Predictors of Adamkiewicz artery and anterior spinal artery detection through computerized tomographic angiography

Abstract

Background:The detection of the Adamkiewicz artery and the anterior spinal artery has been associated with the ability to prevent adverse spinal cord outcomes after aortic surgical procedures. Yet, to our knowledge, no previous studies have attempted to use modern predictive models to identify the most important variables in determining artery detectability.Aims:To develop a model to predict the odds of visualizing the Adamkiewicz artery or anterior spinal artery in patients undergoing computerized tomographic angiography.Methods:We conducted a prospective, cross-sectional study. Outcomes of interest were the non-detection of the Adamkiewicz artery and anterior spinal artery, and their corresponding level of origin. Axial images were inspected in high definition in search of two dense spots characterizing the Adamkiewicz artery and anterior spinal artery. A multiplanar three-dimensional reconstruction was then performed using the OsiriX® software.Results:A total of 110 participants were part of this analysis. When evaluating risks for the Adamkiewicz artery being undetectable, significant factors could be classified into three broad categories: risk factors for arterial disease, established arterial disease, and obesity. Factors in the former category included metabolic syndrome, hypertension, and smoking status, while factors in the arterial disease included descending aortic aneurysm, mural thrombi, aortic aneurysm without a dissection, and aortic disease in general. In relation to anterior spinal artery not being detectable, significant risk factors included hypertension, smoking status, and metabolic syndrome, while those associated with arterial disease involved aortic disease and arterial thrombi. When evaluating the importance of individual clinical factors, the presence of higher body mass index was the single most important risk factor.Conclusion:Arterial disease, established arterial disease, and increased body mass index are risk factors in the detection of Adamkiewicz artery and anterior spinal artery. Specific diagnostic protocols should be in place for patients with these underlying conditions, thus enhancing the likelihood of detection when the Adamkiewicz artery is indeed present.

Desenvolvimento de modelo clínico para predição da possibilidade de identificação da artéria de Adamkiewicz por angiotomografia

“…Considering the entire sample, Table 1 lists the variables collected and the preliminary analyses of the database that have been published previously. 3,5 The outcome selected was identification or failure to identify the AKA using the method proposed. The initial explanatory co-variables were chosen on the basis of prior knowledge of the influence of body mass, arterial disease, and atherosclerosis.…”

“…11 The angiotomographic characteristics of the AKA in populations with and without aortic disease have been studied and reported in an earlier publication by the author. 3,5 Improved knowledge of the spinal blood supply should affect and provide a foundation for creation of new strategies for prevention of spinal cord ischemia during aortic surgery and other neurological surgical procedures. Boll et al analyzed 100 examinations of patients with pancreatic cancer and applied a modified version of a graphical algorithm for reconstruction of images of cerebral vessels.…”

“…Influence from atherosclerosis, mural thrombus, dissection, and body mass has been suggested. 3,5 The imaging protocol used was as close as possible to habitual angiotomography protocols, so that it represented the routine examinations conducted at many medical centers. Care was taken to minimize the radiation dose to reduce risks.…”

“…Presence of abdominal obesity is an essential criterion, combined with two or more of the following criteria: triglycerides ≥ 150 mg/dL; HDL-C < 40 mg/dL for men and < 50 mg/dL for women; SBP ≥ 130 mmHg and/or DBP ≥ 85 mmHg, or treatment for hypertension; fasting glycemia ≥ 100 mg/dL or treatment for diabetes mellitus. 8 The method used to identify AKA has been used by the author, described and validated in a previous publication, 3,6 and an explanatory video illustrating the technique is available at http://vascular.cc/aka.html.…”

“…The findings could also help to establish the importance of preserving this artery in aortic and neurological surgery, reducing the risk of spinal cord ischemia. [1][2][3] The intercostal and lumbar arteries that feed the spinal cord originate from the aorta. The intercostal and lumbar arteries divide three times before reaching the spinal cord.…”