초록접수 현황
| 15F-007 | 구연 발표 |
Effects of Preemptive Cerebrospinal Fluid Drainage and Left Subclavian Artery Revascularization on Spinal Cord Protection during Thoracic Endovascular Aortic Repair
송승준¹, 송석원², 김태훈², 이광훈³, 유경종⁴
¹가톨릭관동대학교 의과대학 국제성모병원 흉부외과
²연세대학교 의과대학 강남세브란스병원 심장혈관외과
³연세대학교 의과대학 강남세브란스병원 영상의학과
⁴연세대학교 의과대학 세브란스병원 심장혈관외과
Background : Spinal cord ischemia (SCI) is a devastating but potentially preventable complication of thoracic endovascular aortic repair (TEVAR) with thoracoabdominal pathologies. Although many strategies have been devised to reduce the SCI, prophylactic cerebrospinal fluid drainage (CSFD), and left subclavian artery (LSA) revascularization still remain controversial.
Methods : From 2012 to 2014, a total of 162 patients underwent TEVAR at a single institution. Among those, we retrospectively reviewed prospectively collected data of 81 patients who underwent preoperative CSFD. LSA revascularization was routinely used when LSA need to be covered. Preoperative characteristics, intraoperative variables, and outcomes were analyzed.
Results : Mean age was 60.6 years (SD 12.5) and 57 (70%) were male. Twenty-five (31%) patients presented with degenerative aneurysm, 48 (59%) type B dissection, 5 (6%) penetrating aortic ulcer, and 3 (4%) with intramural hematoma. Thirty-six (44%) patients underwent LSA revascularization before TEVAR. Two patients (2.5%) experienced SCI in patients who underwent preoperative CSFD, of which 1 case recovered with hypertensive therapy to ambulatory status at discharge and 1 case was permanent. Prior abdominal aortic aneurysm repair tended to relate to SCI (P = 0.065), and preoperative aortic rupture was a significant independent risk factor for SCI (P = 0.002).
Conclusion : Our preemptive CSFD as an adjunctive for TEVAR proved to be better compared with other prior reports of selective use of CSFD when SCI arise. Preoperative CSFD with liberal use of LSA revascularization is recommended as prophylactic procedures in patients at high risk of SCI during TEVAR.
Methods : From 2012 to 2014, a total of 162 patients underwent TEVAR at a single institution. Among those, we retrospectively reviewed prospectively collected data of 81 patients who underwent preoperative CSFD. LSA revascularization was routinely used when LSA need to be covered. Preoperative characteristics, intraoperative variables, and outcomes were analyzed.
Results : Mean age was 60.6 years (SD 12.5) and 57 (70%) were male. Twenty-five (31%) patients presented with degenerative aneurysm, 48 (59%) type B dissection, 5 (6%) penetrating aortic ulcer, and 3 (4%) with intramural hematoma. Thirty-six (44%) patients underwent LSA revascularization before TEVAR. Two patients (2.5%) experienced SCI in patients who underwent preoperative CSFD, of which 1 case recovered with hypertensive therapy to ambulatory status at discharge and 1 case was permanent. Prior abdominal aortic aneurysm repair tended to relate to SCI (P = 0.065), and preoperative aortic rupture was a significant independent risk factor for SCI (P = 0.002).
Conclusion : Our preemptive CSFD as an adjunctive for TEVAR proved to be better compared with other prior reports of selective use of CSFD when SCI arise. Preoperative CSFD with liberal use of LSA revascularization is recommended as prophylactic procedures in patients at high risk of SCI during TEVAR.
책임저자: 송석원
연세대학교 의과대학 강남세브란스병원 심장혈관외과
연락처 : 송승준, Tel: 010-3363-6975 , E-mail : songseungjun@gmail.com
