The impact of preoperative identification of the Adamkiewicz artery on descending and thoracoabdominal aortic repair

Tanaka, Hiroshi; Ogino, Hitoshi; Minatoya, Kenji; Matsui, Yoshiro; Higami, Tetsuya; Okabayashi, Hitoshi; Saiki, Yoshikatsu; Aomi, Shigeyuki; Shiiya, Norihiko; Sawa, Yoshiki; Okita, Yutaka; Sueda, Taijiro; Akashi, Hidetoshi; Kuniyoshi, Yukio; Katsumata, Takahiro

doi:10.1016/j.jtcvs.2015.07.079

Cited by 65 publications

(37 citation statements)

References 21 publications

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“…For patients undergoing emergency procedures for ruptured aneurysm, all patent ICAs were quickly oversewn. The rate of permanent paraplegia was 3.8% in the multicenter registry, including our institution [3]. Advanced age (>65 years) and emergency operation were significant risk factors for spinal cord injury (p < 0.05), and in the subgroup of patients with aneurysm involving the identified ICA-AKA, closure of the identified ICA-AKA without reconstruction was a significant risk factor for paraplegia (p < 0.05) [2,3].…”

Section: Commentmentioning

confidence: 83%

“…Spinal cord ischemia remains a serious postoperative adverse event after open repair for extended descending or thoracoabdominal aortic aneurysm, and it is associated with increased postoperative mortality [1]. We have reported on the affirmative impact of preoperative identification of the ICA-AKA [2,3]. Although the patency rate of the reattached intercostals was only 62% in our previous study [2], the rationale for restoring spinal cord circulation by reattaching the ICA-AKA is sound.…”

Section: Commentmentioning

confidence: 85%

“…(Ann Thorac Surg 2017;103:e567-9) Ó 2017 by The Society of Thoracic Surgeons S pinal cord injury remains a major adverse event of extended thoracic and thoracoabdominal aortic surgical procedures [1]. We have reported on the positive impact of preoperative identification of the Adamkiewicz artery (AKA) and on the importance of prompt reattachment of the targeted intercostal arteries (ICAs) during operation [2,3]. However, in the tortuous aorta or extensively dilatated aneurysm, it would be difficult to identify the accurate ICA supplying the AKA by counting the number of intercostal spaces.…”

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confidence: 99%

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Simple Identification of the Adamkiewicz Artery in Extended Thoracoabdominal Aortic Aneurysm Repair

Uehara

Matsuda

Inoue

et al. 2017

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 83%

Section: Commentmentioning

confidence: 85%

mentioning

confidence: 99%

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Simple Identification of the Adamkiewicz Artery in Extended Thoracoabdominal Aortic Aneurysm Repair

Uehara

Matsuda

Inoue

et al. 2017

The Annals of Thoracic Surgery

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“…The incidence of SCI was 7.3% in the open repair group, with the highest incidence of ischemia occurring with Crawford extent III (14.4%) and Crawford extent II (14.0%). Patients in the open repair group who did not have an artery of Adamkiewicz reconstructed were at higher risk of developing SCI (odds ratio, 2.79, 95% confidence interval, 1.14‐6.79; P = .24) …”

Section: Discussionmentioning

confidence: 99%

Routine anterior spinal artery visualization prior to descending and thoracoabdominal aneurysm repair: High detection success

et al. 2019

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Background: Paraplegia is adevastating complication of open descending (DTAA) and thoracoabdominal aortic aneurysm (TAAA) repair. Despite major advances in imaging and surgical techniques, paraplegia continues to be problematic. We present our experience with routine application of enhanced imaging techniques to detect the anterior spinal artery (ASA) before DTAA and TAAA repair. Methods: We retrospectively reviewed 177 patients with DTAA and TAAA who underwent imaging to detect the ASA before open surgical repair. High definition CT angiography (CTA) and dual energy CT scanning (DECT) were our modalities of choice with angiography used earlier and magnetic resonance angiography (MRA) used when CT was contraindicated. Descriptive statistics and χ 2 analyses were conducted.Results: The imaging protocol successfully detected the level of the ASA in 132 (74.5%) patients, utilizing CTA in 67, DECT in 28, spinal angiography in 31, and MRA in 6. Cross sectional modalities with advanced visualization technique (CT, DECT, and MRA) were more successful at detecting the ASA than angiography (80.72%, 82.35%, 75% vs 59.62%, respectively, P = .04). Concerted efforts were made not to leave the operating room without continuity of the ASA with the circulation (via limited resection, beveled anastomosis, or reimplantation). Transient lower extremity weakness was observed in 11 (6.2%) patients, and permanent paraplegia in 2 (1.12%) patients. Conclusion:Modern imaging technology provides multiple methodologies highly successful at detecting the ASA. The ASA can then be preserved intraoperatively, contributing to low paraplegia rates. We strongly recommend routine application of this technology to arm the surgeon with precise information about the specific patient's spinal cord blood supply. K E Y W O R D S anterior spinal artery, aortic aneurysm, aortic surgery, descending, thoracic aorta, thoracoabdominal aorta

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“…To date, efforts to image the critical spinal cord blood supply preoperatively to guide surgical intervention have met with mixed success. [11][12][13][14][15][16][17] The vasculature supplying the spinal cord is complex 18 and exhibits large inter-subject variability 19,20 in both native vascular anatomy and as a result of prior aortic disease. These factors help to explain the frustration of efforts to prevent spinal cord ischemia.…”

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confidence: 99%

Spatially resolved optical monitoring of spinal cord blood flow with a minimally invasive, multi-level epidural probe

Busch

Lin

Goh

et al. 2020

Preprint

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Spinal cord ischemia leads to iatrogenic injury in multiple surgical fields, and the ability to immediately identify onset and anatomic origin of ischemia is critical to its management. Current clinical monitoring, however, does not directly measure spinal cord blood flow, resulting in poor sensitivity/specificity, delayed alerts, and delayed intervention. We have developed an epidural device employing diffuse correlation spectroscopy (DCS) to monitor spinal cord ischemia continuously at multiple positions. We investigate the ability of this device to localize spinal cord ischemia in a porcine model and validate DCS versus Laser Doppler Flowmetry (LDF).Specifically, we demonstrate continuous (>0.1Hz) spatially resolved (3 locations) monitoring of spinal cord blood flow in a purely ischemic model with an epidural DCS probe. Changes in blood flow measured by DCS and LDF were highly correlated (r=0.83). Spinal cord blood flow measured by DCS caudal to aortic occlusion decreased 62%, with a sensitivity of 0.87 and specificity of 0.91 for detection of a 25% decrease in flow. This technology may enable early identification and critically important localization of spinal cord ischemia.

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The impact of preoperative identification of the Adamkiewicz artery on descending and thoracoabdominal aortic repair

Abstract: In descending/thoracoabdominal aortic repairs, preoperative AKA identification with its adequate reconstruction or preservation, especially, in ORs of aortic pathologies involving the AKA, would be a useful adjunct for more secure spinal cord protection.

Cited by 65 publications

References 21 publications

Simple Identification of the Adamkiewicz Artery in Extended Thoracoabdominal Aortic Aneurysm Repair

Simple Identification of the Adamkiewicz Artery in Extended Thoracoabdominal Aortic Aneurysm Repair

Routine anterior spinal artery visualization prior to descending and thoracoabdominal aneurysm repair: High detection success

Spatially resolved optical monitoring of spinal cord blood flow with a minimally invasive, multi-level epidural probe

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