Retrospective investigation of more than 400 patients undergoing thoracic endovascular aortic repair with or without cerebrospinal fluid drainage.

OBJECTIVE: The aim of this study was to analyze risks and benefits of cerebrospinal fluid drainage (CSFD) placement in patients undergoing thoracic endovascular aortic repair (TEVAR).

METHODS: Between 2009 and 2020, 411 patients underwent TEVAR in one institution where 236 patients (57%) received a preoperative CSFD. Patient and outcome characteristics were retrospectively analyzed and compared between patients with and without preoperative CSFD placement.

RESULTS: Preoperative CSFD was performed significantly more frequently in elective patients, especially those undergoing distal stent graft extension following frozen elephant trunk-stent placement (p < 0.001). Significantly fewer CSFD were placed in patients with acute aortic injury (p < 0.001). The incidence of permanent spinal cord ischaemia (SCI) was higher in patients without preoperative CSFD (10 patients (2%) vs one patient (0.2%), p = 0.001). Postoperative CSFD was placed in three patients (0.7%). Severe CSFD-associated complications affected two patients (0.5%) namely, a subdural spinal haematoma causing permanent paraplegia in one of those two patients.

CONCLUSIONS: CSFS placement is associated with low procedural risk and can potentially help to prevent SCI. However, the SCI incidence is most likely also associated with other preoperative factors including the patient's haemodynamics. Hence, a general recommendation for placing a preoperative CSFD cannot be made when relying on the present evidence.