Department of Cardiovascular Surgery and Radiology, Faculty of Medicine, Saga University, Saga, Japan.
Ann Thorac Surg. 2010 Dec;90(6):1840-6. doi: 10.1016/j.athoracsur.2010.07.056.
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.
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.
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.
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.
本研究旨在证明术前动脉计算机断层血管造影术识别 Adamkiewicz 动脉（AKA）的功效。我们还旨在研究识别 AKA 对预防脊髓损伤策略的影响。
研究了 37 例患者（24 例降主动脉瘤和 13 例胸腹主动脉瘤）。平均年龄为 63.8 岁。将猪尾导管插入降主动脉，其尖端位于左锁骨下动脉下方。随后进行动脉计算机断层血管造影，并识别供应 AKA 的节段动脉。所有病例均选择性使用人工移植物置换动脉瘤。在供应 AKA 的主动脉节段被夹闭的情况下，识别出的节段动脉-AKA 被选择性灌注。在这些情况下，用间置移植物重建节段动脉-AKA。
动脉计算机断层血管造影术成功识别了所有患者的节段动脉-AKA。每位患者观察到的 AKA 平均数量为 1.3±0.6 条 AKA。在 11 例患者中进行了术前识别的节段动脉-AKA 的选择性灌注。降主动脉瘤的重建节段动脉平均数量为 0.5，胸腹主动脉瘤为 1.7。尽管两名患者（5%）出现截瘫，但其余 35 名患者未发生脊髓损伤。
动脉计算机断层血管造影术可靠地识别节段性 AKA。此外，基于准确的术前识别，选择性灌注节段动脉-AKA 可能是预防术中脊髓缺血的一种选择。
