Martha M Wynn1, Joshua Sebranek2, Erich Marks2, Travis Engelbert3, Charles W Acher3. 1. Departments of Anesthesiology. Electronic address: mmwynn@facstaff.wisc.edu. 2. Departments of Anesthesiology. 3. Surgery, University of Wisconsin School of Medicine and Public Health, Madison WI.
Abstract
OBJECTIVE: To study complications from spinal fluid drainage in open thoracic/thoracoabdominal and thoracic endovascular aortic aneurysm repairs to define risks of spinal fluid drainage. DESIGN: Retrospective, prospectively maintained, institutionally approved database. SETTING: Single institution university center. PARTICIPANTS: 724 patients treated from 1987 to 2013 INTERVENTIONS: The authors drained spinal fluid to a pressure≤6 mmHg during thoracic aortic occlusion/reperfusion in open and ≤8 mmHg after stent deployment in endovascular procedures. Low pressure was maintained until leg strength was documented. If bloody fluid appeared, drainage was stopped. Head computed tomography (CT) and, if indicated, spine CT and magnetic resonance imaging (MRI) were performed for bloody spinal fluid or neurologic deficit. MEASUREMENTS AND MAIN RESULTS: Spinal fluid drainage was studied for bloody fluid, CT/MRI-identified intracranial and spinal bleeding, neurologic deficit, and death. Seventy-three patients (10.1%) had bloody fluid; 38 (5.2%) had intracranial blood on CT. One patient had spinal epidural hematoma. Higher volume of fluid drained and higher central venous pressure during proximal clamping were associated with intracranial blood. Most patients with intracranial blood were asymptomatic. Six patients had neurologic deficits: of the 6, 3 died (0.4%), 1 (0.1%) had permanent hemiparesis, and 2 recovered. Three of the six deficits were delayed, associated with heparin anticoagulation. CONCLUSIONS: 10% of patients had bloody spinal fluid; half of these had intracranial bleeding, which was almost always asymptomatic. In these patients, immediately stopping drainage and correcting coagulopathy may decrease the risk of serious complications. Neurologic deficit from spinal fluid drainage is uncommon (0.8%), but has high morbidity and mortality.
OBJECTIVE: To study complications from spinal fluid drainage in open thoracic/thoracoabdominal and thoracic endovascular aortic aneurysm repairs to define risks of spinal fluid drainage. DESIGN: Retrospective, prospectively maintained, institutionally approved database. SETTING: Single institution university center. PARTICIPANTS: 724 patients treated from 1987 to 2013 INTERVENTIONS: The authors drained spinal fluid to a pressure≤6 mmHg during thoracic aortic occlusion/reperfusion in open and ≤8 mmHg after stent deployment in endovascular procedures. Low pressure was maintained until leg strength was documented. If bloody fluid appeared, drainage was stopped. Head computed tomography (CT) and, if indicated, spine CT and magnetic resonance imaging (MRI) were performed for bloody spinal fluid or neurologic deficit. MEASUREMENTS AND MAIN RESULTS: Spinal fluid drainage was studied for bloody fluid, CT/MRI-identified intracranial and spinal bleeding, neurologic deficit, and death. Seventy-three patients (10.1%) had bloody fluid; 38 (5.2%) had intracranial blood on CT. One patient had spinal epidural hematoma. Higher volume of fluid drained and higher central venous pressure during proximal clamping were associated with intracranial blood. Most patients with intracranial blood were asymptomatic. Six patients had neurologic deficits: of the 6, 3 died (0.4%), 1 (0.1%) had permanent hemiparesis, and 2 recovered. Three of the six deficits were delayed, associated with heparin anticoagulation. CONCLUSIONS: 10% of patients had bloody spinal fluid; half of these had intracranial bleeding, which was almost always asymptomatic. In these patients, immediately stopping drainage and correcting coagulopathy may decrease the risk of serious complications. Neurologic deficit from spinal fluid drainage is uncommon (0.8%), but has high morbidity and mortality.
Authors: Jacob T Gutsche; Hynek Riha; Prakash Pate; Lance Atchley; Elizabeth Valentine; Ronak Shah; Sophia T Cisler; Stuart J Weiss; George Silvay; John G T Augoustides Journal: Heart Lung Vessel Date: 2015
Authors: John R Spratt; Kristen L Walker; Tyler J Wallen; Dan Neal; Yury Zasimovich; George J Arnaoutakis; Tomas D Martin; Martin R Back; Salvatore T Scali; Thomas M Beaver Journal: JTCVS Tech Date: 2022-05-11
Authors: Stefano De Paulis; Gabriella Arlotta; Maria Calabrese; Filippo Corsi; Temistocle Taccheri; Maria Enrica Antoniucci; Lorenzo Martinelli; Francesca Bevilacqua; Giovanni Tinelli; Franco Cavaliere Journal: J Pers Med Date: 2022-08-22