Let us introduce ourselves

The Casper Research Group

Thoracic Endovascular Aortic Repair (TEVAR) has become of increasingly importance since its introduction into clinical practice. Compared to open repair TEVAR carries a lower rate of morbidity and mortality, especially regarding spinal cord ischemia (SCI). However, 1 to 10% of patients undergoing a TEVAR might develop temporary or permanent neurologic symptoms due to spinal cord ischemia.

A number of potential factors for SCI following surgery of the descending aorta might exist, which include the extent of the aneurysm extent (related to number of segmental arteries that will be compromised due to the procedure) and its location. Moreover, peri- and postoperative hypotension may play an important role.

Therefore, current concepts in the prevention of SCI include maintaining an adequate perfusion pressure of the spinal cord as well as extensive neuro-monitoring and pharmacological neuro-protection. Further, there is evidence that the use of a cerebrospinal fluid (CSF) drain may lower the risk of SCI at least in patients undergoing open surgery of a thoraco-abdominal aneurysm or dissection.

For endovascular procedures there is currently no consensus about the exact role and benefit of CSF drainage in thoraco-abdominal aneurysms. Currently, only a few randomized controlled trials with heterogeneous results are available.

Consequently, the most recent guidelines of the European Society of Cardiothoracic Surgery (EACTS) for the use of CSF drains in TEVAR procedures and other prophylactic treatments are mainly based on expert opinions regarding patient selection, indications for placement and timing of insertion of spinal catheters.

On the other hand, placing a CSF drain may carry the risk of complications such as direct nerve damage, spinal hematoma, and catheter infections. To date, the exact incidence of these complications or adverse events remains unknown.

CASPER research team:
Department of Anesthesiology and Pain Medicine
Department of Vascular Surgery

K. Houtoff Khemlani, MD, MSc (Consultant Anaesthetist)
J.U. Schreiber, MD, PhD (Consultant Anaesthetist)
W. Buhre, MD, PhD (Professor of Anesthesiology)
G.W. Schurink, MD, PhD (Professor of Vascular Surgery)