Objectives: Paraplegia remains a devastating complication after repair of extensive thoracoabdominal aortic aneurysms (TAAA). Strategies to prevent ischemic spinal cord damage following extensive segmental artery (SA) sacrifice or inevitable occlusion by endovascular repair are still evolving. Methods: 90 patients who underwent extensive SA-sacrifice (median: 13, range: 9–15) during open repair from 06/94–12/07 were reviewed retrospectively. 55 patients-most with extensive TAAA/Crawford type-II; mean age 65±12years-had a single procedure (1-stage group). 35 patients had two operations (2-stage-group): usually Crawford type III/IV repair after operation for descending thoracic aneurysm (DTA)/Crawford type-I; mean age: 62±14 years. The median interval between the 2-stage procedures was 5 years (3 months-17years). There were no significant differences between the groups with regard to age, gender, etiology of the aneurysm, hypertension, COPD, urgency, previous cerebrovascular accidents, year of procedure, or cerebrospinal fluid drainage (84%). Somatosensory-evoked potentials were monitored in all patients, and motor-evoked potentials in 39%. Results: Overall hospital mortality was 11.1%. There were no significant differences in mortality, stroke, postoperative bleeding, infection, renal failure or pulmonary insufficiency between the groups. However, 15% in the 1-stage-group suffered permanent spinal cord injury vs. none in the 2-stage-group, p=.02. The significantly lower rate of paraplegia/paraparesis in the 2-stage group occurred despite a significantly higher number of SAs sacrificed in this group: a median of 14 (11–15) vs. 12 (9–15), p< .0001. Conclusions: A staged approach to extensive TAAA repair results in significantly reduced incidence of spinal cord injury: this is of particular importance in designing strategies involving hybrid or entirely endovascular procedures.
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Etz et al. (2010) studied this question.