Kawaharada Nobuyoshi, Morishita Kiyofumi, Kurimoto Yoshihiko, Hyodoh Hideki, Ito Toshiro, Harada Ryo, Kuwaki Kenji, Higami Tetsuya
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan.
Eur J Cardiothorac Surg. 2007 Jun;31(6):998-1003; discussion 1003. doi: 10.1016/j.ejcts.2007.01.069. Epub 2007 Mar 13.
We reviewed our experience to investigate the determinants of paraplegia/paraparesis after endovascular stent-graft repair of the thoracic aorta, to assess the influence of the artery of Adamkiewicz (ARM) detected by preoperative magnetic resonance angiography (MRA) and to identify patients at risk.
Over a 5-year period (March 2001-June 2006), 149 patients underwent elective endovascular stent-graft repair of the descending thoracic aorta. Patient demographics and perioperative factors relating to the endovascular procedure were evaluated by using univariate statistical analyses. To assess the influence of the ARM in the thoracolumbar region, patients in whom ARM was detected by preoperative MRA were divided into two groups: patients who had occlusion of the intercostal artery for ARM due to stent-graft (group A, n=33) and patients who had patency of the intercostal artery for ARM following stent-graft (group B, n=38).
Five (3.6%) of the 144 patients had paraparesis/paraplegia. Two of these five patients had previously undergone operation for total arch replacement with elephant trunk and one had surgery for descending aortic repair. Univariate analyses identified only prior aortic surgery as a significant risk factor (p=0.04). Paraparesis/paraplegia rates were 10% (three patients) in group A and 0% in group B (p=0.09).
Prior thoracic aortic replacement was found to be a significant predictor of spinal cord ischemia, and therefore vigilance is needed regarding occlusion of the intercostal artery for ARM detected prior to stent-graft repair.
我们回顾了我们的经验，以研究胸主动脉腔内支架植入修复术后截瘫/轻截瘫的决定因素，评估术前磁共振血管造影（MRA）检测到的Adamkiewicz动脉（ARM）的影响，并识别有风险的患者。
在5年期间（2001年3月至2006年6月），149例患者接受了降主动脉腔内支架植入修复术。通过单变量统计分析评估患者的人口统计学和与腔内手术相关的围手术期因素。为了评估ARM在胸腰段区域的影响，将术前MRA检测到ARM的患者分为两组：因支架植入导致ARM肋间动脉闭塞的患者（A组，n = 33）和支架植入后ARM肋间动脉通畅的患者（B组，n = 38）。
144例患者中有5例（3.6%）发生轻截瘫/截瘫。这5例患者中有2例先前接受了象鼻全弓置换手术，1例接受了降主动脉修复手术。单变量分析仅确定先前的主动脉手术是一个显著的风险因素（p = 0.04）。A组轻截瘫/截瘫发生率为10%（3例患者），B组为0%（p = 0.09）。
发现先前的胸主动脉置换是脊髓缺血的一个显著预测因素，因此在支架植入修复术前检测到ARM肋间动脉闭塞时需要保持警惕。
