Safety and efficacy of fluoroscopically guided cerebrospinal fluid drainage for thoracoabdominal aortic aneurysm repair

Abstract

Objective: To review the safety and efficacy of perioperative cerebrospinal fluid (CSF) drainage catheter placement using fluoroscopic guidance in patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair. Methods: Research Ethics Board approval was obtained for this retrospective study. The medical records of patients who underwent fluoroscopically guided lumbar CSF drainage between September 2008 and April 2021 were reviewed. Major complications were defined as CSF leak requiring a blood patch, intracranial hemorrhage, meningitis, symptomatic spinal hematoma, bloody tap causing a delay in surgery, catheter fracture or occlusion, and death. Minor complications included CSF leak not requiring intervention, asymptomatic spinal hematoma, and bloody tap without surgical delay. Results: Eighty-four drainage catheters were attempted in 75 consecutive patients (age, 70.8 ± 8.9 years; 67.9% male) for 15 thoracic endovascular aortic repairs (TEVARs), 59 complex (fenestrated/branched) endovascular aortic repairs (EVARs), and 10 open repairs for 76 aneurysms (90.5%), 1 acute dissection (1.2%), and 7 chronic dissections with aneurysms (8.3%). The technical success rate was 97.6% (82/84). Bloody tap accounted for both technical failures. Most catheters were placed prophylactically (89.3%). There were 4 major complications (2 bloody taps causing a delay in surgery, 1 catheter occlusion, and 1 symptomatic spinal hematoma) and 2 minor complications (CSF leak with no intervention and asymptomatic spinal hematoma). Conclusions: The use of fluoroscopic guidance for CSF drainage catheter placement in patients undergoing open or endovascular TAAA repair is associated with a low complication rate and high technical success rate.

Keywords

• Fluoroscopic guidance
• Cerebrospinal fluid drainage
• Thoracoabdominal aortic aneurysm repair