Higuchi Satoshi, Sato Yuta, Ota Hideki, Mori Ryuichi, Ichinoseki Yuki, Nemoto Hitoshi, Kayano Shingo, Kumagai Kiichiro, Saiki Yoshikatsu, Takase Kei
Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan.
Department of Radiological Technology, Tohoku University Hospital, Sendai, Miyagi, Japan.
Radiol Case Rep. 2024 Dec 28;20(3):1581-1585. doi: 10.1016/j.radcr.2024.12.001. eCollection 2025 Mar.
Preoperative identification of the Adamkiewicz artery (AKA) with adequate reconstruction or preservation during surgery is useful for protecting the spinal cord from ischemia during thoracoabdominal aortic repair. However, the identification of the AKA remains challenging in some cases, especially with chronic aortic dissection. In a 45-year-old man with chronic aortic dissection requiring thoracoabdominal aortic repair, conventional contrast-enhanced CT or MR angiography failed to detect AKA due to the large entry tear and an enlarged false lumen. Intra-arterial ultra-high-resolution CT angiography combined with hemodynamic assessment using 4D flow MRI successfully identified the AKA, allowing for aortic repair with targeted intercostal artery reconstruction without postoperative signs of spinal cord ischemia.
术前识别Adamkiewicz动脉（AKA）并在手术期间进行充分重建或保留，有助于在胸腹主动脉修复术中保护脊髓免受缺血损伤。然而，在某些情况下，尤其是慢性主动脉夹层患者中，识别AKA仍然具有挑战性。在一名45岁需要进行胸腹主动脉修复的慢性主动脉夹层男性患者中，由于较大的入口撕裂和扩大的假腔，传统的对比增强CT或磁共振血管造影未能检测到AKA。动脉内超高分辨率CT血管造影结合使用4D流动MRI进行的血流动力学评估成功识别了AKA，从而能够进行主动脉修复并进行有针对性的肋间动脉重建，术后无脊髓缺血迹象。
