Preventing Spinal Cord Injury in Single-Staged Juxtarenal and Thoracoabdominal Endovascular Aortic Aneurysm Repair: An Evaluation of Cerebrospinal Fluid Catheter Drainage.

Abstract

Objective: This study offers a retrospective assessment of a single-center experience using cerebrospinal fluid catheters to reduce the risk of perioperative spinal cord injury in patients undergoing single-staged complex endovascular juxtarenal or thoracoabdominal aortic aneurysm repair.

Results: A total of 97 patients were included. On average, 70.7%±14.4% of the aortic segment between the left subclavian artery and the aortic bifurcation was covered during the procedures. Of the 53 patients receiving cerebrospinal fluid drainage, 77.4% were prophylactic and 22.6% were in symptomatic patients. The overall spinal cord injury rate was 12.4%, with 8.3% experiencing transient spinal cord injury with immediate improvement after cerebrospinal fluid drainage, and 4.1% of patients suffering permanent spinal cord injury: 2 (2.1%) with minor deficits and 2 (2.1%) with paraplegia. The mean intraoperatively administered heparin dosage was 7500 international units, and an additional intravenous bolus of acetylsalicylic acid was given in 69 cases (71.1%), whereas the cerebrospinal fluid drain was in situ.

Conclusions: The evaluation of the employed in-house protocol for single-staged complex endovascular juxtarenal and thoracoabdominal aortic aneurysm repair, focusing on cerebrospinal fluid catheter management in conjunction with necessary anticoagulant and antiplatelet medication, indicated that the use of a cerebrospinal fluid catheter is a feasible approach for spinal cord injury risk reduction in selected high-risk patients.

Clinical impact: This study highlights the effectiveness of cerebrospinal fluid drainage (CSFD) in reducing spinal cord injury (SCI) rates from 12.4% to 4.1% during single-staged complex endovascular repair of juxtarenal and thoracoabdominal aortic aneurysms. Implementing CSFD within a standardized protocol achieved a 99.7% target visceral and renal vessel patency without major CSFD-related bleeding complications. These findings emphasize CSFD as a feasible and effective tool for SCI prevention in selected high-risk patients. While supporting on-demand catheter placement, this study underscores the potential of selective prophylactic CSFD use, contributing to safer, evidence-based strategies in managing high-risk aortic repairs.