Lumbar cerebrospinal fluid (CSF) drainage is one of the few preventative and therapeutic practices that may reduce spinal cord ischemia in high-risk thoracic endovascular aortic aneurysm repair (TEVAR). Although this is part of clinical guidelines in open thoracoabdominal aortic repair, there are no randomized controlled trials that provide convincing evidence on the protection conferred by CSF drainage in high-risk TEVAR patients. This gap in knowledge obfuscates clinical decision making given the risk of significant complications of CSF drain insertion and management. The current literature is inconclusive and provides conflicting results regarding the efficacy of, and complications from, CSF drainage in TEVAR. Filling the knowledge gap resulting from the limited current state of the literature warrants additional high-quality randomized controlled clinical trials that balance CSF drainage efficacy with potential complications in high-risk TEVAR patients.
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December 2024
Role for Lumbar Cerebrospinal Fluid Drainage in High-risk Thoracic Endovascular Aortic Repair: A Narrative Review
Thomas Shelton, M.D.;
Thomas Shelton, M.D.
1The Ohio State University College of Medicine, Columbus, Ohio.
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Bradley Gigax, B.S.;
Bradley Gigax, B.S.
2Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Ahmed H. Aly, M.D., Ph.D.;
Ahmed H. Aly, M.D., Ph.D.
3Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Katherine Choi, B.A.;
Katherine Choi, B.A.
4The Ohio State University College of Medicine, Columbus, Ohio.
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Esmerina Tili, Ph.D.;
Esmerina Tili, Ph.D.
5Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Kristine Orion, M.D.;
Kristine Orion, M.D.
6Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Bijan Modarai, M.D., Ph.D.;
Bijan Modarai, M.D., Ph.D.
7Academic Department of Vascular Surgery, South Bank Section, School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, United Kingdom.
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Adam Beck, M.D.;
Adam Beck, M.D.
8Division of Vascular Surgery and Endovascular Therapy, The University of Alabama at Birmingham, Birmingham, Alabama.
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Hilary P. Grocott, M.D.;
Hilary P. Grocott, M.D.
9Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada.
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Hamdy Awad, M.D.
Hamdy Awad, M.D.
10Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Submitted for publication March 11, 2024. Accepted for publication August 12, 2024.
Address correspondence to Dr. Awad: Department of Anesthesiology, Ohio State University Wexner Medical Center, 420 W 12th Ave, Columbus, Ohio. hamdy.elsayed-awad@osumc.edu
Anesthesiology December 2024, Vol. 141, 1175–1190.
Citation
Thomas Shelton, Bradley Gigax, Ahmed H. Aly, Katherine Choi, Esmerina Tili, Kristine Orion, Bijan Modarai, Adam Beck, Hilary P. Grocott, Hamdy Awad; Role for Lumbar Cerebrospinal Fluid Drainage in High-risk Thoracic Endovascular Aortic Repair: A Narrative Review. Anesthesiology 2024; 141:1175–1190 doi: https://doi.org/10.1097/ALN.0000000000005200
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