The impact of preoperative identification of the Adamkiewicz artery on descending and thoracoabdominal aortic repair
The impact of preoperative identification of the Adamkiewicz artery on descending and thoracoabdominal aortic repair
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DOI：
10.1016/j.jtcvs.2015.07.079
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发表时间：
2016-01-01
影响因子：
6
通讯作者：
Katsumata, Takahiro
中科院分区：
文献类型：
--
作者：
Tanaka, Hiroshi;Ogino, Hitoshi;Katsumata, Takahiro
目的：通过多中心日本降主动脉和胸腹主动脉修复术中脊髓保护研究（JASPAR）登记研究，探讨术前识别Adamkiewicz动脉（AKA）对预防脊髓损伤（SCI）的影响。2000年1月至2011年10月期间，进行了2435例降主动脉/胸腹主动脉修复术，包括1998例择期修复术和437例紧急修复术，在日本的14个主要中心。患者平均年龄为67 ± 13岁，74.2%为男性。有1471例开放性修复术（OR），包括748例下行和137例胸腹范围[Ex] I、136例Ex II、194例Ex III、115例Ex IV和138例Ex V，以及964例血管内修复术（EVR）。结果：1252例患者中有1096例（87.6%）术前诊断为AKA，其中1252例（51%）术前行MRI或CT血管造影检查。接受OR的患者的住院死亡率为9.2%（n = 136），接受EVR的患者为6.4%（n = 62）。OR组的SCI发生率为7.3%（下降，4.2%; Ex I，9.4%; Ex II，14.0%; Ex III，14.4%; Ex IV，4.2%; Ex V，7.2%），EVR组为2.9%。手术室发生脊髓损伤的危险因素包括高龄、修复时间延长、急诊和双侧腹下动脉闭塞。在涉及AKA的主动脉段的OR中，没有AKA重建是SCI的重要风险因素（比值比，2.79，95%可信区间，1.14-6.79; P = 0.024）。在降主动脉/胸腹主动脉修复术中，术前AKA识别及其充分重建或保留，特别是在涉及AKA的主动脉病变的OR中，将是一个有用的辅助更安全的脊髓保护。
Objective: To investigate the impact of preoperative identification of the Adamkiewicz artery (AKA) on prevention of spinal cord injury (SCI) through the multicenter Japanese Study of Spinal Cord Protection in Descending and Thoracoabdominal Aortic Repair (JASPAR) registry.Methods: Between January 2000 and October 2011, 2435 descending/thoracoabdominal aortic repairs were performed, including 1998 elective repairs and 437 urgent repairs, in 14 major centers in Japan. The mean patient age was 67 +/- 13 years, and 74.2% were males. There were 1471 open repairs (ORs), including 748 descending and 137 thoracoabdominal extent [Ex] I, 136 Ex II, 194 Ex III, 115 Ex IV, and 138 Ex V, and 964 endovascular repairs (EVRs). Of the 2435 patients, 1252 (51%) underwent preoperative magnetic resonance or computed tomography angiography to identify the AKA.Results: The AKAwas identified in 1096 of the 1252 patients who underwent preoperative imaging (87.6%). Hospital mortality was 9.2%(n = 136) in those who underwent OR and 6.4%(n = 62) in those who underwent EVR. The incidence of SCI was 7.3% in the OR group (descending, 4.2%; Ex I, 9.4%; Ex II, 14.0%; Ex III, 14.4%; Ex IV, 4.2%; Ex V, 7.2%) and 2.9% in the EVR group. The risk factors for SCI in ORs were advanced age, extended repair, emergency, and occluded bilateral hypogastric arteries. In ORs of the aortic segment involving the AKA, having no AKA reconstruction was a significant risk factor for SCI (odds ratio, 2.79, 95% confidence interval, 1.14-6.79; P = .024).Conclusions: In descending/thoracoabdominal aortic repairs, preoperative AKA identification with its adequate reconstruction or preservation, especially, in ORs of aortic pathologies involving the AKA, would be a useful adjunct for more secure spinal cord protection.