Anatomical Pattern of Feeding Artery and Mechanism of Intraoperative Spinal Cord Ischemia

Spinal cord protection during thoracoabdominal aortic replacement: spinal cord perfusion maintenance

“…Additionally, there are several measures to maintain SCPP, such as sustaining a high-mean blood pressure during and after a procedure, maintaining distal perfusion using extracorporeal circulation plus rapid recovery of distal perfusion with pulsatile flow and preventing the subclavian steal phenomenon. These countermeasures are applied according to the surgeon's preference [8][9][10]. Reconstruction of the ICAs with the Crawford inclusion method or a Carrel patch should theoretically be effective; however, adverse effects may occur because of technical difficulties [11].…”

Japanese perspective in surgery for thoracoabdominal aortic aneurysms

“…The purpose of neurophysiological monitoring has thus changed from intraoperative feeding artery identification [7] to assessment of the adequacy of collateral blood flow. Maintaining blood flow to the neighboring intercostal arteries was considered mandatory during reconstruction of a solitary hairpin shaped feeding artery [9]. This was achieved by preceding reconstruction of a proximal intercostal artery by segmental cross-clamping while the critical artery was perfused through distal aortic perfusion [10].…”

Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms

“…Spinal cord angiography was used to identify the main supply to the spinal cord (Kieffer et al, 2002). In another study, MRI was used for the detection of the Adamkiewicz artery , and multidirectional row CT has also been used for the same purpose (Shiiya et al, 2009). The Adamkiewicz artery is the major blood supply to the lumbar spinal cord, and its reimplantation after TAA surgery reduced the risk of paralysis to 5-6%.…”