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J Thorac Cardiovasc Surg. 2014 Oct;148(4):1435-1442.e1. doi: 10.1016/j.jtcvs.2014.02.062. Epub 2014 Feb 26.

Spinal cord ischemia after simultaneous and sequential treatment of multilevel aortic disease.

Author information

1
Vascular Surgery, Department of Surgery and Morphological Sciences Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy. Electronic address: gabriele.piffaretti@uninsubria.it.
2
Vascular Surgery, Department of Surgery, Spedali Civili Hospital, University of Brescia School of Medicine, Brescia, Italy.
3
Vascular Surgery, Cardiovascular Department, Poliambulanza Foundation, Brescia, Italy.
4
Cardiac Surgery, Department of Surgery and Morphological Sciences Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy.
5
Thoracic Aortic Research Center, IRCCS Policlinio San Donato, San Donato Milanese, Milan, Italy.
6
Vascular Surgery, Department of Surgery and Morphological Sciences Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy.

Abstract

OBJECTIVES:

The aim of the present study is to report a risk analysis for spinal cord injury in a recent cohort of patients with simultaneous and sequential treatment of multilevel aortic disease.

METHODS:

We performed a multicenter study with a retrospective data analysis. Simultaneous treatment refers to descending thoracic and infrarenal aortic lesions treated during the same operation, and sequential treatment refers to separate operations. All descending replacements were managed with endovascular repair.

RESULTS:

Of 4320 patients, multilevel aortic disease was detected in 77 (1.8%). Simultaneous repair was performed in 32 patients (41.5%), and a sequential repair was performed in 45 patients (58.4%). Postoperative spinal cord injury developed in 6 patients (7.8%). At multivariable analysis, the distance of the distal aortic neck from the celiac trunk was the only independent predictor of postoperative spinal cord injury (odds ratio, 0.75; 95% confidence interval, 0.56-0.99; P=.046); open surgical repair of the abdominal aortic disease was associated with a higher risk of spinal cord injury but did not reach statistical significance (odds ratio, 0.16; 95% confidence interval, 0.02-1.06; P=.057). Actuarial survival estimates at 1, 2, and 5 years after the procedure were 80%±5%, 68%±6%, and 63%±7%, respectively. Spinal cord injury did not impair survival (P=.885).

CONCLUSIONS:

In our experience, the risk of spinal cord injury is still substantial at 8% in patients with multilevel aortic disease. The distance of the distal landing zone from the celiac trunk is a significant predictor of spinal cord ischemia.

PMID:
24698563
DOI:
10.1016/j.jtcvs.2014.02.062
[Indexed for MEDLINE]
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