| Combined use of adamkiewicz artery demonstration and motor-evoked potentials in descending and thoracoabdominal repair. | |
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MedLine Citation:
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PMID: 16863770 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: We retrospectively reviewed the outcome of distal descending aortic and thoracoabdominal aortic repair with preoperative identification of the Adamkiewicz artery by magnetic resonance angiography and intraoperative monitoring of transcranial motor-evoked potentials. METHODS: We began combined use of demonstration of the Adamkiewicz artery and intraoperative recording of motor-evoked potentials for prevention of spinal cord complications in descending and thoracoabdominal aortic aneurysm repair in 1998. Ninety-two consecutive patients were studied, with descending aneurysm in 53 and thoracoabdominal aneurysm in 39 patients. The repair was performed through a left thoracic or thoracoabdominal incision, using partial cardiopulmonary bypass to prevent spinal cord injury. Magnetic resonance angiography revealed the Adamkiewicz artery in 70.7% of cases. During surgery, spinal cord ischemia was monitored using motor-evoked potentials. Anastomoses were performed using a segmental clamp technique to reduce spinal cord ischemic time. Based on the findings of magnetic resonance angiography and motor-evoked potentials, the Adamkiewicz artery and other relevant intercostals and lumbar arteries were revascularized or preserved, or both. RESULTS: The mean durations of partial cardiopulmonary bypass, cross-clamping, and surgery, respectively, were 144.4 +/- 232.2, 106.0 +/- 65.5, and 411.8 +/- 170.7 minutes. Three hospital deaths (3.3%) occurred in patients with a thoracoabdominal aortic aneurysm. Motor-evoked potentials changed in 9 patients (9.8%), in 8 (88.9%) of whom they were eventually restored. Although paraplegia developed in 1 patient (1.1%) with a mycotic descending aneurysm, the other patients survived without spinal cord injury. CONCLUSIONS: Combined visualization of the Adamkiewicz artery and determination of motor-evoked potentials are useful in preventing spinal cord injury in descending and thoracoabdominal aortic repair. |
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Authors:
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Hitoshi Ogino; Hiroaki Sasaki; Kenji Minatoya; Hitoshi Matsuda; Naoaki Yamada; Soichiro Kitamura |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 82 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2006 Aug |
Date Detail:
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Created Date: 2006-07-25 Completed Date: 2006-08-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 592-6 Citation Subset: AIM; IM |
Affiliation:
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Department Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan. hogino@hsp.ncvc.go.jp |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Aorta, Thoracic / surgery* Aortic Aneurysm, Abdominal / diagnosis, physiopathology, surgery* Aortic Aneurysm, Thoracic / diagnosis, physiopathology, surgery* Evoked Potentials, Motor* Female Humans Magnetic Resonance Angiography Male Middle Aged Monitoring, Intraoperative* Retrospective Studies Spinal Cord / blood supply Spinal Cord Injuries / prevention & control* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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