Background
Thoracic endovascular aortic repair (TEVAR) may be associated with a risk of spinal cord ischemia (SCI). Cerebrospinal fluid (CSF) drainage has emerged as an effective adjunct to reduce SCI in TEVAR for the degenerative thoracic aortic aneurysm. Type B dissection often needs a shorter stent graft implanted in the proximal thoracic aorta, and CSF drainage is seldom employed. However, when a longer segment is involved, especially when a secondary stent graft is distally needed to cover the new-onset entry tears, the CSF monitoring and drainage have scarcely been reported. This study reviewed the effect of CSF drainage on the dissections requiring a distal second stent graft.
Methods
Four type B dissected cases were gathered recently for the late-appearing intimal ruptures distal to the stent graft implanted 12–24 months ago. Preoperatively, CSF monitoring and drainage system was setup. All the patients received the second stent grafts deployed adjacent to the initial ones. During a 72-h intra- and postoperative period, once the CSF pressure significantly increased, CSF drainage was performed to maintain the pressure at or slightly below its preoperative basic level. In addition, the systolic blood pressure was maintained at ≥90 mmHg in that period.
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