Ohtsubo S, Furukawa K, Rikitake K, Okazaki Y, Sato M, Natsuaki M, Matsumoto K, Kato A, Kudo S, Itoh T
Department of Thoracic and Cardiovascular Surgery, Saga Medical School, Saga, Japan.
Kyobu Geka. 2004 Apr;57(4):285-90.
We report our method for delineating the Adamkiewicz artery using multidetector row computed tomography (MDCT) with selective perfusion using a distal perfusion cannula that is clinically available for off-pump coronary artery bypass (OPCAB). The tip of a distal perfusion catheter (Medtronic Quickflow, Minneapolis) designed for OPCAB was applicable for selective perfusion of the segmental arteries. The femoro-femoral venoarterial bypass was branched off into selective perfusion of the segmental arteries, using an independent roller pump and heat exchanger. Our method of visualization of the Adamkiewicz artery was MDCT scanning with injection of contrast medium directly into the proximal descending aorta: namely, "CT during aortography". Lower descending aorta to abdominal aorta (the range involving the aneurysm) was scanned in a cephalad-to-caudal direction using a detector collimation of 4 x 1.25 mm with a table speed of 9.4 mm/sec, pitch of 6, and image thickness of 1.25 mm. All images were reviewed on a workstation to investigate the continuity between the Adamkiewicz artery and its proximal segmental artery with paging, mulitplanar reformation and curved planar reformation. Distal perfusion cannulae of 2.0 mm in diameter were inserted into the respective intercostal arteries. 4-0 polyethylene sutures were placed to tourniquet the catheters. Segmental arteries were perfused with total flow of approximately 80 ml/min at a circuit pressure of 120 mmHg. Reattachment of the ninth intercostal arteries related to the Adamkiewicz artery was carried out. A total of 6 consecutive 6 patients with thoracoabdominal aortic aneurysm (TAAA) have undergone graft replacement by the methods described, since April 2002. All patients survived surgery without any neurological complications. This method is expected to minimize the ischemic time of the spinal cord and attenuate the reperfusion injury.
我们报告了一种使用多排螺旋计算机断层扫描（MDCT）结合选择性灌注来描绘Adamkiewicz动脉的方法，该方法使用临床上可用于非体外循环冠状动脉搭桥术（OPCAB）的远端灌注套管。专为OPCAB设计的远端灌注导管（美敦力Quickflow，明尼阿波利斯）的尖端适用于节段性动脉的选择性灌注。股-股静脉动脉旁路通过一个独立的滚压泵和热交换器分支为节段性动脉的选择性灌注。我们描绘Adamkiewicz动脉的方法是通过将造影剂直接注入降主动脉近端进行MDCT扫描，即“主动脉造影时的CT”。使用4×1.25mm的探测器准直、9.4mm/秒的床速、6的螺距和1.25mm的图像厚度，从头部到尾部方向扫描降主动脉下部至腹主动脉（包括动脉瘤的范围）。所有图像在工作站上进行回顾，通过分页、多平面重建和曲面重建来研究Adamkiewicz动脉与其近端节段性动脉之间的连续性。将直径为2.0mm的远端灌注套管插入各个肋间动脉。放置4-0聚乙烯缝线以扎紧导管。节段性动脉在120mmHg的回路压力下以约80ml/分钟的总流量进行灌注。对与Adamkiewicz动脉相关的第九肋间动脉进行重新连接。自2002年4月以来，共有6例连续的胸腹主动脉瘤（TAAA）患者通过上述方法接受了移植物置换。所有患者术后存活，无任何神经并发症。该方法有望使脊髓的缺血时间最短，并减轻再灌注损伤。
