Risk factors and management for paraplegia after thoracic endovascular aortic repair
Objective: To investigate the risk factors of paraplegia after thoracic endovascular aortic repair (TEVAR) and its management strategies. Methods: The clinical data of 593 patients with Stanford type B aortic dissection who underwent TEVAR between May 2011 and May 2015 were reviewed. The risk factors for postoperative paraplegia were analyzed and the treatment methods were summarized. Results: Among the 593 patients, post-TEVAR paraplegia occurred in 9 cases (1.5%). Univariate analysis showed that diabetes, hypertension, smoking, left subclavian artery occlusion, and perioperative hypotension were associated with post-TEVAR paraplegia (all P<0.05), and further multivariate Logistic regression analysis showed that perioperative blood pressure was the significant risk factor for paraplegia after TEVAR (P<0.05). The nervous system function was completely recovered in all the patients with post-TEVAR paraplegia after combined treatment that included cerebrospinal fluid drainage, hormone stosstherapy, appropriate blood pressure elevation, anticoagulation, vascular dilation, neuro-nutrition and lowering intracranial pressure Conclusion: Perioperative hypotension is an important risk factor for paraplegia after TEVAR. Early adoption of corresponding conservative treatments to increase spinal cord perfusion may effectively improve the results.