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Sufali et al. Vessel Plus 2024;8:16 https://dx.doi.org/10.20517/2574-1209.2023.139 Page 7 of 14

Table 2. Demographic and CLINICAL CHARACTEristics of 104 patients receiving F/B-EVAR for Crawford’s I-III TAAAs
Overall SCI Non-SCI
Variable P value
N = 104 N = 8 (7.7%) N = 96 (92.3%)
Male gender 74 (71.2) 6 (75.0) 68 (70.8) 1.000
Age 72.6 ± 6.3 73 (78-68) 72.5 ± 6.2 1.000
Hypertension 102 (98.1) 8 (100) 94 (97.9) 1.000
Tobacco use 72 (69.2) 4 (50.0) 68 (70.8) 0.433
Dyslipidemia 70 (67.3) 4 (50.0) 66 (68.8) 0.277
Diabetes 10 (9.6) 0 (0.0) 10 (10.4) 1.000
BMI > 31 13 (12.6) 0 (0.0) 13 (13.7) 0.591
Chronic renal impairment 52 (50.0) 3 (37.5) 49 (51.0) 0.715
Hemodialysis 5 (4.8) 1 (12.5) 4 (4.2) 0.335
Coronary artery disease 38 (36.5) 4 (50.0) 34 (35.4) 0.459
Chronic obstructive pulmonary disease 46 (44.2) 2 (25.0) 44 (45.8) 0.297
Peripheral artery occlusive disease 18 (17.3) 1 (12.5) 17 (17.7) 1.000
Cerebrovascular disease 7 (6.7) 0 (0.0) 7 (7.3) 1.000
History of stroke/TIA 11 (10.6) 0 (0.0) 11 (11.5) 0.595
Atrial fibrillation 11 (10.6) 2 (25.0) 9 (9.4) 0.200
Anticoagulant medication 11 (10.6) 1 (12.5) 10 (10.4) 1.000
BMI: Body mass index. Continuous data are presented as the means ± SD or median (IQR); categorical data are given as the counts (percentage).

The beneficial effect of a bundled protocol for SCI prevention was already shown by Scali et al., who
compared the results of F/B-EVAR before and after the introduction of a dedicated protocol for SCI
prevention, including cerebrospinal fluid drainage, blood pressure control, transfusion strategy, and
pharmacological adjuncts (steroids, naloxone) . They found a significant reduction in SCI rate from 13%
[23]
to 3% (P = 0.007), with even more significant results in Crawford’s extent I-III TAAA (19% vs. 4%,
P = 0.004). Moreover, a subsequent beneficial effect on 1-year survival was obtained, with an increase from
90% to 99% after the introduction of the protocol (P = 0.05), although a possible influence by a combination
of factors such as the natural learning curve of the surgeons may have occurred.

As a matter of fact, a study on Vascular Quality Initiative data published in 2021 by Aucoin et al. also
showed a decrease in SCI rates over the study period (2014-2019), despite an unchanged use of prophylactic
CSFD . This finding suggests that other measures included in the protocols over the years may contribute
[4]
to better outcomes.

In our series, the combined 30-day/in-hospital mortality was significantly higher in patients with SCI
(P:0.032). Moreover, patients with SCI had a lower survival rate than patients without SCI at follow-up (18%
and 69% at 2 years, respectively).

Similar results were reported by Heidemann et al. In their multicenter retrospective cohort study including
877 patients treated with F/B-BEVAR for a juxta-/para-renal aneurysm or a TAAA, SCI occurred in 10.7%
of cases . Among all the SCI cases reported, 37% occurred after 30 days from the endovascular treatment.
[24]
In their study, SCI was not associated with a higher in-hospital/30-day mortality, but with later mortality
(14.7% of 90-day mortality in patients presenting SCI compared to 1.1% of those without SCI, P > 0.05). The
authors suggest that these results may be due to the effectiveness of the intensive care units, with a worse
outcome occurring in the patients transferred to other clinical settings.