{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T09:44:20Z","timestamp":1788515060482,"version":"build-2803163510"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To analyze the incidence of spinal cord ischemia (SCI) after complex endovascular aortic repair (EVAR) after the introduction of a dedicated SCI preventive protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective review of all consecutive patients undergoing complex EVAR with branched (BEVAR) and\/or fenestrated grafts (FEVAR) during a 6-year period starting January 1st, 2015. The preventive protocol consisted of staging extensive aortic repairs, maintaining a mean arterial pressure (MAP) &amp;gt;80\u2005mm\u2005Hg, Hb level &amp;gt;110\u2005g\/L, early lower limb reperfusion and neurological control per hour during the post-operative stay in the intensive care unit (36\u201372\u2005h). Prophylactic cerebrospinal fluid drainage (CSFD) was used selectively. Pre- intra-, and 30-day postoperative clinical data and imaging were collected. Primary end point was the development of perioperative SCI. Secondary outcome included technical and clinical success.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Complex EVAR was performed in 205 patients (167 males, 72 (67\u201375) years, 182 (88.8%) elective) with juxtarenal aneurysms (JRA, 155 patients) or thoracoabdominal aortic aneurysms (TAAA). SCI occurred after JRA repair in two patients (1.3%, both ruptures) and after TAAA repair in three (6.0%, one rupture) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.06), all within 9\u2005h postoperatively. There was symptom regression in three cases (one partial, two complete), resulting in a persistent SCI level of 0.6% and 4.0% for JRA and TAAA, respectively. Only one patient with persistent SCI could be discharged from the hospital alive. Patients developing SCI were more commonly female (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.016), presented with rupture (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u2009.001), had preoperative renal insufficiency (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u2009.001) and had lower minimal MAP (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.015). No regression analysis was done due to the limited number of SCI events in relation to the study population size. Primary technical success was achieved in 162 patients (83.5%) and clinical success in 153 patients (75.4%), without any differences between the groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The incidence of persistent SCI after complex EVAR is low with the use of a dedicated SCI preventive protocol allowing the early diagnosis. Females, patients with ruptured aneurysms and preoperative renal insufficiency are at higher risk. Further studies are needed to customize the protocols particularly in those high-risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2024.1440674","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T01:26:44Z","timestamp":1722475604000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["A dedicated preventive protocol sustainably avoids spinal cord ischemia after endovascular aortic repair"],"prefix":"10.3389","volume":"11","author":[{"given":"Lina","family":"Rosvall","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelos","family":"Karelis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"Sonesson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuno V.","family":"Dias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1863","DOI":"10.1056\/NEJMoa0909305","article-title":"Endovascular versus open repair of abdominal aortic aneurysm","volume":"362","author":"Greenhalgh","year":"2010","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1097\/SLA.0000000000004982","article-title":"Midterm outcomes of a prospective, nonrandomized study to evaluate endovascular repair of Complex aortic aneurysms using fenestrated-branched endografts","volume":"274","author":"Oderich","year":"2021","journal-title":"Ann Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1016\/j.jvs.2021.10.039","article-title":"A systematic review of spinal cord ischemia prevention and management after open and endovascular aortic repair","volume":"75","author":"Lella","year":"2022","journal-title":"J Vasc Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1578","DOI":"10.1016\/j.jvs.2023.01.205","article-title":"Predictors and outcomes of spinal cord injury following complex branched\/fenestrated endovascular aortic repair in the US aortic research consortium","volume":"77","author":"Aucoin","year":"2023","journal-title":"J Vasc Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/j.jvs.2018.05.216","article-title":"Risk of spinal cord ischemia after fenestrated or branched endovascular repair of complex aortic aneurysms","volume":"69","author":"Spanos","year":"2019","journal-title":"J Vasc Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1450","DOI":"10.1016\/j.jvs.2015.07.066","article-title":"Spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms with fenestrated and branched stent grafts","volume":"62","author":"Katsargyris","year":"2015","journal-title":"J Vasc Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.jvs.2013.07.007","article-title":"Hypogastric and subclavian artery patency affects onset and recovery of spinal cord ischemia associated with aortic endografting","volume":"59","author":"Eagleton","year":"2014","journal-title":"J Vasc Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1016\/j.jvs.2015.12.062","article-title":"Intraoperative neuroprotective interventions prevent spinal cord ischemia and injury in thoracic endovascular aortic repair","volume":"63","author":"Acher","year":"2016","journal-title":"J Vasc Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1016\/j.ejcts.2011.01.046","article-title":"Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation?","volume":"40","author":"Weigang","year":"2011","journal-title":"Eur J Cardiothorac Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1007\/s00772-018-0410-z","article-title":"Staged procedures for prevention of spinal cord ischemia in endovascular aortic surgery","volume":"23","author":"Heidemann","year":"2018","journal-title":"Gefasschirurgie"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e396","DOI":"10.1097\/SLA.0000000000005653","article-title":"Multicenter study to evaluate endovascular repair of extent I\u2013III thoracoabdominal aneurysms without prophylactic cerebrospinal fluid