Lumbar Drain Indications for TEVAR

High-Risk Criteria Requiring Prophylactic Lumbar Drain

• The American College of Cardiology recommends cerebrospinal fluid drainage via lumbar drain for TEVAR patients at high risk of spinal cord ischemic injury, specifically those with extensive aortic coverage (>15 cm), prior aortic surgery, planned left subclavian artery coverage without revascularization, or involvement of critical collateral vessels 1, 2
• Planned left subclavian artery coverage without revascularization increases spinal cord ischemia risk, and the American Heart Association suggests that left subclavian artery revascularization before TEVAR may reduce the need for prophylactic drainage by preserving collateral flow to the spinal cord 3, 4, 5

Management Protocol

• The American College of Cardiology suggests maintaining spinal cord perfusion pressure by optimizing the difference between mean arterial pressure and CSF pressure, with a target CSF pressure <10 mmHg 6

Important Caveats

• Left subclavian artery revascularization before TEVAR is a Class I recommendation that may reduce the need for prophylactic drainage by preserving collateral flow to the spinal cord, according to the American College of Cardiology 3, 4