Preservation of intercostal arteries during thoracoabdominal aortic aneurysm surgery: A retrospective study

Objective: The purpose of this article was to examine the influence of reim plantation of patent intercostal and lumbar arteries on the incidence of po stoperative paraplegia/paraparesis in patients undergoing clamp-and-sew sur gical repair of thoracoabdominal aortic aneurysms, Methods: Data from Janua ry 1987 through December 1997 were retrospectively collected on 132 patient s. Ninety-one patients in group I underwent aneurysm repairs before January 1995 and did not undergo intercostal artery reimplantation, Group II inclu ded the more recent 41 patients who had vessels between the eighth thoracic intercostal and the second lumbar arteries reimplanted to the graft or pre served at the aortic anastomoses, Results: The operative mortality rate was 13.2% (12/91) in group I and 4.9% (2/41) in group n: (P = .22), The incide nce of postoperative paraplegia was significantly lower in the more recent cohort of patients (8.8% [8/91] in group I vs 0% [0/41] in group II, P = .0 5). The overall rate of spinal cord dysfunction was lowered from 9.9% (9/91 ) in group I to 2.4% (1/41) in group II (P = .17). However, a multivariable logistic regression analysis identified only aneurysm extent (Crawford typ e I and type II) as a predictor of less postoperative spinal cord injury (P = .08). The average aortic crossclamp time in group I was 30.3 +/- 11.5 (S D) minutes, and the time of aortic occlusion in group II was not significan tly prolonged,,vith an average crossclamp time of 31.0 +/- 21.0 (SD) minute s (P = .88). Conclusions: An aggressive approach to maintain intercostal ar tery patency during clamp-and-sew repair of thoracoabdominal aortic aneurys ms may effectively lower the incidence of spinal cord injury without prolon ging aortic crossclamp time.