Thoracoabdominal or descending aortic aneurysm repair after preoperative demonstration of the Adamkiewicz artery by magnetic resonance angiography☆

Kawaharada, Nobuyoshi; Morishita, Kiyofumi; Fukada, Johji; Yamada, Akira; Muraki, Satoshi; Hyodoh, Hideki; Abe, Tomio

doi:10.1016/s1010-7940(02)00097-0

Cited by 67 publications

(42 citation statements)

References 16 publications

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“…One possible cause of this variance is that diagnostic criteria were not identical among the studies. Multiphase dynamic imaging was performed by using MR imaging, [13][14][15][16] whereas single-phase imaging was performed by using CT. [19][20][21]24 We believe that multiphase imaging can improve the precision of AKA diagnosis. The present study showed that the detection rates of IACTA were better than those of IVCTA when using the same scan variables, contrast dose, injection rate, and diagnostic criteria.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12] However, selective angiography is time consuming, and complications including spinal cord injury can develop. 10,11 Recently, MR angiography (MRA) [13][14][15][16][17][18] and CT angiography (CTA) [17][18][19][20][21] have been used to visualize the AKA less invasively with reported detection rates of 67%-93% and 68%-90%, respectively. However, these rates could be further improved.…”

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confidence: 99%

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Preoperative Visualization of the Artery of Adamkiewicz by Intra-Arterial CT Angiography

Uotani¹,

Yamada²,

Kono³

et al. 2008

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:CT and MR angiographies have been reported to visualize the artery of Adamkiewicz (AKA) noninvasively to prevent spinal cord ischemia in surgery of thoracic descending aortic aneurysms. The purpose of this work was to compare the usefulness of CT angiography (CTA) with intra-arterial contrast injection (IACTA) with that of conventional CTA with intravenous contrast injection (IVCTA).

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Preoperative Visualization of the Artery of Adamkiewicz by Intra-Arterial CT Angiography

Uotani¹,

Yamada²,

Kono³

et al. 2008

American Journal of Neuroradiology

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“…4,5,[10][11][12][13] The use of these imaging techniques for preoperative analysis and surgical planning enables selective reconstruction of the feeding radiculomedullary artery. 4,5,14 However, it is di‹cult to reconstruct the artery of Adamkiewicz itself because of its small size (about 0.5 mm in diameter) and its branching from the intercostal/lumbar artery at the intervertebral foramen. Therefore, in the surgical approach, 2 methods are used to maintain the blood ‰ow to the artery of Adamkiewicz.…”

Section: Discussionmentioning

confidence: 99%

“…8 No. 4,2009 tors that might aŠect the branching level diŠerence: aortic elongation, decreasing vertebral height, vascular formative anomalies, and collateral supply. In our case series, there was no evidence of vertebral compression nor vascular formative anomalies.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have reported that the rate of spinal cord ischemia was signiˆcantly decreased in patients who underwent successful preoperative identiˆca-tion of the artery of Adamkiewicz (also known as the great anterior radiculomedullary artery and the dominant arterial feeder of the spinal cord) compared to patients in whom this artery was not identiˆed. 4,5 Greenberg's group reported on neurologic deˆcit caused by spinal cord ischemia in 3 of 25 patients (12z) undergoing endovascular thoracoabdominal aneurysm repair, with long-segment thoracic aortic coverage found to be a signiˆcant risk factor in predicting clinically evident spinal cord ischemia.…”

Section: Introductionmentioning

confidence: 99%

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MR Angiography for Detecting the Artery of Adamkiewicz and Its Branching Level from the Aorta

et al. 2009

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Purpose: We evaluated the e‹cacy of magnetic resonance angiography (MRA) for detecting the artery of Adamkiewicz (AKA) and the vertebral level of its feeding arteries branching from the aorta.Materials and Methods: Eighty-two patients (67 men, 15 women; aged 34 to 86 years, mean age 68.6 years) with thoracic descending and thoracoabdominal aortic lesions (aneurysm in 55, dissection in 25, coarctation in 2) underwent MRA to detect AKA. MRA was performed using 6-phase, dynamic-enhanced, 3-dimensional, fast spoiled gradient recalled acquisition in steady state (GRASS) on a 1.5-tesla (T) system, with double-dose bolus contrast injection. The vertebral levels of AKA branching and the AKA feeder artery branching from the aorta were determined.Results: The AKA was detected in 67 patients (81.7z). Branching of AKA occurred at levels T7 to T12 on the left side (n＝52) and on the right (n＝15). Vascular continuity from the aorta to the anterior spinal artery was demonstrated in 55 patients (67.1z). Comparing the vertebral level of arterial branching from the aorta to that of the AKA at the intervertebral foramen, the AKA branched at the same vertebral level in 44 patients (80.0z), one vertebral level above/below in 10 (18.2z), and 2 vertebral levels above in one (1.8z).Conclusion: MRA can be useful in the preoperative work-up of patients with thoracoabdominal aortic lesions to localize AKA and the segmental trajectories of vessels supplying blood to the AKA.

