Staged Endovascular Repair of Thoracoabdominal Aortic Aneurysms Does Not Confer Protection Against Spinal Cord Ischemia

Staged aortic aneurysm repair is one method used to decrease the risk of spinal cord ischemia (SCI) after endovascular intervention. Sequential sacrifice arteries perfusing spine might allow for improved perfusion through development collateral networks over time. To evaluate effect staging repairs on SCI, we conducted a conservative analysis Vascular Quality Initiative data. De-identified data were queried cases thoracic and thoracoabdominal from 2013 2018. Cases selected using following inclusion criteria: aneurysmal disease, no rupture, prior surgery, retreatment, complete zones SCI. The χ2, Student t, Mann-Whitney U tests univariable analysis, as appropriate. Logistic regression analyses identify independent predictors outcome. Of 1421 repairs, 116 staged (8.2%) fit study criteria. overall rate SCI within cohort was 3.4% (n = 48). distribution events according zone coverage are displayed in Table I. Patients who had undergone higher rates preoperative drain placement, non–African-American race, chronic obstructive pulmonary smoking history, positive stress tests, aspirin statin use, increased estimated blood loss, usage physician modified endografts, number covered, lower hemoglobin levels, larger sac size, fusiform aneurysms, longer total procedure times (Table II). After adjusting, priori, factors associated with P < .1 not (odds ratio [OR], 1.86; 95% confidence interval [CI], 0.77-4.50; .17). six time ≥6 hours (OR, 2.49; CI, 1.09-5.70; .031) covered 1.15; 1.00-1.32; .047) predictive In large national dataset, performed patients more extensive disease. only ∼8% cases, remained low. adjusting baseline comorbidities, extent other that potentiate SCI.Table IDistribution stratified by anatomy treatedAortic coverageSCIStaged repairSCI/staged repairArcha 30/28 (0)4/28 (14.3)0/4 (0)Arch 42/171 (1.2)10/171 (5.8)0/10 56/123 (4.9)9/123 (7.3)1/9 (11.1)Arch ABD0/51 (0)16/51 (31.4)0/16 (0)Zone 3 41/74 (1.4)0/74 (0)0/0 512/246 (4.9)10/246 (4.1)2/10 (20)Zone ABD7/87 (8)28/87 (32.2)2/28 (7.1)Zone 4 52/145 (1.4)2/145 (1.4)0/2 ABD10/117 (8.5)23/117 (19.7)2/23 (8.7)Zone 5 ABD8/379 (2.1)14/379 (3.7)1/13 (7.7)Total48/1421 (3.4)116/1421 (8.2)8/116 (6.9)Data presented number/Number (%).aArch indicates 0-2; ABD >5. Open table new tab IIDemographic, medication, procedural variables underwent repairsVariableNot stagedStaged repairP valueMale sex744/1305 (57.0)68/116 (58.6).737African American180/1305 (13.8)5/116 (4.3).004Diabetes239/1305 (18.3)17/116 (14.7).326Hypertension1143/1305 (87.6)104/116 (89.7).515COPD480/1305 (36.8)58/116 (50.0).005Smoking history1055/1305 (80.8)104/116 (89.7).019Congestive heart failure175/1305 (13.4)16/116 (13.8).908Coronary artery disease301/1305 (23.1)35/116 (30.2).084Positive test527/1304 (40.4)59/116 (50.9).028Cerebrovascular disease165/1420 (12.7)18/116 (15.5).378Symptomatic presentation329/1304 (25.2)26/116 (22.4).502Fusiform sac887/1265 (70.1)101/116 (87.1)<.001Aspirin775/1305 (59.4)85/116 (73.3).003Statin834/1304 (64.0)90/116 (77.6).003Beta-blocker817/1304 (62.7)77/116 (66.4).426Preoperative drain561/1303 (43.1)68/116 (58.6).001Physician endograft347/1305 (26.6)68/116 (58.6)<.001LSCA occluded intraoperatively74/366 (20.2)7/40 (17.5).683SCI40/1305 (3.1)8/116 (6.9) Permanent27/1305 (2.1)3/116 (2.6).029 Transient13/1305 (1.0)5/116 (4.3).009Age, years72.2 ± 1072.0 8.831eGFR, mL/min/1.73 m270.2 2666.1 26.115Hemoglobin, g/dL12.7 212.0 2.002Maximum diameter, mm60.8 1365.0 11<.001Procedure time, hours3.1 23.5 2.062Estimated mL327 630362 459.300Zones no.3.4 2.25.7±2.7<.001COPD, Chronic disease; eGFR, glomerular filtration rate; LSCA, left subclavian artery; ischemia.Data (%).