Document Detail


Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. a study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry.
MedLine Citation:
PMID:  18154984     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Endovascular treatment of thoracic aortic disease may be associated with severe neurologic complications. The current study used the data of a multicenter registry to assess of the incidence and the risk factors for paraplegia or paraparesis and intracranial stroke.
METHODS: The European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) database prospectively enrolled 606 patients. Thoracic pathologies with urgent or elective presentation, which included degenerative aneurysm in 291, aortic dissection in 215, traumatic rupture in 67, anastomotic false aneurysm in 24, and infectious or nonspecified disorders in 9. Study end points included evidence of perioperative spinal cord ischemia (SCI) or stroke. Univariate analysis and multivariate regression models were used to assess the significance of clinical factors that potentially influenced the occurrence of neurological sequelae.
RESULTS: Paraplegia or paraparesis developed in 15 patients (2.5%) and stroke in 19 (3.1%); two patients had both complications. At multivariate regression analysis, independent correlation with SCI was observed for four factors: (1) left subclavian artery covering without revascularization (odds ratio [OR], 3.9; P = .027), (2) renal failure (OR, 3.6; P = .02), (3) concomitant open abdominal aorta surgery (OR, 5.5; P = .037) and (4) three or more stent grafts used (OR, 3.5; P = .043). In patients with perioperative stroke, two correlating factors were identified: (1) duration of the intervention (OR, 6.4; P = .0045) and (2) female sex (OR, 3.3; P = .023). A neurologic complication (paraplegia or stroke) developed in 8.4% of the patients in whom left subclavian covering was required compared with 0% of patients with prophylactic revascularization (P = .049).
CONCLUSION: Perioperative paraplegia or paraparesis was significantly associated with blockage of the left subclavian artery without revascularization. The clinical significance of this source of collateral perfusion of the spinal cord had not been confirmed previously. Intracranial stroke was associated with lengthy manipulation of wires, catheters, and introducer sheaths within the aortic arch, reflected by a longer duration of the procedure.
Authors:
Jacob Buth; Peter L Harris; Roel Hobo; Randolph van Eps; Philippe Cuypers; Lucien Duijm; Xander Tielbeek
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  46     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-12-24     Completed Date:  2008-02-07     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1103-1110; discussion 1110-1     Citation Subset:  IM    
Affiliation:
EUROSTAR Data Registry Center, Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. jaap.buth@cze.nl
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Aortic Aneurysm, Thoracic / epidemiology,  surgery*
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation / adverse effects*,  instrumentation
Cooperative Behavior
Europe / epidemiology
Female
Humans
Incidence
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Paraplegia / epidemiology,  etiology*
Paresis / epidemiology,  etiology*
Prospective Studies
Registries
Renal Insufficiency / complications
Risk Assessment
Risk Factors
Sex Factors
Spinal Cord Ischemia / epidemiology,  etiology*
Stents*
Stroke / epidemiology,  etiology*
Subclavian Artery / surgery
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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