Lower extremity weakness after endovascular aneurysm repair with multibranched thoracoabdominal stent grafts

Objective We conducted our study to describe the incidence, presentation, management, risk factors, and outcomes of lower extremity weakness (LEW) after elective endovascular aneurysm repair with multibranched thoracoabdominal stent grafts. Methods Excluding symptomatic patients and those with aorti...

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Bibliographic Details
Published in:Journal of vascular surgery 2015-03, Vol.61 (3), p.623-629
Main Authors: Sobel, Julia D., BS, Vartanian, Shant M., MD, Gasper, Warren J., MD, Hiramoto, Jade S., MD, Chuter, Timothy A.M., DM, Reilly, Linda M., MD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - diagnosis
Aortic Aneurysm, Abdominal - surgery
Aortic Aneurysm, Thoracic - diagnosis
Aortic Aneurysm, Thoracic - surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - instrumentation
Chi-Square Distribution
Elective Surgical Procedures
Endovascular Procedures - adverse effects
Endovascular Procedures - instrumentation
Female
Humans
Incidence
Logistic Models
Lower Extremity
Male
Middle Aged
Multivariate Analysis
Muscle Weakness - epidemiology
Muscle Weakness - physiopathology
Muscle Weakness - therapy
Muscle, Skeletal - innervation
Odds Ratio
Paraparesis - epidemiology
Paraplegia - epidemiology
Prospective Studies
Prosthesis Design
Risk Factors
San Francisco - epidemiology
Stents
Surgery
Time Factors
Treatment Outcome
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Summary:Objective We conducted our study to describe the incidence, presentation, management, risk factors, and outcomes of lower extremity weakness (LEW) after elective endovascular aneurysm repair with multibranched thoracoabdominal stent grafts. Methods Excluding symptomatic patients and those with aortic dissection, between July 2005 and October 2013, 116 patients with aortic aneurysms were treated in a prospective, single-center trial of multibranched endovascular aneurysm repair. LEW that resolved within 30 days of operation was classified as transient. Persistent LEW was defined as inability to walk or stand 30 days after surgery. Perioperative spinal cord protection measures included bypass as needed to maintain flow to the subclavian and internal iliac arteries, cerebrospinal fluid drainage, and permissive hypertension. Results Postoperative LEW occurred in 24 of 116 patients (20.6%). In 15 (12.9%), LEW was transient with full recovery. Nine patients (7.7%) had persistent LEW, three with paraparesis and six with paraplegia. Five of 24 patients (21%) awoke from anesthesia with LEW. Symptoms of LEW developed within 72 hours of operation in 14 of 24 (58%). Late-onset LEW (≥72 hours postoperatively) always occurred in the presence of a precipitating hypotensive event (5 of 24; 21%). Univariate analysis showed no association between LEW and Crawford type, staged repair, aneurysm extent, or postoperative endoleak. Baseline glomerular filtration rate 190 minutes (OR, 3.6; 95% CI, 1.0-12.7; P  = .04), and sustained hypotension (OR, 2.9; 95% CI, 1.1-7.7; P  = .04) were identified as independent risk factors for LEW in multivariate analysis. Conclusions Most episodes of LEW after multibranched endovascular aneurysm repair are transient and do not occur in the operating room. Adjunctive strategies to maintain spinal perfusion, including cerebrospinal fluid drainage and permissive hypertension, may help prevent permanent LEW.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2014.10.013