• Giulianna B Marcondes, Nolan C Cirillo-Penn, Emanuel R Tenorio, Donald J Adam, Carlos Timaran, Martin J Austermann, Luca Bertoglio, Tomasz Jakimowicz, Michele Piazza, Maciej T Juszczak, Carla K Scott, Bärbel Berekoven, Roberto Chiesa, Guilherme B B Lima, Katarzyna Jama, Francesco Squizzato, Martin Claridge, Bernardo C Mendes, Gustavo S Oderich, and Trans-Atlantic Aortic Research Consortium Investigators.
• Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, TX.
• Ann. Surg. 2023 Aug 1; 278 (2): e396e404e396-e404.

ObjectiveTo assess outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) of Extent I-III thoracoabdominal aortic aneurysms (TAAAs) without prophylactic cerebrospinal fluid drainage (CSFD).BackgroundProphylactic CSFD has been routinely used during endovascular TAAA repair, but concerns about major drain-related complications have led to revising this paradigm.MethodsWe reviewed a multicenter cohort of 541 patients treated for Extent I-III TAAAs by FB-EVAR without prophylactic CSFD. Spinal cord injury (SCI) was graded as ambulatory (paraparesis) or nonambulatory (paraplegia). Endpoints were any SCI, permanent paraplegia, response to rescue treatment, major drain-related complications, mortality, and patient survival.ResultsThere were 22 Extent I, 240 Extent II and 279 Extent III TAAAs. Thirty-day mortality was 3%. SCI occurred in 45 patients (8%), paraparesis occurring in 23 (4%) and paraplegia in 22 patients (4%). SCI was more common in patients with Extent I-II compared with Extent III TAAAs (12% vs. 5%, P =0.01). Rescue treatment included permissive hypertension in all patients, with CSFD in 22 (4%). Symptom improvement was noted in 73%. Twelve patients (2%) had permanent paraplegia. Two patients (0.4%) had major drain-related complications. Independent predictors for SCI by multivariate logistic regression were sustained perioperative hypotension [odds ratio (OR): 4.4, 95% confidence interval (95% CI): 1.7-11.1], patent collateral network (OR: 0.3, 95% CI: 0.1-0.6), and total length of aortic coverage (OR: 1.05, 95% CI: 1.01-1.10). Patient survival at 3 years was 72%±3%.ConclusionFB-EVAR of Extent I-III TAAAs without CSFD has low mortality and low rates of permanent paraplegia (2%). SCI occurred in 8% of patients, and rescue treatment improved symptoms in 73% of them.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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