Chronic aortic dissection not a risk factor for neurologic deficit in thoracoabdominal aortic aneurysm repair

Eur J Vasc Endovasc Surg. 2002 Mar;23(3):244-50. doi: 10.1053/ejvs.2001.1583.


Objective: chronic aortic dissection has long been considered a risk factor for neurologic deficit following thoracoabdominal aortic aneurysm (TAA) surgery. We reviewed our experience with regard to aneurysm extent and the use of adjunct, (distal aortic perfusion/cerebrospinal fluid drainage), and examined the impact of these factors on neurologic deficit among chronic dissection and non-dissection cases.

Methods: between February 1991 and March 2001, we repaired 800 aneurysms of the descending thoracic and thoracoabdominal aorta. Seven hundred and twenty-nine cases were elective; 196 chronic dissection, 533 non-dissection. 182/729 (24.9%) were TAA extent II. Among these, 61/182 (33%) involved chronic dissection. Adjunct was used in 507/729 (69.6%). We conducted detailed multivariate analyses to isolate the impact of chronic aortic dissection on neurologic morbidity, with other important risk factors taken into account.

Results: overall, 32/729 (4.4%) patients had neurologic deficit upon awakening; 7/196 (3.6%) in chronic dissections, and 25/533 (4.7%) in non-dissections. Adjunct had a major effect, reducing neurologic deficit in TAA extent II from 10/36 (27.8%) to 10/146 (6.9%) (p=0.001). However, in univariate and multivariate analysis, chronic dissection did not increase the risk of neurologic deficit, regardless of extent or mode of treatment.

Conclusion: in contrast to previous reports, we determined that chronic aortic dissection is not a risk factor in TAA patients.

MeSH terms

  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Diseases / complications*
  • Chronic Disease
  • Dissection / adverse effects*
  • Female
  • Humans
  • Male
  • Nervous System Diseases / etiology*
  • Outcome Assessment, Health Care
  • Retrospective Studies
  • Risk Factors