|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.|
|PMID: 18154984 Owner: NLM Status: MEDLINE|
|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.
|Jacob Buth; Peter L Harris; Roel Hobo; Randolph van Eps; Philippe Cuypers; Lucien Duijm; Xander Tielbeek|
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|Type: Journal Article; Multicenter Study|
|Title: Journal of vascular surgery Volume: 46 ISSN: 0741-5214 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2007 Dec|
|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|
|Languages: eng Pagination: 1103-1110; discussion 1110-1 Citation Subset: IM|
|EUROSTAR Data Registry Center, Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. email@example.com|
|APA/MLA Format Download EndNote Download BibTex|
Aged, 80 and over
Aortic Aneurysm, Thoracic / epidemiology, surgery*
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation / adverse effects*, instrumentation
Europe / epidemiology
Paraplegia / epidemiology, etiology*
Paresis / epidemiology, etiology*
Renal Insufficiency / complications
Spinal Cord Ischemia / epidemiology, etiology*
Stroke / epidemiology, etiology*
Subclavian Artery / surgery
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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