Page 241 - Read Online

Page 6 of 14 Sufali et al. Vessel Plus 2024;8:16 https://dx.doi.org/10.20517/2574-1209.2023.139

Each patient received a preoperative evaluation by an anesthesiologist of a dedicated team, with the
[22]
assignment of a score according to the American Society of Anesthesiologists (ASA) scoring system .
Statistical analysis
Continuous variables are reported as mean ± standard deviation (SD) or median (interquartile range), when
the sample number was insufficient to allow a gaussian distribution. Categorical variables are expressed as
frequency. Survival was estimated by the Kaplan-Meier method. Statistical analysis was performed using
SPSS 25.0 for Windows software (SPSS, Inc., Chicago, IL).

RESULTS
A total of 104 patients underwent elective endovascular repair in the period of study, with 6 (6%) presenting
with Crawford’s extent I, 51 (49%) with extent II, and 47 (45%) with extent III. Table 2 provides a summary
of demographic and clinical characteristics of the population (71% male, mean age 73 ± 6 years). Aneurysm
characteristics and procedural details are reported in Table 3. Forty-eight (46%) patients have had a
previous aortic procedure, mostly a surgical aortic repair (39 out of 48 patients). All the procedures were
performed under general anesthesia. A single-stage repair was performed in 20% of cases, with 80%
undergoing a staged repair, according to endograft design, anatomical and clinical characteristics. A
fenestrated device was used in 18% and a branched device in 68% of cases, with a custom-made device with
fenestrations and branches chosen in the remaining 14% of cases. To ensure an adequate proximal and
distal sealing zone, a thoracic endograft was deployed in 95 cases, 22 during a previously planned step and
73 simultaneously with the thoracoabdominal module release. Thirteen supra-aortic trunks debranching
were also needed, and an iliac branch device was used in 18 patients. Prophylactic spinal drainage was
performed overall in 90% of cases; and in 81% of staged repairs, it was also used in the second stage. The
mean ICU stay was 5 ± 5 days and the mean hospital stay was 25 ± 22 days.

Postoperative events are reported in Table 4. Eight patients developed SCI: 2 transitory, with complete
regression of symptoms, and 6 with different severity degrees of permanent deficits. Among the latest, 3
cases had permanent paraplegia. Details of the 8 patients with SCI are specified in Table 5. Five cases of
cerebral hemorrhage were detected, 2 among SCI patients (one having a post-traumatic cerebral
hemorrhage that occurred after the aortic repair). Postoperative cardiac and pulmonary morbidity were
reported in 6 cases, respectively. A renal function worsening of any degree occurred in 21 (20%) of the
patients, 3 requiring hemodialysis (2 permanently).

Three patients died within 30 postoperative days, while other 4 during a prolonged/complicated
hospitalization (overall in-hospital mortality 7%). The mean follow-up was 30 ± 18 months. Overall
estimated 3-year survival was 62%, with a significant difference in survival at 2 years of follow-up between
patients with and without postoperative SCI (SCI: 18% vs. no-SCI: 69%; P < 0.001), as shown in Figure 1.

DISCUSSION
The dedicated multidisciplinary SCI prevention protocol in elective F/B-EVAR for Crawford’s I-III TAAAs
analyzed in this paper led to encouraging rates of SCI (8% overall SCI, 6% permanent impairment with 3%
paraplegia).