drainage","volume":"278","author":"Marcondes","year":"2023","journal-title":"Ann Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/j.jvs.2020.07.107","article-title":"Spinal cord protection practices used during endovascular repair of complex aortic aneurysms by the U. S. aortic research consortium","volume":"73","author":"Aucoin","year":"2021","journal-title":"J Vasc Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/j.ejvs.2014.12.034","article-title":"Short-term outcome of spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms","volume":"49","author":"Dias","year":"2015","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1067\/mva.2002.123763","article-title":"Reporting standards for endovascular aortic aneurysm repair","volume":"35","author":"Chaikof","year":"2002","journal-title":"J Vasc Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1016\/j.jvs.2010.07.008","article-title":"Society for vascular surgery ad hoc committee on TRS. Reporting standards for thoracic endovascular aortic repair (TEVAR)","volume":"52","author":"Fillinger","year":"2010","journal-title":"J Vasc Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"4S","DOI":"10.1016\/j.jvs.2020.06.011","article-title":"Reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries","volume":"73","author":"Oderich","year":"2021","journal-title":"J Vasc Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1177\/1526602817690730","article-title":"Technical aspects of implanting the t-branch off-the-shelf multibranched stent-graft for thoracoabdominal aneurysms","volume":"24","author":"Tsilimparis","year":"2017","journal-title":"J Endovasc Ther"},{"key":"B18","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1016\/j.ejvs.2012.01.022","article-title":"Development of off-the-shelf stent grafts for juxtarenal abdominal aortic aneurysms","volume":"43","author":"Resch","year":"2012","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f7661","article-title":"Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial","volume":"348","author":"Powell","year":"2014","journal-title":"Br Med J"},{"key":"B20","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1016\/j.ejvs.2023.01.030","article-title":"Additional aortic coverage with an off the shelf, multibranched endograft compared with custom made devices for endovascular repair of pararenal abdominal aortic aneurysms","volume":"65","author":"Spath","year":"2023","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1016\/j.jvs.2019.05.053","article-title":"Women undergoing endovascular thoracoabdominal aortic aneurysm repair differ significantly from their male counterparts preoperatively and postoperatively","volume":"71","author":"Witheford","year":"2020","journal-title":"J Vasc Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"383","DOI":"10.3171\/2016.1.SPINE151199","article-title":"The use of lumbar drains in preventing spinal cord injury following thoracoabdominal aortic aneurysm repair: an updated systematic review and meta-analysis","volume":"25","author":"Khan","year":"2016","journal-title":"J Neurosurg Spine"},{"key":"B23","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.jvs.2008.07.076","article-title":"Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: a report of 486 patients treated from 1987 to 2008","volume":"49","author":"Wynn","year":"2009","journal-title":"J Vasc Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"15266028231215972","DOI":"10.1177\/15266028231215972","article-title":"Spinal cord protection during thoracic and thoracoabdominal endovascular aortic repair: 5-year results of a preventive protocol including prophylactic cerebrospinal fluid drainage in high-risk patients","author":"Borghese","year":"2023","journal-title":"J Endovasc Ther"},{"key":"B25","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.ejvs.2016.06.005","article-title":"Editor\u2019s choice\u2014management of descending thoracic aorta diseases: clinical practice guidelines of the European society for vascular surgery (ESVS)","volume":"53","author":"Riambau","year":"2017","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1478","DOI":"10.1016\/j.jvs.2021.10.050","article-title":"Systematic review and meta-analysis of association of prophylactic cerebrospinal fluid drainage in preventing spinal cord ischemia after thoracic endovascular aortic repair","volume":"75","author":"Zhang","year":"2022","journal-title":"J Vasc Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1016\/j.jvs.2024.01.156","article-title":"Outcomes of elective and non-elective fenestrated-branched endovascular aortic repair for treatment of thoracoabdominal aortic aneurysms","volume":"79","author":"Babocs","year":"2024","journal-title":"J Vasc Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.jvs.2024.02.041","article-title":"Prospective randomized pilot trial comparing prophylactic vs therapeutic cerebrospinal fluid drainage during complex endovascular thoracoabdominal aortic aneurysm repair","volume":"80","author":"Blakeslee-Carter","year":"2024","journal-title":"J Vasc Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1218","DOI":"10.1007\/s12630-017-0974-1","article-title":"Spinal cord injury after thoracic endovascular aortic aneurysm repair","volume":"64","author":"Awad","year":"2017","journal-title":"Can J Anaesth"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e452","DOI":"10.1097\/SLA.0000000000005044","article-title":"Association between hospital volume and failure to rescue after open or endovascular repair of intact abdominal aortic aneurysms in the VASCUNET and international consortium of vascular registries","volume":"274","author":"D'Oria","year":"2021","journal-title":"Ann Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e025488","DOI":"10.1136\/bmjopen-2018-025488","article-title":"Paraplegia prevention in aortic aneurysm repair by thoracoabdominal staging with \u2018minimally invasive staged segmental artery coil embolisation\u2019 (MIS(2)ACE): trial protocol for a randomised controlled multicentre trial","volume":"9","author":"Petroff","year":"2019","journal-title":"BMJ Open"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1440674\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T01:26:47Z","timestamp":1722475607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1440674\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":31,"alternative-id":["10.3389\/fcvm.2024.1440674"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2024.1440674","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,1]]},"article-number":"1440674"}}