Document Detail


Operative strategy for descending and thoracoabdominal aneurysm repair with preoperative demonstration of the Adamkiewicz artery.
MedLine Citation:
PMID:  21095322     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Our study aimed to demonstrate the efficacy of preoperative intraarterial computed tomographic angiography to identify the Adamkiewicz artery (AKA). We also aimed to investigate the impact of identification of the AKA on the strategy for preventing spinal cord injury.
METHODS: Thirty-seven patients (24 cases of descending aortic aneurysms and 13 cases of thoracoabdominal aortic aneurysms), were studied. Average age was 63.8 years old. A pigtail catheter was inserted into the descending aorta and its tip was located immediately below the left subclavian artery. Subsequently, intraarterial computed tomographic angiography was performed and the segmental artery to the AKA was identified. Aneurysms were replaced electively with prosthetic graft in all cases. In cases where the aortic segment that supplied the AKA was cross-clamped, the identified segmental artery-AKA was selectively perfused. In these cases, the segmental artery-AKA was reconstructed with an interposition graft.
RESULTS: Intraarterial computed tomographic angiography successfully identified the segmental artery-AKA in all patients. The average number of AKA observed per patient was 1.3± 0.6 AKAs. Selective perfusion of preoperatively identified segmental artery-AKAs was performed in 11 cases. The average number of reconstructed segmental arteries was 0.5 in descending aortic aneurysms and 1.7 in thoracoabdominal aortic aneurysms. Although paraparesis occurred in two patients (5%), the remaining 35 patients did not suffer spinal cord injury.
CONCLUSIONS: Intraarterial computed tomographic angiography reliably identifies the segmental-AKA. Furthermore, selective perfusion of the segmental artery-AKA, based on accurate preoperative identification, might be one option for preventing intraoperative spinal cord ischemia.
Authors:
Kojiro Furukawa; Keiji Kamohara; Junichi Nojiri; Yoshiaki Egashira; Yukio Okazaki; Sho Kudo; Shigeki Morita
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  90     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1840-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiovascular Surgery and Radiology, Faculty of Medicine, Saga University, Saga, Japan. furukako@cc.saga-u.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Angiography / methods*
Aortic Aneurysm, Abdominal / radiography,  surgery*
Aortic Aneurysm, Thoracic / radiography,  surgery*
Arteries*
Blood Vessel Prosthesis Implantation / methods,  standards*
Female
Humans
Male
Middle Aged
Practice Guidelines as Topic*
Preoperative Period
Prognosis
Retrospective Studies
Spinal Cord / blood supply*
Spinal Cord Ischemia / prevention & control
Tomography, X-Ray Computed
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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