Document Detail


Combined use of adamkiewicz artery demonstration and motor-evoked potentials in descending and thoracoabdominal repair.
MedLine Citation:
PMID:  16863770     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Hitoshi Ogino; Hiroaki Sasaki; Kenji Minatoya; Hitoshi Matsuda; Naoaki Yamada; Soichiro Kitamura
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  82     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-07-25     Completed Date:  2006-08-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  592-6     Citation Subset:  AIM; IM    
Affiliation:
Department Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan. hogino@hsp.ncvc.go.jp
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MeSH Terms
Descriptor/Qualifier:
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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