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.
