Functional recovery after spinal cord ischemia post-TAAA repair is a long process up to 24 months, with endovascular repair and CSF drainage significantly improving the likelihood of recovery.
Background Spinal cord ischemia (SCI) continues to be an in-depth complication of thoracoabdominal aortic aneurysm repair (TAAA); little is known about long-term outcomes, determinants of functional recovery, or comprehensive longitudinal data about this complication. However, both long-term functional pathways and the prognostic modifiable determinants after SCI are not well characterized. Procedures A single-center, retrospective, cohort study was performed in a tertiary aortic referral hospital. Out of 3,216 TAAA repairs that had been done between 2015 and 2023, 218 patients (7.7%) with a documented postoperative SCI were the analytic cohort. The principle outcome was the time to favorable recovery, which was operationalized and measured as a modified Rankin Scale (mRS) score of ≤3. Independent predictors were identified by the use of multivariable Cox proportional-hazard and logistic regression models. The recovery trajectories, mortality, and utilization of health -care resources were estimated in a 24 months period. Results The average age of the participants was 69.2 years old, with 58.3% of the total respondents being aged over 70 years. The favorable recovery rates improved to 35.3% at 3 months to 63.1% at 24 months ( p -trend 0.001). On multivariable Cox analysis, incomplete SCI adjusted hazard ratio (aHR) 3.85, 95% CI 2.45–6.05, endovascular repair (aHR 1.52, 95% CI 1.08–2.14), and use of cerebrospinal fluid drainage (aHR 2.44, 95% CI 1.61–3.70) were independently associated with a higher rate of achieving favorable functional recovery. Significant adverse predictors included advanced age, chronic kidney disease, Crawford type II aneurysm and duration of spinal ischaemia over 45 min (all p 0.05). A clinical nomogram based on these variables showed an acceptable level of discriminative power (C- index = 0.78). Patients who had achieved positive recovery had significantly better 5 years survival (68% vs. 18% log-rank, p 0.001) and less health-care utilization. Conclusion Functional recovery in the post-SCI period after TAAA repair is a long process up to 24 months. The severity of the attack at the onset of the disease is the most critical prognostic variable; however, the interventions (endovascular intervention and drainage via the CSF) which can be controlled significantly improve the likelihood of recovery. Achievement of desirable functional outcome is closely linked with a high survival advantage thus demonstrating the critical significance of preventive measures, high surgical proficiency and long-term rehabilitation.
Liu et al. (Mon,) studied this question.