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. 2024 Jan 31;13(3):832.
doi: 10.3390/jcm13030832.

Impact of Intercostal Artery Reinsertion on Neurological Outcome after Thoracoabdominal Aortic Replacement: A 25-Year Single-Center Experience

Florian Helms  1 , Reza Poyanmehr  1 , Heike Krüger  1 , Bastian Schmack  1 , Alexander Weymann  1 , Aron-Frederik Popov  1 , Arjang Ruhparwar  1 , Andreas Martens  2 , Ruslan Natanov  2
Affiliations

Impact of Intercostal Artery Reinsertion on Neurological Outcome after Thoracoabdominal Aortic Replacement: A 25-Year Single-Center Experience

Florian Helms et al. J Clin Med. .

Abstract

Background: Intercostal artery reinsertion (ICAR) during thoracoabdominal aortic replacement remains controversial. While some groups recommend the reinsertion of as many arteries as possible, others consider the sacrifice of multiple intercostals practicable. This study investigates the impact of intercostal artery reinsertion or sacrifice on neurological outcomes and long-term survival after thoracoabdominal aortic repair.

Methods: A total of 349 consecutive patients undergoing thoracoabdominal aortic replacement at our institution between 1996 and 2021 were analyzed in a retrospective single-center study. ICAR was performed in 213 patients, while all intercostal arteries were ligated and sacrificed in the remaining cases. The neurological outcome was analyzed regarding temporary and permanent paraplegia or paraparesis.

Results: No statistically significant differences were observed between the ICAR and non ICAR groups regarding the cumulative endpoint of transient and permanent spinal cord-related complications (12.2% vs. 11.8%, p = 0.9). Operation, bypass, and cross-clamp times were significantly longer in the ICAR group. Likewise, prolonged mechanical ventilation was more often necessary in the ICAR group (26.4% vs. 16.9%, p = 0.03). Overall long-term survival was similar in both groups in the Kaplan-Meier analysis.

Conclusion: Omitting ICAR during thoracoabdominal aortic replacement may reduce operation and cross-clamp times and thus minimize the duration of intraoperative spinal cord hypoperfusion.

Keywords: aortic surgery; intercostal artery reinsertion; spinal cord protection; thoracoabdominal aorta.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Absolute numbers of thoracoabdominal aortic replacements with (blue) or without (orange) intercostal artery reinsertion performed at our institution from 1996 to June 2021.
Figure 2
Figure 2
Kaplan–Meier analysis for overall mortality after thoracoabdominal aortic replacement with (dark green) or without (blue) intercostal artery reinsertion.
See this image and copyright information in PMC

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