LAUSR

OBJECTIVES To review complications associated with perioperative lumbar drain (LD) placement for endovascular aortic repair. METHODS Patients who had perioperative lumbar drain placement for endovascular repair of thoracic and thoracoabdominal aortic pathologies from 2010-2019 were reviewed. The primary endpoints were major and minor LD-associated complications. Complications that resulted in neurological sequelae, required intervention, or delay in operation were defined as major. These included intracranial hemorrhage, symptomatic spinal hematoma, cerebrospinal fluid (CSF) leak requiring intervention, meningitis, retained catheter tip, arachnoiditis, and bloody tap resulting in delayed operation. Minor complications were defined as bloody tap without delay in operation, asymptomatic epidural hematoma, and CSF leak with no intervention required. Isolated headaches were recorded separately due to minimal clinical impact. RESULTS There were 309 LD placed in 268 consecutive patients for 222 TEVAR, 85 complex EVAR (F-BEVAR/parallel grafting), and 2 EVAR (65±13 years, 71% male) for aortic pathology including 47% aneurysm, 49% dissection, 3% penetrating aortic ulcer, and 0.6% traumatic injury. A dedicated neurosurgical team performed all LD procedures, the majority performed by the same individual, with a technical success rate of 98%. Radiological guidance was required in 3%. Reasons for unsuccessful placement were body habitus (2) and severe spinal disease (3). Most were placed prophylactically (96%). The overall complication rate was 8.1% (4.2% major, 3.9% minor). Major complications included spinal hematoma with paraplegia (1), intracranial hemorrhage (2), meningitis (2), arachnoiditis (3), CSF leak requiring a blood patch (3), bloody tap delaying operation (1), and a retained catheter tip (1). Patients who had prior LD placement had significantly more major LD-related complications (12.2% vs. 3%, p=.019). The rate of total LD-associated complications did not differ between prophylactic and emergent therapeutic placements (8.1% vs. 7.7%, p=1), and neither did major or minor complications. On multivariate analysis, prior LD placement and an overweight body mass index were the only independent predictors of major LD-related complications. CONCLUSION Complications associated with LD placement can be severe even when performed by a dedicated team. Prior lumbar drain placement and overweight BMI associated with significantly higher risk of complications, but emergent therapeutic placement is not. While these risks are justified in therapeutic LD placement, the benefit of prophylactic lumbar drain placement to prevent paraplegia should be weighed against these serious complications.