Complications of lumbar drainage after thoracoabdominal aortic aneurysm repair

Objectives. Paraplegia remains a frequent complication of thoracoabdominal aortic aneurysm (TAAA) repair. Many adjunct therapies have been developed t o address this complication. Lumbar drainage is frequently used in an attem pt to decrease intrathecal pressure and improve intramedullary perfusion pr essure. The effectiveness of this therapy is unclear, and the complications of lumbar drainage used for this indication are unknown. We present a case of intraspinal hematoma with significant neurologic deficit after TAAA rep air and review the associated complications of lumbar drains placed for TAA A. Methods. The charts of all patients undergoing operations for TAAA repair w ere reviewed. Patients who underwent perioperative placement of a lumbar dr ain were included regardless of aneurysm type or etiology. Demographics, Cr awford grade, and perioperative parameters and complications were reviewed. Results. Sixty-five patients underwent TAAA repair with 62 (95%) receiving a preoperative lumbar drain. There were two (3.2%) intraspinal hemorrhagic complications, including one patient with a poor neurologic outcome. No inf ections or other complications directly related to drainage were identified . Multivariate logistic regression analysis failed to demonstrate a signifi cant association between lumbar drain complications and perioperative and i ntraoperative parameters such as blood loss or hypotension, level of drain placement, and Crawford grade. Conclusions. Lumbar drainage is a frequent adjunct to TAAA repair. However, placement of the drain itself can be associated with significant complicat ions whose aggravating factors may be unidentifiable. Complications resulti ng from lumbar drainage should be considered in any patient who has postope rative lower extremity neurologic deficits.