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Differentiation of spinal cord arteries and veins by time‐resolved MR angiography

Jaspers

Nijenhuis

Backes

2007

Magnetic Resonance Imaging

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Purpose: To dynamically resolve the inlet arteries and outlet veins of the spinal cord, particularly the Adamkiewicz artery (AKA) and great anterior radiculomedullary vein (GARV), using MR angiography (MRA). Materials and Methods:First, conventional two-phase angiography (acquisition time ϭ 38 -55 seconds) utilizing elliptic centric k-space ordering was applied to aortic-aneurysm patients. Changes of vessel intensity were compared between two subsequent dynamic phases. Computer modeling of bolus enhancement and k-space sampling was performed to demonstrate the relation between vessel enhancement, acquisition time, and vessel diameter. Second, time-resolved (TR, or "keyhole") angiography using a reduced number of phase-encoding steps was explored in healthy volunteers and aortic-aneurysm patients using acquisition times (range ϭ 6 -8.5 seconds) shorter than the spinal cord circulation time.Results: Using two-phase angiography the AKA and GARV were covisualized in the early phase, and contrast decreased for the AKA and increased for the GARV in most (70%) but not all cases. Computer modeling showed that the arteriovenous contrast strongly depended on vessel diameter, and complete separation was only obtained with short acquisition times. Using TR MR angiography (TR-MRA), complete temporal separation of the AKA and GARV was realized in all cases (100%). Conclusion:The AKA and GARV can be completely separated by TR-MRA. SEPARATION OF ARTERIES AND VEINS is a general problem and challenge in noninvasive vascular radiology. This differentiation is especially difficult for the anterior spinal cord vasculature, since the vessels have a small caliber (0.2-1.5 mm), a close anatomical relation, and a more or less similar spatial configuration (1). Therefore, distinction based solely on vascular anatomical features is unreliable. Selective identification and localization of the inlet arteries of the thoracolumbar spinal cord, in particular the great anterior radiculomedullary artery (i.e., the Adamkiewicz artery (AKA)), is of relevance in several clinical situations. Possible indications for AKA localization include thoracoabdominal aortic aneurysm (TAAA) surgery (2-5), thoracoscopic spinal discectomy (6), and embolization of vertebral metastases (7) and spinal dural arteriovenous malformations (8).The standard of reference for spinal cord vascular imaging is invasive (intra-arterial) catheter-based angiography, which enables selective visualization of arteries and veins. Although spinal cord catheter angiography provides superior image quality, it carries a risk for neurologic complications and can only be performed at highly specialized centers. Moreover, it has a limited and variable sensitivity (43-86%, (9,10)) for identifying the AKA in TAAA patients. Recent studies (3,4,(11)(12)(13)(14) have achieved promising results in noninvasive visualization of the spinal cord vasculature in patients with TAAA and spinal cord vascular abnormalities by employing contrast-enhanced (CE)-MRA.Because MR acquisition times tend to be lon...

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Thoracoabdominal or descending aortic aneurysm repair after preoperative demonstration of the Adamkiewicz artery by magnetic resonance angiography☆

Abstract: Preoperative detection of the ARM is possible by MRA and is very useful for reducing the incidence of ischemic injury of the spinal cord and for reducing the time of an operation for repair of an aneurysm of the thoracoabdominal or descending aorta.

Cited by 67 publications

References 16 publications

Preoperative Visualization of the Artery of Adamkiewicz by Intra-Arterial CT Angiography

Preoperative Visualization of the Artery of Adamkiewicz by Intra-Arterial CT Angiography

MR Angiography for Detecting the Artery of Adamkiewicz and Its Branching Level from the Aorta

Differentiation of spinal cord arteries and veins by time‐resolved MR angiography

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