Neuromonitoring, Cerebrospinal Fluid Drainage, and Selective Use of Iliofemoral Conduits to Minimize Risk of XXXX During Complex Endovascular Aortic Repair.

@entity1 @entity101 @entity63 @entity2334 @entity439 @entity1566
PURPOSE: To review outcomes of continuous motor/somatosensory-evoked potential (MEP/SSEP) monitoring, cerebrospinal fluid drainage, and selective use of iliofemoral conduits in @entity1 undergoing endovascular repair of descending thoracic @entity439 (DTA) and @entity2334 ( @entity2334 ). METHODS: The clinical data of 49 @entity1 (mean age 75  8 years; 38 @entity1 ) who underwent endovascular repair of DTA and @entity2334 (2011-2014) were reviewed. All @entity1 had cerebrospinal fluid drainage, permissive @entity101 (mean arterial pressure >= 80 mm Hg), and MEP/SSEP monitoring. There were 44 (90%) @entity1 with @entity2334 and 5 (10%) with DTA. Types I and II @entity2334 were repaired in staged procedures. Iliofemoral conduits were used for small iliac arteries and to minimize time of lower extremity @entity63 in @entity1 with difficult anatomy. In @entity1 with changes in MEP/SSEPs, a standardized protocol was employed to optimize spinal cord perfusion and restore lower extremity blood flow. Endpoints were mortality, @entity1566 ( @entity1566 ), and lower extremity @entity63 complications. RESULTS: Sixteen (33%) @entity1 had staged TAAA repair. A total of 163 visceral arteries were targeted by fenestrations and branches (mean 3.7  1.0 vessels/ @entity1 ). Temporary iliofemoral conduits were used in 16 limbs/14 @entity1 . A stable MEP/SSEP was achieved in all @entity1 . Thirty-one (63%) @entity1 had a >= 75% decrease in MEP/SSEP amplitude in 50 limbs starting on average 75  28 minutes after obtaining vascular access. MEP/SSEP amplitude improved with maneuvers in 12 (39%) @entity1 and returned to baseline with restoration of lower extremity flow in all except 1 @entity1 who developed immediate @entity1566 . Thirty-day mortality was 4%. Three (6%) @entity1 had @entity1566 , 2 permanent and 1 temporary at 14 days. There were no lower extremity @entity63 complications. CONCLUSION: Neuromonitoring predicted immediate @entity1566 and allowed use of a protocol to optimize spinal cord and lower extremity perfusion during complex endovascular aortic repair. Larger clinical experience is needed to evaluate the efficacy of neuromonitoring to prevent @entity1566 .
