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J Thorac Cardiovasc Surg 2002;124:1260
© 2002 The American Association for Thoracic Surgery

Letters to the Editor

Reply

Tatjana Fleck, MD, Martin Grabenwöger, MD

University of Vienna, Department of Cardiothoracic Surgery, Leitstelle 20A, Waehringer Guertel 18-20, Vienna, 1090 Austria

Reply to the Editor:

We appreciate the comments regarding our article by Oberwalder and colleagues and thank them for the valuable adjuncts regarding cerebrospinal fluid (CSF) drainage in stent-graft implantation.

Because of the restricted number of references in brief communications, we considered only publications in the high-impact journals. Nevertheless, we are aware of the report of Tiesenhausen and associates,Go 1 who described for the first time the impact of CSF drainage in a case of paraplegia after stent-graft implantation.

To close the entry tear in the descending aorta it is sometimes necessary to deploy a stent graft in the region (Th 8- L2) most prone to ischemia, but we agree that this should be avoided whenever possible. However, the risk of paraplegia has to balanced against the risk of rupture of the aneurysm in these patients.

Routine use of CSF drainage in stent-graft implantations could help to reduce the risk of paraplegia in such cases.

References

  1. Tiesenhausen K, Amann W, Koch G, Hausegger KA, Oberwalder P, Rigler B. Cerebrospinal fluid drainage to reverse paraplegia after endovascular thoracic aortic aneurysm repair. J Endovasc Ther. 2000;7:132-5.[Medline]




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