Less-invasive thoracic aortic aneurysm repair

Simultaneous Evaluation of the Whole Aorta and Artery of Adamkiewicz by MDCT

“…Recent studies have shown noninvasive visualization of the artery of Adamkiewicz using MRI or MDCT, 1,2,25) and its usefulness for surgery. [13][14][15][16][17] The usefulness of the preoperative evaluation of the artery of Adamkiewicz has been re-evaluated.…”

“…However, the preoperative clarification of the origin of the artery of Adamkiewicz and reconstruction of only the intercostal/ lumbar artery as its supplying blood vessel shorten the intraoperative arterial cross-clamping time, 13,15) and may contribute to the accurate preservation of postoperative blood flow in the artery of Adamkiewicz. If the artery of Adamkiewicz can be confirmed to be located outside the range allowing artery replacement, intercostal artery reconstruction can be omitted, which shortens the operation time.…”

“…16) When the artery of Adamkiewicz arises from the aortic replacement range, the intercostal artery for reconstruction can be identified before surgery, and the operation time can be shortened compared with the surgical method achieving reconstruction of as many intercostal arteries as possible. 15,17) Since the intraoperative arterial cross-clamping time is associated with postoperative complications, its shortening is a major benefit.…”

“…For the former, the preoperative identification of the artery of Adamkiewicz, which most markedly contributes to spinal cord blood supply in the thoracolumbar region, is useful. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] Identification of the level of the intercostal or lumbar artery supplying the artery of Adamkiewicz enables the formulation of a surgical plan including the intercostal artery reconstruction level, reducing the operation time, and the preservation of the artery giving rise to the artery of Adamkiewicz or its surrounding arteries. In this study, concerning the preoperative identification of the artery of Adamkiewicz using MDCT, the anatomy of the spinal cord arteries, and examination, image processing, and evaluation methods were described, and the clinical usefulness of visualization of the artery of Adamkiewicz was discussed.…”