Surgical management of ruptured abdominal aortic aneurysms

Powell JT, Wanhainen A. Analysis of the Differences Between the ESVS 2019 and NICE 2020 Guidelines for Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg. 2020 Jul;60(1):7-15.

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See also: Surgical Grand Rounds: EVAR, FEVAR, and Open Repair: What to make of alphabet soup

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Prophylactic cerebrospinal fluid drainage for thoracic endovascular aortic repair (TEVAR)

Mazzeffi M, et al. Contemporary Single-Center Experience With Prophylactic Cerebrospinal Fluid Drainage for Thoracic Endovascular Aortic Repair in Patients at High Risk for Ischemic Spinal Cord Injury. J Cardiothorac Vasc Anesth. 2018 Apr;32(2): 883-889.

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Flowchart TEVAR high risk ISCI outcomes_complications

Fig 2. Flowchart showing patient outcomes and complications in the cohort. SCI, spinal cord injury; SCPP, spinal cord perfusion pressure; TEVAR, thoracic endovascular aortic repair.

In summary, in a contemporary cohort of 102 patients undergoing TEVAR with a high risk for ischemic SCI, prophylactic CSF drainage was associated with a 2% paraplegia rate and 3.9% rate of drain-related complications. No patient with a drain-related complication had permanent injury, and only 1 patient required surgical intervention for spinal cord compression from epidural hematoma. Three patients with new paraplegia after surgery improved with targeted MAP increases and CSF drainage aimed to increase SCPP by 25%, whereas 1 patient’s symptoms never improved. These data further support the safety of prophylactic lumbar CSF drainage in patients undergoing TEVAR with a high risk for ischemic SCI.”

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