Clinical Research Of Postoperative Paraplegia Of Stanford B Aortic Dissection After Thoracic Endovascular Aortic Repair

Objective:We reviewed our clinical and imaging data to investigate the determinants of paraplegia after Thoracic endovascular aortic repair (TEVAR), identify patients at risk, and assess the effectiveness of ancillary techniques.Materials and Methods:We reviewed221patients underwent TEVAR at our center in a1-year period (May2011to May2013). Indications for treatment were type B aortic dissection. Patient demographics and perioperative factors related to the TEVAR were evaluated by using univariate statistical analysis and multicariate logistic regression analysis. All patients with paraplegia were treated with CSF drainage, steroids administration, arterial pressure pharmacologic adjustment, anticoagulation, vasodilation, neuroprotection, and decreacing intracranial pressure.Result:A primary technical success rate was100%. Four patients had delayed neurologic deficit. Univariate analysis multicariate logistic regression analysis showed that diabetes, hypertension, smoke, LSA occlusion, perioperative hypotension may be significant risk factors. Perioperative blood pressure is independent risk factor for paraplegia after TEVAR. After cerebrospinal fluid (CSF) drainage, steroids administration, anticoagulation, vasodilation, neuroprotection, decreacing intracranial pressure, and arterial pressure pharmacologic adjustment, all patients had full recovery.Conclusion:The mechanism of postoperative paraplegia appears to be multifactorial. Avoiding perioperative hypotension may reduce the risk of paraplegia. CSF drainage, steroids administration, anticoagulation, vasodilation, neuroprotection, decreacing intracranial pressure, and arterial pressure pharmacologic adjustment is useful when postoperative paraplegia occurs.