Assessment of risk factors for spinal cord ischaemia in surgery of thoracoabdominal aneurysms without use of adjuncts

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Abstract
Between January 1983 and June 1986, 61 patients underwent resection of athoracoabdominal aneurysm (TAA) by means of simple cross-clamping withoutthe use of adjuncts. All patients survived the operation. Mortality was6.5% at 30 days and 16.4% at 1 year. Spinal cord injury occurred in 8patients. Three patients sustained paraplegia and 5 patients recovered fromparaparesis within 6 months. In univariate analysis, risk factors were thepresence of symptoms (P less than or equal to 0.01) and emergency operation(P less than or equal to 0.03). Spinal cross-clamptime (ACX), aetiology andthe number of open intercostal arteries (ICA) did not appear to be singledenominators for spinal cord injury. Testing clusters of variable relatedto spinal cord injury revealed an increased risk for the group of patients(n = 20) with type I (most of the thoracic and the upper abdominal aorta)and type III (the distal half of the thoracic and varying segments of theabdominal aorta) aneurysms, when the number of ICA was greater than orequal to 4 or less than or equal to 1, with a spinal ACX of greater than orequal to 35 min, and in the presence of symptoms and previous dissection (P= 0.001). In patients (n = 19) with type II aneurysm (involving most of thethoracic and most of the abdominal aorta) an increased risk was presentwhen the number of open ICA was greater than or equal to 4, with a spinalACX of greater than or equal to 35 min and in the presence of symptoms (P =0.01). Spinal cord injury was confined to these types of TAA (P less thanor equal to 0.001) and paraplegia occurred only in type I and IIIaneurysms.

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