Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: A report of 486 patients treated from 1987 to 2008

Martha M. Wynn, Matthew Mell, Girma Tefera, John R. Hoch, Charles W. Acher

Research output: Contribution to journalArticle

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Abstract

Objective: Spinal fluid drainage reduces paraplegia risk in thoracic (TAA) and thoracoabdominal (TAAA) aortic aneurysm repair. There has not been a comprehensive study of the risks of spinal fluid drainage and how these risks can be reduced. Here we report complications of spinal fluid drainage in patients undergoing TAA/TAAA repair. Methods: The study comprised 648 patients who had TAA or TAAA repair from 1987 to 2008. Spinal drains were used in 486 patients. Spinal fluid pressure was measured continuously, except when draining fluid, and was reduced to <6 mm Hg during thoracic aortic occlusion and reperfusion. After surgery, spinal fluid pressure was kept <10 mm Hg until patients were awake with normal leg lift. Drains were removed 48 hours after surgery. Spinal and head computed tomography (CT) scans were performed in patients with bloody spinal fluid or neurologic deficit. We studied the incidence of headache treated with epidural blood patch, infection, bloody spinal fluid, intracranial and spinal bleeding on CT, as well as the clinical consequences. Results: Twenty-four patients (5%) had bloody spinal fluid. CT exams showed seven had no evidence of intracranial hemorrhage, 14 (2.9%) had intracranial blood without neurologic deficit, and three with intracranial bleeding and cerebral atrophy had neurologic deficits (1 died, 1 had permanent hemiparesis, and 1 with transient ataxia recovered fully). Two patients without bloody spinal fluid or neurologic deficit after surgery presented with neurologic deficits 5 days postoperatively and died from acute on chronic subdural hematoma. Neurologic deficits occurred after spinal fluid drainage in 5 of 482 patients (1%), and 3 died. The mortality from spinal fluid drainage complications was 0.6% (3 of 482). By univariate and multivariate analysis, larger volume of spinal fluid drainage (mean, 178 mL vs 124 mL, P < .0001) and higher central venous pressure before thoracic aortic occlusion (mean, 16 mm Hg vs 13 mm Hg, P < .0012) correlated with bloody spinal fluid. Conclusion: Strategies that reduce the volume of spinal fluid drainage but still control spinal fluid pressure are helpful in reducing serious complications. Patients with cerebral atrophy are at increased risk for complications of spinal fluid drainage.

Original languageEnglish (US)
Pages (from-to)29-35
Number of pages7
JournalJournal of Vascular Surgery
Volume49
Issue number1
DOIs
StatePublished - Jan 1 2009
Externally publishedYes

Fingerprint

Thoracic Aortic Aneurysm
Drainage
Neurologic Manifestations
Cerebrospinal Fluid Pressure
Tomography
Atrophy
Thorax
Epidural Blood Patch
Hemorrhage
Hematoma, Subdural, Chronic
Central Venous Pressure
Intracranial Hemorrhages
Paraplegia
Paresis
Ataxia
Reperfusion
Headache
Leg
Multivariate Analysis
Head

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair : A report of 486 patients treated from 1987 to 2008. / Wynn, Martha M.; Mell, Matthew; Tefera, Girma; Hoch, John R.; Acher, Charles W.

In: Journal of Vascular Surgery, Vol. 49, No. 1, 01.01.2009, p. 29-35.

Research output: Contribution to journalArticle

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