Aggressive use of prophylactic cerebrospinal fluid drainage to prevent spinal cord ischemia during thoracic endovascular aortic repair is not supportive.

OBJECTIVE

We investigated whether prophylactic preoperative cerebrospinal fluid drainage was effective in preventing spinal cord ischaemia during thoracic endovascular aortic repair for degenerative descending thoracic aortic aneurysm, excluding dissecting aneurysms.

METHODS

We retrospectively reviewed medical records of the patients who underwent thoracic endovascular aortic repair with proximal landing zones 3 and 4 for between 2009 and 2020.

RESULTS

Eighty-nine patients with preemptive cerebrospinal fluid drainage (68 men; median [range] age, 76.0 [71.0-81.0] years) and 115 patients without cerebrospinal fluid drainage (89 men; median [range] age, 77.0 [74.0-81.5] years) were included in this study. Among them, 59 from each group were matched based on propensity scores to regulate for differences in backgrounds. The incidence rate of spinal cord ischaemia was similar: 8/89 (9.0%) in the cerebrospinal fluid drainage group and 6/115 (5.2%) in the non-cerebrospinal fluid drainage group (p = 0.403). Shaggy aorta (odds ratio, 5.13; p = 0.004) and iliac artery access (odds ratio, 5.04; p = 0.005) were identified as positive predictors of spinal cord ischaemia. Other clinically important confounders included Adamkiewicz artery coverage (odds ratio, 2.53; p = 0.108) and extensive stent graft coverage (>8 vertebrae) (odds ratio, 1.41; p = 0.541) were not statistically significant. Propensity scores matching yielded similar incidence of spinal cord ischaemia: 4/59 (6.8%) in the cerebrospinal fluid drainage group and 3/59 (5.1%) in the non-cerebrospinal fluid drainage group (p = 0.697).

CONCLUSIONS

Aggressive use of prophylactic cerebrospinal fluid drainage was not supportive in patients without complex risks of spinal cord ischaemia.