Paraplegia events and follow-up results after thoracic endovascular aortic repair.

Abstract

Objective: To retrospectively investigate the clinical characteristics, risk factors, and prognosis of paraplegia complications after thoracic endovascular aortic repair (TEVAR).

Methods: A total of 420 patients with Stanford type B acute aortic dissection who underwent TEVAR between December 2015 and December 2020 were divided into a non-paraplegic (403 patients) or paraplegic group (17 patients) according to the presence or absence of paraplegia. Logistic regression analysis was used to identify the risk factors for paraplegia. The patients were followed up for a median of 38 months (interquartile range[IQR]: 24-50 months), and the clinical outcomes of the patients in the two groups were assessed. The primary endpoint was death from any cause. The Kaplan-Meier estimation was applied to determine the time to the primary endpoint, while the log-rank test was employed to compare group survival rates. Additionally, Cox regression analysis was used to detect the factors influencing the survival rate of the two groups.

Results: The overall incidence of paraplegia after TEVAR was 4.05% (17/420 patients). The paraplegic and non-paraplegic groups were significantly different in terms of hypertension, false lumen thrombosis, perioperative hypotension, distance from the stent end to the ostia of celiac axis, and the rate of distal true lumen stenosis (p < 0.1). One-way logistic regression analysis of these factors showed that hypertension, false lumen thrombosis,perioperative hypotension, distance from the stent end to the ostia of celiac axis, and the rate of distal true lumen stenosis were significant risk factors for paraplegia (p < 0.1). Further, multivariate logistic regression analysis demonstrated significant differences in perioperative hypotension, distance from the stent end to the ostia of celiac axis, and the rate of distal true lumen stenosis (P < 0.01). The Kaplan-Meier curves revealed significant differences in all-cause mortality between the paraplegic and non-paraplegic groups (hazard ratio [HR], 11.57; 95% confidence interval [CI], 2.58-51.76; P = 0.00). Moreover, Cox regression analysis indicated that paraplegia was an independent risk factor for all-cause mortality after TEVAR (HR, 3.05; 95% CI, 1.20-7.79; P= 0.01).

Conclusion: The overall incidence of concomitant paraplegia after TEVAR was 4.05%. Perioperative hypotension, distance from the stent end to the ostia of celiac axis, and the rate of distal true lumen stenosis were independent risk factors for the postoperative occurrence of paraplegia. During a median follow-up of 38 months, a significant difference in survival rate was found between the patients in the paraplegic and non-paraplegic groups. Furthermore, paraplegia was an independent risk factor for all-cause mortality in patients after endovascular aortic repair.