Splanchnic occlusive disease is associated with spinal cord injury in patients undergoing descending thoracic (DTA) and thoracoabdominal aortic (TAAA) aneurysm open repair, according to research published in the Journal of Vascular Surgery.
To evaluate the impact of splanchnic occlusive disease on spinal cord injury and major adverse events following these procedures, researchers conducted a retrospective review of prospectively collected data from a DTA/TAAA database at the Weill Cornell Medical College Department of Cardiothoracic Surgery in New York.
Patients who underwent DTA/TAAA repair between 1997 and 2019 with validated splanchnic occlusive disease were included in the study.
Throughout the study period, 888 patients underwent DTA/TAAA repair; 19 were excluded due to missing data. Patients were group based on the absence or presence of splanchnic occlusive disease (81.9% vs 18%). Patients with splanchnic occlusive disease had a higher risk profile, including decreased left ventricular ejection fraction (45% vs 50%), more frequent renal impairment (38.9% vs 24.6%), and higher rates of peripheral arterial disease (38.2% vs 22.8%) compared to patients who did not present with splanchnic occlusive disease.
Aortic disease etiology was more frequently attributed to aortic dissection in the group with splanchnic occlusive disease (56.1% vs 43.7%), whereas nondissecting aneurysm was more likely the etiology in the group without splanchnic occlusive disease (56.3% vs 43.9%).
Patients without splanchnic occlusive disease were more likely to present with aneurysms that were more cranially located. Comparatively, patients with splanchnic occlusive disease were more likely to present with caudally loaded aneurysms; this group also presented with longer aortic clamp and splanchnic ischemic times (41 vs 19 minutes; 28 vs 24.5 minutes, respectively). Splanchnic perfusion was more frequent in this group.
After propensity score matching, investigators had 144 patient pairs. Matched patients with splanchnic occlusive disease had a longer splanchnic ischemic time and higher use of splanchnic perfusion (28 min vs 26 min; 67.4% vs 42.4%, respectively). This group also had a higher rate of spinal cord injury and major adverse events (6.9% vs 1.4%; 32.6% vs 18.1%, respectively). Subgroup analyses for extent I to III TAAA repairs confirmed increased spinal cord injury rates and major adverse events in patients with splanchnic occlusive disease (8.1% vs 1.7%; 36.9% vs 20.5%, respectively).
Finally, sensitivity analyses with multivariable regression confirmed that spinal cord injury and aneurysm extent were both significant predictors of splanchnic occlusive disease (odds ratio, 2.48 and 3.80; 95% CI, 1.04-5.87 and 1.10-13.12, respectively). Survival in this group was decreased at years 1, 5, and 10.
Study limitations include an inability to validate the diagnosis via radiologic or clinical records in 36 patients and a potential lack of generalizability to surgical centers not specialized in DTA/TAAA repair.
“[Splanchnic occlusive disease] is a significant predictor of [spinal cord injury] in patients undergoing open DTA/TAAA repair,” the researchers concluded. “The investigation of measures to prolong neuronal ischemia tolerance (e.g. hypothermia) is warranted in such patients.”
Gambardella I, Lau C, Gaudino MFL, et al. Splanchnic occlusive disease predicts spinal cord injury after open descending thoracic and thoraco-abdominal aneurysm repair. J Vasc Surg. Published online March 4, 2021. doi:10.1016/j.jvs.2021.02.030