CEREBROSPINAL-FLUID DRAINAGE AND DISTAL AORTIC PERFUSION - REDUCING NEUROLOGIC COMPLICATIONS IN REPAIR OF THORACOABDOMINAL AORTIC-ANEURYSM TYPE-I AND TYPE-II
Hj. Safi et al., CEREBROSPINAL-FLUID DRAINAGE AND DISTAL AORTIC PERFUSION - REDUCING NEUROLOGIC COMPLICATIONS IN REPAIR OF THORACOABDOMINAL AORTIC-ANEURYSM TYPE-I AND TYPE-II, Journal of vascular surgery, 23(2), 1996, pp. 223-228
Purpose: This study was conducted to evaluate the role of cerebrospina
l fluid (CSP) drainage and distal aortic perfusion (DAP) in the preven
tion of postoperative neurologic complications for high-risk patients
who had undergone type I and type II thoracoabdominal aortic aneurysm
(TAAA) repair. Methods: CSP drainage and DAP were used as an adjunct i
n the treatment of 94 patients with TAAA(31 type I, 63 type II) betwee
n September 1992 and December 1994; 67 were men and 27 were women. The
median age was 64 years (range, 28 to 88 years). Aortic dissection oc
curred in 35 of 94 patients (37%). Thirty-six of 94 patients (38%) had
previously undergone proximal aortic surgery. All patients underwent
intraoperative DAP and perioperative CSP drainage. Median aortic cross
-clamp time was 67 minutes (race, 20 to 131 minutes). Results: The 30-
day survival rate was 90% (85 of 94 patients). Early neurologic compli
cations occurred in 5 of 94 patients (5%), and late neurologic complic
ations occurred in 3 of 94 patients (3%). We compared the neurologic c
omplications of our current group of 94 patients with the data from 42
patients (control group) who also underwent repair of TAAA type I and
type II with only simple cross-clamp and without CSP drainage or DAP.
Both groups were treated by the senior author (HJS) at the same insti
tution. Total neurologic complications for the current group occurred
in 8 of 94 patients (9%) versus 8 of 42 patients (19%) for the control
group (p = 0.090). Neurologic complications for patients with type II
TAAA occurred in 8 of 63 patients (13%) versus 17 of 42 patients (41%
) (p = 0.014). For all patients with aortic clamp times greater than o
r equal to 45 minutes, neurologic complications occurred in 7 of 55 (1
3%) versus 7 of 18 (39%) (p = 0.033). Conclusion: The period of risk d
uring aortic cross-clamp time is reduced with the adjuncts of CSP drai
nage and DAP, which significantly lower the incidence of neurologic co
mplications after repair of TAAA types I and II.