3:36 PM Abstract No. 95 Minimization of spinal cord ischemia after thoracoabdominal aortic aneurysm repair with coil embolization of intercostal/lumbar artery origin(s): initial experience

Paraplegia resulting from spinal cord ischemia remains one of the most feared complications of thoracoabdominal aortic aneurysm (TAAA) or thoracic aortic aneurysm (TAA) repair. Staged preoperative embolization of the intercostal and/or lumbar artery origin(s), sometimes referred to as minimally invasive segmental artery coil embolization (MISACE), should stimulate development of the paravertebral collateral arterial supply and may thereby theoretically reduce the risk of postoperative spinal cord ischemia that occurs with long-coverage thoracic and/or abdominal aortic aneurysm repairs. The purpose of this study was to assess the safety and potential complications of this technique prior to open TAAA or TAA repair. Retrospective review of our procedural database yielded 7 patients who underwent selective coil embolization of the origin of one or more intercostal and/or lumbar arteries (MISACE) prior to open TAA or TAAA repair. Medical records were reviewed for the development of neurologic sequelae or other complications post procedure. Outcomes after TAA/TAAA repair were also reviewed. MISACE was technically successful in all 7 patients. 3 patients underwent two-stage MISACE, with two weeks separating each procedure, and 4 patients underwent single-stage MISACE. The mean total number of intercostal and/or lumbar arteries embolized was 5 (range, 1 – 12). The time interval between MISACE and open TAA/TAAA repair ranged from 7 to 82 days. There were no neurologic sequelae attributable to MISACE or any other complications following MISACE and prior to TAA/TAAA repair. During TAA/TAAA repair, between 18 and 26 intercostal and lumbar arteries were excluded by the stent graft. One patient suffered postoperative paraplegia; embolization had been performed 4 weeks preoperatively, in this patient with prior TEVAR who then underwent open TAAA repair with complete aortic debranching. MISACE was safe in this small cohort of patients. Further research is needed with regard to the optimal interval between MISACE and TAA/TAAA repair and the number and location of arteries embolized.