Adam Beck, M.D., Holt A. McDowell Jr., M.D., Endowed Chair of Vascular Surgery at UAB and UAB Vascular Surgery Integrated Resident, Angela Sickels, M.D., aimed to determine what part of the population benefited from prophylactic drains. Their research on the topic was presented at the 2025 Southern Association for Vascular Surgery Annual Meeting, and was featured in the national society newsletter.
Beck and Sickels’ research was working to address spinal cord ischemia (SCI), in patients who have undergone a branched or fenestrated endovascular aortic repair. SCI occurs when there is a lack of blood flow to the spinal cord, which can result from coverage of the arteries supplying the spinal cord with the endograft – without blood flow, patients can become paralyzed. For a long time, a way to prevent this was by using prophylactic spinal drains, though these have inherent risks, including brain bleeds or epidural hematomas, a collection of blood on the spine.
To conduct their study, they analyzed 2,585 patients who had undergone an elective fenestrated endovascular repair (F/BEVAR). Patients were categorized based on the year of their surgery: (2011-2013), mid (2014-2021), and late (2022-2024) and based on when a prophylactic cerebrospinal fluid drain (CSFD) was inserted: prophylactic (placed prior to procedure), therapeutic (placed after the procedure), and no CSFD, where no drain was inserted.
The study revealed that prophylactic CSFDs provide marginal benefit for reducing risk of spinal cord injuries, and are associated with higher CSFD complication rates. Unexpectedly, the rate of SCI dropped even in high risk patients despite decreasing prophylactic spinal drain use, which calls into question previous assumptions made and paves a way for creating more safe surgical practices and procedures.
Through their research, they found CSFD use has been continuously declining in patients who have undergone branched/fenestrated endovascular repair over the past 12 years in the United States Aortic Research Consortium experience. However, SCI rates have also continued to go down. Which means that there are other important and less invasive components for SCI prevention for branched/fenestrated endovascular aortic repair patients, and that prophylactic CSFD use may not be necessary, even in the most high-risk patients.
“These findings have been received very well so far.” Sickels said, “While spinal drains have a place in the mitigation of spinal cord ischemia, there are other highly effective, less invasive methods of SCI prevention, which are part of our comprehensive prevention protocol here. In order for more selective spinal drain use to be successful, I think it is important for institutions performing these procedures to have explicitly stated SCI protocols in place.”
Moving forward, Beck and Sickels plan to look more closely at patients with Crawford Extent Aneurysms 2 and 3 which are typically the highest risk patients to see if there is a benefit in that specific patient population when considering other factors.