Introduction: The rate of spinal cord infarction associated with repair of an aortic aneurysm or dissection is uncertain.
Methods: We identified all adult patients discharged from nonfederal acute care hospitals in California, New York, and Florida who underwent surgical or endovascular repair of a thoracic or abdominal aortic aneurysm or dissection between 2005 and 2013. Our outcome was a spinal cord infarction (ICD9-CM codes: 336.1 or 344.1-5) occurring during the index hospitalization for aortic repair. Patients with a spinal cord infarction prior to the hospitalization for aortic repair were excluded. Descriptive statistics with exact confidence intervals (CIs) were used to report crude rates of spinal cord infarction in patients with repair of ruptured aortic aneurysm or dissection and in patients with repair of unruptured aneurysm. In a secondary analysis, we evaluated the rate of spinal cord infarction in these groups by treatment approach – surgical versus endovascular.
Results: We identified 116,892 patients who underwent repair for an aortic aneurysm or dissection, and spinal cord infarction was diagnosed in 658 cases (0.56%, 95% CI, 0.52-0.61%). Patients with spinal cord infarction were more often male and more likely to have vascular risk factors. In patients undergoing repair of a ruptured aneurysm or dissection, the rate of spinal cord infarction was 1.91% (95% CI, 1.70-2.13%), compared to 0.35% (95% CI, 0.32-0.39%) in patients undergoing repair of an unruptured aneurysm. In secondary analysis of patients with repair of ruptured aneurysm or dissection, spinal cord infarction occurred in 1.88% (95% CI, 1.63-2.13%) of those undergoing surgical repair and 2.01% (95% CI, 1.59-2.44%) of those undergoing endovascular repair. For patients with repair of unruptured aneurysm, spinal cord infarction occurred in 0.42% (95% CI, 0.36-0.47%) of those undergoing surgical repair and 0.29% (95% CI, 0.24-0.33%) of those undergoing endovascular repair.
Conclusions: Clinically apparent spinal cord infarction results from approximately 1 in 50 procedures to repair an aortic dissection or ruptured aneurysm and 1 in 300 procedures to repair an unruptured aortic aneurysm.