Adjunct Perfusion Branch for Reduction of Spinal Cord Ischemia in the Endovascular Repair of Thoracoabdominal Aortic Aneurysms

Objectives: We demonstrate our experience and the outcome of using a perfusion branch for temporary sac perfusion to reduce the spinal cord ischemia (SCI) in the endovascular repair of thoracoabdominal aortic aneurysms (TAAAs).

Methods: Between January 2012 and August 2016, thirty patients (18, men; median age 72 years) were treated for TAAAs with total endovascular repair using customized branched / fenestrated endografts in our institution. The median aneurysm size was 6.6 cm. Types of TAAA were: type I, 9 (30%), type II, 5 (16.6%), type III, 4 (13.3%), type IV, 6 (20%), and type V, 6 (20%). Ten patients received a perfusion branch to create an intentional endoleak, which was occluded with vascular plugs in mean interval time of 8.2 weeks (range: 6–10). At the time of the planned re-interventions, the mean arterial pressure (MAP) gradients were measured between the temporarily perfused aneurysm sac and the aortic endografts and were significantly higher (mean gradients 42.5 ± 10 mm Hg; range: 30–60) within the aortic grafts. Staged procedure and automated Cerebrospinal fluid drainage were used in 23 (77%) and 24 (80%) patients respectively.

Results: The technical success was 97%. A total of 107 renovisceral target vessels were revascularized (32 fenestrations, 75 branches). The in-hospital and 30 days mortality was 3.3%. The overall incidence of postoperative SCI was 10% (3/30 patients) and no neurologic complications were observed in the group of the perfusion branch. The mean follow up was 12 months (range: 2–51).

Conclusion: In our experience, the use of dedicated perfusion branch is feasible and may serve as protective adjuvant to reduce the risk of SCI in endovascular treatment of TAAA. The risk of rupture in interval appears to be low. Larger series and multicenter studies are of course warranted to corroborate these results.