Routine intercostal artery reattachment strategy reduces delayed and permanent spinal cord injury after open descending thoracic and thoracoabdominal aortic aneurysm repair

Objective

During open descending thoracic and thoracoabdominal aortic aneurysm (DTAA/TAAA) repair, we used a routine T8-T12 intercostal artery (ICA) reattachment strategy from July 2004 to June 2009 and after 2017, we used a selective ICA reattachment strategy (reattaching T8-T12 ICAs only when neuromonitor signals were lost) from July 2009 to 2016. This study reviewed our nearly 2-decade experience to assess the impact of 2 ICA reattachment strategies on spinal cord injury (SCI).

Methods

All open DTAA/TAAA repairs performed from July 2004 to June 2022 were included, except for cases without intraoperative cerebral spinal fluid drainage. Perioperative data were reviewed. Univariable and multivariable analyses and propensity matching for risk-adjusted effects of 2 strategies for ICA reattachment on SCI were used.

Results

In all, 375 patients were operated on with selective strategy and 584 with routine strategy. Age and prevalence of rupture and redo were similar in the 2 groups. The rate of operative mortality and immediate SCI was also similar (selective vs routine: mortality, 12.5% vs 12.3%; immediate SCI, 3.2% vs 2.2%). However, the incidence of delayed and permanent SCI was increased in the selective group (delayed, 10.4% vs 6.9%; permanent, 8.5% vs 5.3%). Multivariable analyses demonstrated selective strategy was a predictor of delayed and permanent SCI, along with TAAA extent II/III, and older age.

Conclusions

Two strategies of ICA reattachment did not impact the incidence of immediate SCI, which was infrequent, but the selective strategy was associated with greater rates of delayed permanent SCI. Reattachment of the ICAs within T8-T12 should be performed during open DTAA/TAAA.