Preoperative Visualization of the Artery of Adamkiewicz by Dual-Phase CT Angiography in Patients with Aortic Aneurysm

Amako, Mau; Yamamoto, Yoshiaki; Nakamura, Katsumi; Tobinaga, Satoru; Nakamura, Eiji; Hosokawa, Yukio; Ohno, Teruo; Akashi, Hidetoshi; Aoyagi, Shigeaki; Tanaka, Hiroyuki

doi:10.2739/kurumemedj.58.117

Cited by 15 publications

(10 citation statements)

References 16 publications

(38 reference statements)

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“…In our study, MRA technique was reserved for cases in which CTA was inappropriate or contraindicated and has shown high sensitivity with a successful detection rate of 80%. The disadvantage of MRA is that it requires a longer image acquisition time and offers slightly lower spatial resolution …”

Section: Discussionmentioning

confidence: 99%

“…The disadvantage of MRA is that it requires a longer image acquisition time and offers slightly lower spatial resolution. 2,14 The traditional technique for identification of spinal artery has been direct contrast angiography. 15 While potentially providing superb visualization of the spinal artery and a high detection rate of up to 89%, direct angiography has multiple potential drawbacks.…”

Section: Methodsmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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“…An interesting modification of the IV-CTA procedure was presented in a study conducted by Amako et al [ 17 ]. The contrast agent was administered twice with a vascular catheter, directly inserted into the right atrium.…”

Section: Discussionmentioning

confidence: 99%

“…Although the presented procedure shows high accuracy, we should bear in mind its possible restrictions. The patient is exposed to a double dose of X-ray radiation and administered a huge volume of a contrast agent, which might be a contraindication for patients with renal failure [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Ischaemia of the medullary cone after stent-graft implantation in a patient with abdominal aortic aneurysm – a case study

Wachowski

Polguj

Ścibór³

et al. 2018

wiitm

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Preoperative visualization of the Adamkiewicz artery – the vessel which is to a great extent responsible for supplying blood to the medullary cone – is an important step which must be taken before initiating restorative procedures in the aorta. We present a case of a 67-year-old patient who underwent an intravascular stent-graft implantation procedure, due to clinical signs of abdominal aortic aneurysm. Routine pre-operative computed tomography examination failed to demonstrate the Adamkiewicz artery. On the second day after the surgery, as a result of unexpected clinical deterioration, an magnetic resonance imaging examination of the lumbar spine was carried out. Based on the magnetic resonance imaging images and clinical manifestations the diagnosis of ischaemia of the medullary cone was made. In our work we also present a deep analysis of the anatomy of small-sized vessels supplying blood to the spinal cord and discuss effective techniques which enable visualization of the Adamkiewicz artery.

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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.…”

mentioning

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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Preoperative Visualization of the Artery of Adamkiewicz by Dual-Phase CT Angiography in Patients with Aortic Aneurysm

Cited by 15 publications

References 16 publications

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

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

Ischaemia of the medullary cone after stent-graft implantation in a patient with abdominal aortic aneurysm – a case study

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

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