Saitoh Daiki, Yamazaki Yuya, Tsuji Tatsunori, Sakoda Naoya, Yakuwa Kazuki, Tabayashi Azuma, Koizumi Junichi, Ohsawa Satoshi, Kin Hajime
Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan.
Department of Cardiovascular Surgery, San-ai Hospital, Iwate, Japan.
Interdiscip Cardiovasc Thorac Surg. 2024 Jun 5;38(6). doi: 10.1093/icvts/ivae087.
Our goal was to evaluate postoperative patterns of collateral arteries to the spinal cord during occlusion of the segmental arteries supplying the artery of Adamkiewicz (AKA).
Between April 2011 and December 2022, a total of 179 patients underwent thoraco-abdominal aortic aneurysm repair; 141 had an identifiable AKA on preoperative multidetector computed tomography scans, 40 underwent thoraco-abdominal aortic aneurysm replacement (TAAR) and 101 underwent thoracic endovascular aortic repair (TEVAR). New postoperative collateral blood pathways invisible on preoperative contrast-enhanced computed tomography scans were identified in 42 patients (10 patients who had TAAR vs 32 patients who had TEVAR) who underwent preoperative and postoperative multidetector computed tomography scanning for AKA identification.
The thoracodorsal and segmental arteries were the main collateral pathways in both groups. Th9-initiated collaterals were the most common. Collaterals from the internal thoracic artery were observed in the TEVAR group but not in the TAAR group. One patient in the TEVAR group experienced postoperative paraparesis, which was not observed in the TAAR group. Postoperative paraplegia was more common in the non-Th9-origin group, but this difference was not significant.
Thoracodorsal and segmental arteries may be important collateral pathways after TEVAR and TAAR. For thoracodorsal arteries, preserving the thoracodorsal muscle during the approach would be crucial; for segmental arteries, minimizing the area to be replaced or covered would be paramount. An AKA not initiated at the Th9 level poses a high risk of postoperative paraplegia.
我们的目标是评估在阻断供应Adamkiewicz动脉（AKA）的节段动脉期间脊髓侧支动脉的术后模式。
2011年4月至2022年12月期间，共有179例患者接受了胸腹主动脉瘤修复术；141例在术前多排计算机断层扫描中可识别出AKA，40例行胸腹主动脉瘤置换术（TAAR），101例行胸段血管腔内主动脉修复术（TEVAR）。在42例（10例行TAAR的患者与32例行TEVAR的患者）术前和术后进行多排计算机断层扫描以识别AKA的患者中，发现了术前对比增强计算机断层扫描上不可见的新的术后侧支血液通路。
两组中胸背动脉和节段动脉均为主要的侧支通路。起源于Th9的侧支最为常见。TEVAR组观察到来自胸廓内动脉的侧支，而TAAR组未观察到。TEVAR组有1例患者术后出现轻截瘫，TAAR组未观察到。术后截瘫在非Th9起源组中更常见，但差异无统计学意义。
胸背动脉和节段动脉可能是TEVAR和TAAR术后重要的侧支通路。对于胸背动脉，手术入路时保留胸背肌至关重要；对于节段动脉，尽量减少置换或覆盖的面积至关重要。起源于非Th9水平的AKA术后发生截瘫的风险很高。
