Spinal cord arteriography: A safe adjunct before descending thoracic or thoracoabdominal aortic aneurysmectomy

Abstract

SCA is a safe adjunct that warrants more widespread use in the management of descending thoracic or thoracoabdominal aortic aneurysms.

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

“…Red arrow points to AKA. ICA=intercostals artery, Th9=9th thoracic vertebra, Th11=th11 thoracic vertebra, Ao=aorta, VR; VR: volume rendering, MPR; multi planar reconstruction DETECTION OF THE AKA BY CT ANGIOGRAPHY effective and established technique, and the detectability of the AKA has been reported to be 43% to 86% [5,6]. This technique, however, is invasive, time-consuming, technically diffi cult to perform, and may be hazardous.…”

“…This technique, however, is invasive, time-consuming, technically diffi cult to perform, and may be hazardous. Kieffer et al [5] reported that major complications developed in 6 (1.2%) of 480 patients, including paraplegia in 2 patients. With recent advances in MR angiography and CT angiography technologies, CT angiography and MR angiography have gained acceptance as effective and noninvasive alternative methods that allow visualization of the AKA and the ASA.…”

“…For preoperative identifi cation of the AKA and the ASA, several angiographic techniques including selective spinal cord angiography [5,6], MR angiography [12,13], and CT angiography [7][8][9][10][11] B) A 2D curved-MPR demonstrates connection from aorta to anterior spinal artery by the AKA, and its continuity through the collateral circulation ( * ). Red arrow points to AKA.…”

“…Previous studies have shown that selective spinal cord angiography [5,6], multi-detector row computed tomography (CT) angiography [7][8][9][10][11], and magnetic resonance (MR) angiography [12,13] are useful for identifying the AKA and the ASA preoperatively. However, the visualization of the AKA and of the continuity between the aorta and the ASA with these techniques may not be adequate to prevent spinal cord ischemia after surgery.…”

Detection of the Adamkiewiczartery in computed tomography of the thorax and abdomen

“…2 Kieffer et al reported an 86% AKA detection rate in a study involving 487 SS-DSA procedures, but critical complications occurred in 6 patients (1.2%), including paraplegia, renal failure and stroke; while 2 patients (0.4%) died as a direct result of SS-DSA. 16 The advantage of this method is the possibility to plan endovascular treatment precisely. However, the patient is exposed to high levels of ionizing radiation compared to CTA; furthermore, the examination is time-consuming and requires an experienced specialist.…”