Neuromonitoring during Endovascular Thoracoabdominal Aortic Aneurysm Repair: A Systematic Review.

Publisher: Elsevier Country of Publication: Netherlands NLM ID: 8703941 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1615-5947 (Electronic) Linking ISSN: 08905096 NLM ISO Abbreviation: Ann Vasc Surg Subsets: MEDLINE

Publication: <2007->: Netherlands : Elsevier
Original Publication: Detroit : [Published by Expansion scientifique française for Annals of Vascular Surgery, Inc. and Association pour la promotion de la chirurgie vasculaire, Paris, c1986-

Endovascular Procedures*/adverse effects ; Endovascular Procedures*/mortality ; Aortic Aneurysm, Thoracic*/surgery ; Aortic Aneurysm, Thoracic*/mortality ; Aortic Aneurysm, Thoracic*/physiopathology ; Aortic Aneurysm, Thoracic*/diagnostic imaging ; Spinal Cord Ischemia*/prevention & control ; Spinal Cord Ischemia*/etiology ; Spinal Cord Ischemia*/diagnosis ; Spinal Cord Ischemia*/physiopathology ; Intraoperative Neurophysiological Monitoring* ; Blood Vessel Prosthesis Implantation*/adverse effects ; Blood Vessel Prosthesis Implantation*/mortality ; Evoked Potentials, Motor* ; Evoked Potentials, Somatosensory* ; Predictive Value of Tests*; Humans ; Risk Factors ; Treatment Outcome ; Female ; Male ; Aged ; Risk Assessment ; Spectroscopy, Near-Infrared ; Middle Aged ; Incidence ; Aortic Aneurysm, Thoracoabdominal

Background: Spinal cord ischemia (SCI) is a potentially devastating complication of thoracic endovascular aortic repair (TEVAR) and fenestrated-branched endovascular aortic repair (F-BEVAR). The aim of this systematic review was to evaluate the efficacy of neuromonitoring modalities to mitigate the risk of SCI during TEVAR and F-BEVAR procedures.
Methods: Following the PRISMA guidelines, we conducted a detailed literature search of databases including PubMed, MEDLINE via Ovid, Embase, Scopus, and Cochrane CENTRAL, from 1998 to the present. Inclusion criteria were original research articles examining neuromonitoring during TEVAR and F-BEVAR. The primary outcome was the incidence of SCI, while the secondary outcome included early mortality. The quality of studies was assessed using the Newcastle-Ottawa Scale.
Results: From 1,450 identified articles, 11 met inclusion criteria, encompassing data from 1,069 patients. Neuromonitoring modalities included motor-evoked potentials (MEPs), somatosensory evoked potentials (SSEPs), and near-infrared spectroscopy. The combination of MEPs and SSEPs was most commonly used, with 93% sensitivity and 96% specificity for detecting SCI risks. SCI incidence ranged from 3.8 to 17.3%, with permanent deficits occurring in 2.7-5.8% of cases. In-hospital mortality ranged from 0.4 to 8%. Risk factors for SCI were identified, including operation duration and extent of aortic coverage.
Conclusions: Neuromonitoring with MEPs and SSEPs appears to be effective in detecting perioperative SCI risk during TEVAR and F-BEVAR. However, discrepancies between neuromonitoring changes and actual SCI outcomes suggest the need for cautious interpretation. While the incidence of SCI remains variable, identified risk factors may guide clinical decisions, particularly in high-risk procedures. Future research should focus on prospective studies and randomized controlled trials to validate these findings and improve SCI prevention strategies in TEVAR and F-BEVAR.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Date Created: 20240715 Date Completed: 20241030 Latest Revision: 20241030

20241031

10.1016/j.avsg.2024.06.012

39009132