Spinal Cord Infarction After Aortic Intervention
What is the rate of spinal cord infarction (SCI) after surgical or endovascular repair of aortic aneurysm or dissection?
Administrative claims data from nonfederal acute care hospitals in California, New York, and Florida were analyzed. Surgical or endovascular repairs of aortic aneurysms and dissection between 2005 and 2013 were evaluated, and SCI during index hospitalization for aortic repair was identified. Rates were compared using exact confidence intervals stratified by diagnosis (dissection, ruptured aneurysm, or unruptured aneurysm) and technique (surgical vs. endovascular).
SCI occurred in 235 of 91,212 patients who had repair of an aortic aneurysm or dissection (0.26%; 95% confidence interval [CI], 0.22%–0.29%). The highest rates of SCI were observed with ruptured aneurysm or dissection (0.74%; 95% CI, 0.60%–0.88%) compared with 0.16% (95% CI, 0.13%–0.19%) for unruptured aneurysm. SCI rates were similar after endovascular versus surgical repair of ruptured aneurysm or dissection (0.91%; 95% CI, 0.62%–1.19% vs. 0.68%; 95% CI, 0.53%–0.83%; p = 0.147). Higher SCI rates were observed, however, following surgical repair of unruptured aneurysms (0.20%; 95% CI, 0.15%–0.25% vs. 0.08%-0.14% for endovascular repair; p < 0.001).
SCI occurs in approximately 1 in 130 patients undergoing aortic dissection or ruptured aortic aneurysm repair, and in 1 in 600 patients undergoing unruptured aortic aneurysm repair.
Aortic aneurysm and dissection are not mutually exclusive, and these diagnoses often coexist in the same patient, but may or may not be coded as such. The approach used in this retrospective administrative data analysis therefore may have been limited by misclassification. Lack of anatomic data (including aneurysm diameter, branch patency, and extent of aortic replacement or coverage) are other factors that limit conclusions that can be drawn from this analysis.
These limitations aside, administrative data can often be a valuable source of evidence related to adverse perioperative events, providing evidence from a spectrum of low-, medium-, and high-volume centers while avoiding negative publication bias. This study provides useful information related to rates and risk factors for SCI, a rare but potentially devastating complication for patients undergoing aortic procedures. The results support previously published findings suggesting increased risk of SCI associated with procedures performed as emergencies or dissection as the primary diagnosis. The higher SCI rate observed after surgical repair of intact aneurysms warrants consideration during treatment selection, although the absolute risk reduction associated with endovascular repair was small in magnitude and therefore might not always justify tradeoffs with long-term, aneurysm-specific outcomes.
Keywords: Aneurysm, Dissecting, Aortic Aneurysm, Aortic Rupture, Cardiac Surgical Procedures, Endovascular Procedures, Infarction, Risk Factors, Spinal Cord Ischemia, Stroke, Treatment Outcome, Vascular Diseases
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