| Mechanisms of Symptomatic Spinal Cord Ischemia After TEVAR: Insights From the European Registry of Endovascular Aortic Repair Complications (EuREC). | |
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MedLine Citation:
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PMID: 22313200 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Abstract Purpose: To test the hypothesis that simultaneous closure of at least 2 independent vascular territories supplying the spinal cord and/or prolonged hypotension may be associated with symptomatic spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR). Methods: A pattern matching algorithm was used to develop a risk model for symptomatic SCI using a prospective 63-patient single-center cohort to test the positive predictive value (PPV) of prolonged intraoperative hypotension and/or simultaneous closure of at least 2 of 4 the vascular territories supplying the spinal cord (left subclavian, intercostal, lumbar, and hypogastric arteries). This risk model was then applied to data extracted from the multicenter European Registry on Endovascular Aortic Repair Complications (EuREC). Between 2002 and 2010, the 19 centers participating in EuREC reported 38 (1.7%) cases of symptomatic spinal cord ischemia among the 2235 patients in the database. Results: In the single-center cohort, direct correlations were seen between the occurrence of symptomatic SCI and both prolonged intraoperative hypotension (PPV 1.00, 95% CI 0.22 to 1.00, p = 0.04) and simultaneous closure of at least 2 independent spinal cord vascular territories (PPV 0.67, 95% CI 0.24 to 0.91, p = 0.005). Previous closure of a single vascular territory was not associated with an increased risk of symptomatic spinal cord ischemia (PPV 0.07, 95% CI 0.01 to 0.16, p = 0.56). The combination of prolonged hypotension and simultaneous closure of at least 2 territories exhibited the strongest association (PPV 0.75, 95% CI 0.38 to 0.75, p<0.0001). Applying the model to the entire EuREC cohort found an almost perfect agreement between the predicted and observed risk factors (kappa 0.77, 95% CI 0.65 to 0.90). Conclusion: Extensive coverage of intercostal arteries alone by a thoracic stent-graft is not associated with symptomatic SCI; however, simultaneous closure of at least 2 vascular territories supplying the spinal cord is highly relevant, especially in combination with prolonged intraoperative hypotension. As such, these results further emphasize the need to preserve the left subclavian artery during TEVAR. |
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Authors:
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Martin Czerny; Holger Eggebrecht; Gottfried Sodeck; Fabio Verzini; Piergiorgio Cao; Gabriele Maritati; Vicente Riambau; Friedhelm Beyersdorf; Bartosz Rylski; Martin Funovics; Christian Loewe; Jürg Schmidli; Piergiorgio Tozzi; Ernst Weigang; Toru Kuratani; Ugolino Livi; Giampiero Esposito; Santi Trimarchi; Jos C van den Berg; Weiguo Fu; Roberto Chiesa; Germano Melissano; Luca Bertoglio; Lars Lonn; Ingrid Schuster; Michael Grimm |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists Volume: 19 ISSN: 1545-1550 ISO Abbreviation: J. Endovasc. Ther. Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-02-08 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100896915 Medline TA: J Endovasc Ther Country: United States |
Other Details:
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Languages: eng Pagination: 37-43 Citation Subset: IM |
Affiliation:
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1 Department of Cardiovascular Surgery, Inselspital, University Hospital Berne, Switzerland. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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