Thoracoabdominal aortic aneurysm repair based on pre- and postoperative evaluation of the artery of Adamkiewicz

Imamura, Yuki; Kin, Hajime; Yoshioka, Kunihiro; Tabayashi, Azuma; Saitoh, Daiki

doi:10.1093/ejcts/ezac196

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…We performed open aortic surgery with intercostal artery (ICA) reconstruction in 23 patients at our hospital from January 2016 to December 2022. All patients underwent preoperative multislice CT scan angiography of the Adamkiewicz artery (AKA) [5].…”

Section: Methodsmentioning

confidence: 99%

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Cool-Shot Technique to Protect Spinal Cord during Thoracoabdominal Aortic Replacement

Yamamoto,

Endo,

Yokoyama

et al. 2024

Thorac Cardiovasc Surg

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Deep hypothermia helps protect the spinal cord, but is invasive. Here, we present a method to avoid reperfusion injury by selectively circulating cold blood under high pressure to the intercostal artery during reperfusion after intercostal artery reconstruction. Of the 23 patients who underwent thoracoabdominal aortic aneurysm open repair, one died. The motor evoked potential disappeared during aortic clamping in nine patients. Six patients recovered completely from aortic clamping release, two showed recovery >50% and one achieved full recovery three months later. Permanent motor impairment did not occur. This method could prevent reperfusion injury and paraplegia following thoracoabdominal aortic aneurysm surgery.

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Section: Methodsmentioning

confidence: 99%

“…All patients underwent preoperative multislice computed tomography scan angiography of the Adamkiewicz artery (AKA). 5…”

Section: Methodsmentioning

confidence: 99%

Cool-Shot Technique to Protect Spinal Cord during Thoracoabdominal Aortic Replacement

Yamamoto,

Endo,

Yokoyama

et al. 2024

Thorac Cardiovasc Surg

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Patterns of collateral arteries to the spinal cord after thoraco-abdominal aortic aneurysm repair

Saitoh,

Yamazaki,

Tsuji

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES To evaluate postoperative patterns of collateral arteries to the spinal cord during occlusion of the segmental arteries supplying the artery of Adamkiewicz (AKA). METHODS Between April 2011 and December 2022, 179 patients underwent thoraco-abdominal aortic aneurysm repair; 141 had an identifiable AKA on preoperative multidetector computed tomography (MDCT) scans, 40 underwent thoraco-abdominal aortic aneurysm replacement (TAAR), and 101 underwent thoracic endovascular aortic repair (TEVAR). New postoperative collateral blood pathways invisible on preoperative contrast-enhanced computed tomography scans were identified in 42 patients (10 patients in TAAR vs 32 patients in TEVAR) who underwent preoperative and postoperative MDCT scanning for AKA identification. RESULTS The thoracodorsal and segmental arteries were the main collateral pathways in both groups. Th9-initiated collaterals were the most common. Collaterals from the internal thoracic artery were observed in the TEVAR group but not in the TAAR group. One patient in the TEVAR group experienced postoperative paraparesis, which was not observed in the TAAR group. Postoperative paraplegia was more common in the non-Th9-origin group, but this difference was non-significant. CONCLUSIONS Thoracodorsal and segmental arteries may be important collateral pathways after TEVAR and TAAR. For thoracodorsal arteries, preserving the thoracodorsal muscle during the approach would be crucial; for segmental arteries, minimizing the area to be replaced or covered would be paramount. An AKA not initiated at the Th9 level poses a high risk of postoperative paraplegia.

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Recent Innovation of CT Imaging in Vascular Diseases

2023

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Recent innovations of CT have made great advances in imaging of vascular disease. This is because CT has made it possible to obtain wide areas with high speed and thin slice thickness. In addition, imaging options such as ECG-gated scan, subtraction technique and ultra-high-resolution CT have enhanced the diagnostic utility for vascular diseases. On the other hand, photon-counting CT, the newest type of CT equipment, is promising to be applied to the vascular imaging because of its high spatial resolution and high capability of material decomposition.

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Thoracoabdominal aortic aneurysm repair based on pre- and postoperative evaluation of the artery of Adamkiewicz

Cited by 3 publications

References 28 publications

Cool-Shot Technique to Protect Spinal Cord during Thoracoabdominal Aortic Replacement

Cool-Shot Technique to Protect Spinal Cord during Thoracoabdominal Aortic Replacement

Patterns of collateral arteries to the spinal cord after thoraco-abdominal aortic aneurysm repair

Recent Innovation of CT Imaging in Vascular Diseases

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