Spinal cord ischaemia predictors and outcomes in complex endovascular aortic repair – a single centre retrospective study

Introduction Spinal cord ischemia (SCI) is an infrequent distressing complication following thoraco-abdominal (TAAA) and complex abdominal aortic aneurysm (CAAA) repair. Prior studies showed controversial results regarding risk factors and preventive measures. We aim to analyze the incidence of SCI after endovascular treatment of complex aortic aneurysms in our center and perform a descriptive analysis. Methods Single-center retrospective study conducted in a tertiary care center including all patients with a TAAA or CAAA who underwent endovascular repair using a fenestrated/branched endograft from June 2010 to February 2025. Patient characteristics, peri-procedural and follow-up data were obtained. SCI was defined according to the Society for Vascular Surgery reporting standards as new-onset motor or sensitive deficits after endovascular treatment. Results 145 patients (91% male, mean age 71±6 years) were included, of which 59 (41%) had degenerative TAAAs (types I-V) and 57 (39%) CAAAs. Mean aneurysm diameter was 66±14mm. A prophylactic cerebrospinal fluid drainage (CSFD) was preoperatively placed in 61 patients (42%). Total incidence of SCI was 8% (12/145): minimal sensory deficits in 33% (4/12), paraparesis in 8% (1/12) and paraplegia in 59% (7/12). Most patients (83%, 10/12) presented with delayed SCI. After symptom onset, 58% of patients (n=7) required rescue CSFD. Regarding patients with grade 3 SCI (n=7), a complete recovery was observed in 3 patients, 1 patient experienced partial recovery and 3 did not recover. No differences concerning prior aortic surgery, internal iliac artery patency, procedural staging or preoperative CSFD placement were found between SCI and no-SCI patients. Conclusion In this study, SCI manifested mostly as a delayed event. Prophylactic CSFD may prevent permanent injury. The small sample size could hinder the investigation of more robust findings. Despite several risk factors and preventive measures having been identified, the best preventive approach is still lacking. Further studies are required to prevent this devastating complication.