Role for Lumbar Cerebrospinal Fluid Drainage in High-risk Thoracic Endovascular Aortic Repair: A Narrative Review

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.