J Endovasc Ther. 2026 Oct 30:15266028261487351. doi: 10.1177/15266028261487351. Online ahead of print.
ABSTRACT
BACKGROUND: Spinal cord ischemia (SCI) after fenestrated and branched endovascular aortic repair (F/B-EVAR) is a devastating complication with a non-negligible incidence, and better risk prediction is necessary. Preoperative imaging allows assessment of anatomical and morphological characteristics that may predispose to SCI. This scoping review aimed to systematically search the literature and provide an overview of the current evidence on the association of preoperative imaging-derived factors with SCI after F/B-EVAR.
METHODS: This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic literature search of PubMed, EMBASE, Cochrane, and Web of Science was performed from database inception to October 21, 2025, to identify studies that reported on the association of preoperative imaging-derived factors with SCI following F/B-EVAR. Only studies published in English were included. Studies were screened by 2 reviewers, and data were charted using a standardized data-extracting form. Identified factors were categorized as aortic-related, aortic side-branch-related, thrombus-related, and miscellaneous factors.
RESULTS: A total of 2231 studies were identified, and 45 were included in this scoping review. Included studies consisted of observational cohort studies and nonrandomized investigational device exemption studies, with all studies using univariable and multivariable analyses. A total of 18 imaging-derived factors were identified and categorized into aortic-related (33 studies), aortic side-branch-related (17 studies), thrombus-related (5 studies), and miscellaneous (psoas muscle parameters, median arcuate ligament [MAL]) (6 studies). Aneurysm extent, maximum aortic diameter, and rupture were the most frequently reported investigated factors. Most (n = 39, 87%) studies were performed in cohorts of less than 400 patients. Definitions of similar investigated factors varied, and associations found were variable across studies. Only a limited number of included studies performed a multivariable analysis.
CONCLUSION: This scoping review provides a categorized overview of preoperative imaging-derived factors and their associations with SCI after F/B-EVAR. Identified factors showed heterogeneous associations and inconsistent definitions across studies limited comparability. Large prospective cohort studies, including standardized definitions of parameters, are needed to investigate the influence of preoperative imaging-derived factors on the risk of SCI.Clinical ImpactSpinal cord ischemia (SCI) after fenestrated and branched endovascular aortic repair remains a significant complication despite continual advancements in preventive strategies and identification of clinical risk factors. Preoperative imaging allows assessment of anatomical and morphological characteristics that may predispose to SCI. This scoping review provides a categorized overview of preoperative imaging-derived factors and the evidence on their association with SCI. Identified factors had varying definitions and showed heterogeneous associations with SCI. Recommendations for future research are outlined to further optimize SCI risk prediction using preoperative imaging-derived factors.
PMID:42960850 | DOI:10.1177/15266028261487351