Thoracoabdominal aortic aneurysm repair based on pre- and postoperative evaluation of the artery of Adamkiewicz
Thoracoabdominal aortic aneurysm repair based on pre- and postoperative evaluation of the artery of Adamkiewicz
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基于 Adamkiewicz 动脉术前术后评估的胸腹主动脉瘤修复术
DOI：
10.1093/ejcts/ezac196
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发表时间：
2022
影响因子：
3.4
通讯作者：
Saitoh Daiki
中科院分区：
文献类型：
--
作者：
Imamura Yuki;Kin Hajime;Yoshioka Kunihiro;Tabayashi Azuma;Saitoh Daiki
目的：本研究的目的是基于对Adamkiewicz （AKA）动脉的术前和术后评估来评估我们胸腹主动脉瘤修复的经验。方法：在2017年4月至2021年5月期间，32例胸腹主动脉修复患者接受了术前和术后多排计算机断层扫描（MDCT）进行AKA评估。根据术前MDCT对AKA的识别，只有1条关键节段动脉重新连接到AKA上（CSA-AKA）。术后用MDCT评估再附着的CSA-AKA的通畅程度。结果所有患者（100%）术前和术后MDCT均能识别和显示AKA。8例患者通过侧支循环形成AKA的替代连续性。32例CSA-AKA伴侧支循环48例；每例节段性动脉再连接数为1.3±0.9条（范围0-4）。再附着CSA-AKA的总通畅率为53%（23/43）。3例出现脊髓损伤（截瘫2例，截瘫1例）。在2例再植CSA-AKA部分或完全闭塞的截瘫病例中，术后MDCT未观察到侧支循环的发展。在截瘫病例中，术后MDCT帮助观察CSA-AKA侧支循环的发展情况，导致出院时完全康复。结论：研究结果表明，脊髓损伤不会发生在术前确定的CSA-AKA或侧支循环发育的情况下。术前和术后对AKA侧支通路的识别可能有助于揭示截瘫的危险因素。
OBJECTIVESThe aim of this study was to evaluate our experience with thoraco-abdominal aortic aneurysm repair based on the pre- and postoperative evaluation of the artery of Adamkiewicz (AKA).METHODSBetween April 2017 and May 2021, 32 patients who underwent thoracoabdominal aortic repair underwent pre- and postoperative multidetector row computed tomography (MDCT) for AKA evaluation. Based on the identification of the AKA on preoperative MDCT, only 1 critical segmental artery was reattached to the AKA (CSA-AKA). Postoperative MDCT was used to evaluate the patency of the reattached CSA-AKA.RESULTSPre- and postoperative MDCT helped identify and visualize the AKA in all patients (100%). In 8 patients, alternative continuity to the AKA developed through collateral circulation. The total number of CSA-AKA with collateral circulation was 48 among the 32 cases; the number of reattached segmental arteries per case was 1.3 ± 0.9 (range, 0–4). The overall rate of patency of the reattached CSA-AKA was 53% (23/43). Three patients exhibited spinal cord injuries (paraplegia, 2; paraparesis, 1). In the 2 paraplegia cases exhibiting partial or complete occlusion of the reattached CSA-AKA, the development of collateral circulation was not visualized via postoperative MDCT. In the paraparesis case, postoperative MDCT helped visualize the development of collateral circulation to the CSA-AKA, resulting in full recovery at discharge.CONCLUSIONSThe study findings suggest that spinal cord injuries do not occur in the presence of a patent preoperatively identified CSA-AKA or the development of collateral circulation. Pre- and postoperative identification of collateral pathways to the AKA may help reveal paraplegia risk factors.