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Spinal Cord Injury in Patients Undergoing Fenestrated-branched Endovascular Repair of Complex Aortic Aneurysms: Incidence, Clinical Course and Survival
Hannah Victoria Oden-Brunson
1, Ying Huang
1, Zemia Maria Camara Costa Ferreira
1, Steven Maximus
1, Jorge Miranda
1, Erin Greenleaf
1, Naveed U. Saqib
2, Thanila A. Macedo
1, Manju Kalra
3, Gustavo S. Oderich
1 1Baylor College of Medicine, Houston, TX;
2The University of Texas Health, Houston, TX;
3Mayo Clinic, Rochester, MN
Objective: Spinal cord injury (SCI) is a devastating complication following fenestrated-branched endovascular aortic repair (FB-EVAR) for complex abdominal (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs). This study aimed to characterize the clinical course and survival among patients who sustained SCI after FB-EVAR.
Methods: Clinical data of consecutive patients enrolled in a prospective, non-randomized physician-sponsored investigational device exemption study of FB-EVAR (2013-2025) were reviewed. SCI was classified by timing (immediate, delayed), severity (Grade 1, sensory deficit; Grade 2, paraparesis or ambulatory; Grade 3, paraplegia or non-ambulatory), and recovery relative to baseline functional status (complete, partial or none). Primary endpoints were timing, severity, and recovery of SCI.
Results: 607 patients were treated for 164 (27%) CAAAs and 443 (73%) TAAAs. Incidence of SCI was 5.7% (n=35; CAAAs, 1.2% vs. TAAAs, 7.4%; p<.001). Timing was immediate in 16 patients (46%) and delayed in 19 (54%). Severity was Grade 2 in 12 patients (34%) and Grade 3 in 23 (66%). Complete recovery was achieved in 21 patients (60%) and partial in 7 (20%). Overall, 1.2% (7/607) had persistent deficits with no recovery. Among patients who sustained SCI, cerebrospinal fluid drainage was used prophylactically in 19 (54%) and as a rescue maneuver in 12 (34%). Among 16 patients with immediate-onset SCI, 12 (75%) had Grade 3 and 10 (83%) had complete or partial recovery, compared with 11 (58%) and 7 (64%) among 19 patients with delayed-onset SCI. Five (Grade 2, 1; Grade 3, 4) of the seven patients without recovery presented with delayed SCI. Length of hospital stay was prolonged among patients with Grade 3 compared to Grade 2 SCI (22±12 vs 13±11 days, p=0.02). Absence of recovery was associated with higher late mortality than complete recovery (hazard ratio, 3.45; 95% confidence interval, 1.17-10.2; p=0.03; median survival, 12 months), while survival did not differ between partial and complete recovery (p=0.58).
Conclusions: SCI occurred in 5.7% of patients, with complete or partial recovery in 80%. Overall, persistent deficit with no recovery was rare (1.2%). Survival was similar for those with partial or complete recovery but worse for patients without recovery, with median survival of 1year.
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