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Systematic review and meta-analysis of association of prophylactic cerebrospinal fluid drainage in preventing spinal cord ischemia following TEVAR

Published:November 15, 2021DOI:https://doi.org/10.1016/j.jvs.2021.10.050

      ABSTRACT

      Objectives

      We conducted a systemic review and meta-analysis to compare the association of prophylactic cerebrospinal fluid drainage (CSFD) versus non-CSFD in preventing spinal cord ischemia following thoracic endovascular aortic repair (TEVAR) for aneurysm and dissection.

      Methods

      MEDLINE, Embase, and Cochrane databases were systematically searched to identify all relevant studies published prior to April 1, 2020. A systematic review and meta-analysis were performed. We assessed the association between CSFD strategies including routine CSFD versus selective CSFD or non-CSFD and SCI rates following TEVAR in patients with aortic dissection (AD), solitary thoracic aortic aneurysm (TAA) or thoracoabdominal aortic aneurysm (TAAA). Subgroup analyses were conducted to assess the association between different aortic pathologies including AD and thoracic aneurysms and SCI rates following TEVAR with or without prophylactic CSFD. Data were presented using a pooled event rate (ER) with a 95% confidence interval (CI).

      Results

      Thirty-four studies consisting of 3561 patients (2671 with TAA/TAAA and 890 with type B aortic dissection) were included in this analysis. Data were presented using a pooled event rate (ER) with a 95% CI. The overall SCI rate in patients undergoing TEVAR with prophylactic CSFD for aortic dissection (ER, 1.80%; 95% CI, 0.88%-2.72%) was significantly lower than that for aortic aneurysm (ER, 5.73%; 95% CI, 4.20%-7.27%, P values < 0.0001). The SCI rate following TEVAR with prophylactic CSFD was not significantly different from that without CSFD for aortic dissection (P=0.51). There was no association found between the rates of SCI following TEVAR with routine prophylactic CSFD versus with selective prophylactic CSFD for aortic aneurysm (P values = 0.76) and aortic dissection (P values = 0.70), respectively. The SCI rate following TEVAR without CSFD for aortic aneurysm, including isolated TAA and TAAA, (ER, 3.49%; 95% CI, 0.23%-6.76%) was not significantly different from that for aortic dissection (ER, 3.20%; 95% CI, 0.00%-7.20%, P values = 0.91). In patients with TAAA the rate of SCI following TEVAR with routine prophylactic CSFD was significantly lower than that with selective prophylactic CSFD (P values = 0.04).

      Conclusions

      Our systematic review and meta-analysis showed that spinal cord ischemia occurs more commonly following TEVAR for aortic aneurysm than for aortic dissection. Routine prophylactic CSFD, compared with selective CSFD, is associated with lower rate of postoperative SCI following TEVAR for TAAA. No significant association between the rates of SCI and routine prophylactic CSFD was observed in patients undergoing TEVAR for isolated TAA or AD.

      Keywords

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