TY - JOUR
T1 - Systematic Review of the Effect of Cerebrospinal Fluid Drainage on Outcomes After Endovascular Descending Thoracic/Thoraco-Abdominal Aortic Aneurysm Repair
AU - Frankort, Jelle
AU - Mees, Barend
AU - Doukas, Panagiotis
AU - Keszei, Andràs
AU - Kontopodis, Nikolaos
AU - Antoniou, George A.
AU - Jacobs, Michael J.
AU - Gombert, Alexander
N1 - Funding Information:
Funding: This work was supported by grants from the National Institutes of Health (T32 GM007250 and T32 AI089474 to B.Z., P01 AI141350 to D.W.A. and G.R.D., and R35 GM141603 to D.W.A.). Author contributions: B.Z. and C.B.R. conceived the project, designed and carried out the experiments, and collated and interpreted the data. B.Z. wrote the manuscript. B.Z., C.B.R., G.R.D., and D.W.A. edited the manuscript. Competing interests: The authors declare that they have no competing interests. Data and materials availability: All data needed to evaluate the conclusions in the paper are present in the paper or the Supplementary Materials. All cell lines generated are available upon reasonable request.
Publisher Copyright:
© 2023 European Society for Vascular Surgery
PY - 2023/10
Y1 - 2023/10
N2 - Objective: This study aimed to investigate whether prophylactic use of cerebrospinal fluid (CSF) drainage in endovascular descending thoracic aortic aneurysm (DTAA) and thoraco-abdominal aortic aneurysm (TAAA) repair contributes to a lower rate of post-operative spinal cord ischaemia (SCI). Data Sources: MEDLINE, Embase, and CINAHL. Review Methods: A literature review was conducted in accordance with PRISMA guidelines (PROSPERO registration no. CRD42021245893). Risk of bias was assessed through the Newcastle–Ottawa scale (NOS), and the certainty of evidence was graded using the GRADE approach. A proportion meta-analysis was conducted to calculate the pooled rate and 95% confidence interval (CI) of both early and late onset SCI. Pooled outcome estimates were calculated using the odds ratio (OR) and associated 95% CI. The primary outcome was SCI, both early and lateonset. Secondary outcomes were complications of CSF drainage, length of hospital stay, and peri-operative (30 day or in hospital) mortality rates. Results: Twenty-eight observational, retrospective studies were included, reporting4 814 patients (2 599 patients with and 2 215 without CSF drainage). The NOS showed a moderate risk of bias. The incidence of SCI was similar in patients with CSF drainage (0.05, 95% CI 0.03 ? 0.08) and without CSF drainage (0.05, 95% CI 0.00 ? 0.14). No significant decrease in SCI was found when using CSF drainage (OR 0.67, 95% CI 0.29 ? 1.55, p = .35). The incidence rate of CSF drainage related complication was 0.10 (95% CI 0.04 ? 0.19). The 30 day and in hospital mortality rate with CSF drainage was 0.08 (95% CI 0.05 ? 0.12). The 30 day and in hospital mortality rate without CSF drainage and comparison with late mortality and length of hospital stay could not be determined due to lack of data. The quality of evidence was considered very low. Conclusion: Pre-operative CSF drainage placement was not related to a favourable outcome regarding SCI rate in endovascular TAAA and DTAA repair. Due to the low quality of evidence, no clear recommendation on pre-operative use of CSF drainage placement can be made.
AB - Objective: This study aimed to investigate whether prophylactic use of cerebrospinal fluid (CSF) drainage in endovascular descending thoracic aortic aneurysm (DTAA) and thoraco-abdominal aortic aneurysm (TAAA) repair contributes to a lower rate of post-operative spinal cord ischaemia (SCI). Data Sources: MEDLINE, Embase, and CINAHL. Review Methods: A literature review was conducted in accordance with PRISMA guidelines (PROSPERO registration no. CRD42021245893). Risk of bias was assessed through the Newcastle–Ottawa scale (NOS), and the certainty of evidence was graded using the GRADE approach. A proportion meta-analysis was conducted to calculate the pooled rate and 95% confidence interval (CI) of both early and late onset SCI. Pooled outcome estimates were calculated using the odds ratio (OR) and associated 95% CI. The primary outcome was SCI, both early and lateonset. Secondary outcomes were complications of CSF drainage, length of hospital stay, and peri-operative (30 day or in hospital) mortality rates. Results: Twenty-eight observational, retrospective studies were included, reporting4 814 patients (2 599 patients with and 2 215 without CSF drainage). The NOS showed a moderate risk of bias. The incidence of SCI was similar in patients with CSF drainage (0.05, 95% CI 0.03 ? 0.08) and without CSF drainage (0.05, 95% CI 0.00 ? 0.14). No significant decrease in SCI was found when using CSF drainage (OR 0.67, 95% CI 0.29 ? 1.55, p = .35). The incidence rate of CSF drainage related complication was 0.10 (95% CI 0.04 ? 0.19). The 30 day and in hospital mortality rate with CSF drainage was 0.08 (95% CI 0.05 ? 0.12). The 30 day and in hospital mortality rate without CSF drainage and comparison with late mortality and length of hospital stay could not be determined due to lack of data. The quality of evidence was considered very low. Conclusion: Pre-operative CSF drainage placement was not related to a favourable outcome regarding SCI rate in endovascular TAAA and DTAA repair. Due to the low quality of evidence, no clear recommendation on pre-operative use of CSF drainage placement can be made.
KW - Cerebrospinal fluid drainage
KW - Descending thoracic aortic aneurysm repair
KW - Spinal cord ischaemia
KW - Thoraco-abdominal aortic aneurysm repair
U2 - 10.1016/j.ejvs.2023.05.006
DO - 10.1016/j.ejvs.2023.05.006
M3 - (Systematic) Review article
C2 - 37182608
SN - 1078-5884
VL - 66
SP - 501
EP - 512
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 4
ER -