; Trans-Atlantic Aortic Research Consortium Investigators. Multicenter Study to Evaluate Endovascular Repair of Extent I-III Thoracoabdominal Aneurysms Without Prophylactic Cerebrospinal Fluid Drainage. Ann Surg. 2023 Aug 1;278(2):e396-e404. doi: 10.1097/SLA.0000000000005653. Epub 2022 Aug 4. PMID: 35925761.en_US
dc.identifier.doi10.1097/SLA.0000000000005653
dc.identifier.eissn1528-1140
dc.identifier.pmid35925761
dc.identifier.urihttp://hdl.handle.net/20.500.14200/2286
dc.language.isoenen_US
dc.publisherLippincott, Williams & Wilkinsen_US
dc.relation.urlhttps://journals.lww.com/annalsofsurgery/abstract/2023/08000/multicenter_study_to_evaluate_endovascular_repair.48.aspxen_US
dc.rightsCopyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
dc.source.beginpagee396
dc.source.countryUnited States
dc.source.endpagee404
dc.source.issue2
dc.source.journaltitleAnnals of Surgery
dc.source.volume278
dc.subjectSurgeryen_US
dc.titleMulticenter Study to Evaluate Endovascular Repair of Extent I-III Thoracoabdominal Aneurysms Without Prophylactic Cerebrospinal Fluid Drainage.en_US
dc.typeArticle
dspace.entity.typePublication
oa.grant.openaccessnaen_US
rioxxterms.versionNAen_US
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