Complications of Cerebrospinal Fluid Drainage in Tevar
Gökay Deniz, Evren Özçinar, Mehmet Çakici, Çagdas Baran, Ali Ihsan Hasde, Sadik Eryilmaz, Sadik Bilgiç, Bülent Kaya.
Ankara University Heart Center, Ankara, Turkey.
BACKGROUND:Spinal cord ischemia (SCI) is a serious complication in TEVAR. Cerebrospinal fluid drainage (CFD) is recommended in patients at risk for SCI to increase spinal cord perfusion. In addition, catastrophic complications related to CFD are also reported and the safety of CFD is questioned in patients undergoing TEVAR. METHODS: Between 2005 and 2018, 103 patients who suffered from aortic diseases were treated with TEVAR. The 10-year results of our TEVAR operations were retrospectively reviewed. Complications and mortality associated with TEVAR were investigated, and patients with CFD and complications were identified. RESULTS: The first-month mortality in 103 patients was 9 (8.7%). After 4 rupture patients, the most important reason for mortality is CFD related intracranial hemorrhages (ICH) in 3 patients. CFD was performed in 20 patients who were at risk for SCI and ICH occurred in 3 patients of them (15%). Three of the patients died in the first postoperative month because of ICH. Laminectomy was performed in 1 patient with the paraplegia due to the epidural hematoma in the medulla spinalis (Figure 1). CFD may be considered as a risk factor in patients with TEVAR, and CSD increases the risk of 14-fold ICH. CONCLUSIONS: In our single-center retrospective study, complications related to CFD were high. Because of these complications we have seen in patients who underwent TEVAR with CFD, the mortality rate is 2.9% and narrows the therapeutic window of CFD.
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