Satoshi Saito, Shigeyuki Aomi, Hiroyuki Tomioka, Hiromi Kurosawa; Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
Objective: To evaluate the efficacy of selective reconstruction of Adamkiewicz artery (ARM) during descending(TAA) or thoracoabdominal (TAAA) repair on post operative spinal cord blood supply, we had prospectively analysed source of blood supply for spinal cord by multidetecter computer tomography (MDCT) before and after surgery.
Methods: Sixty two consecutive patients who had aneurysms of the descending ( n=15 ) or thoracoabdominal aorta (n=47 ) were studied prospectively with MDCT to identify ARM before and after surgery. Median age was 62 years(range ,29 to 77) and 37patients had non-dissecting aneurysm and 25 had aortic dissections. All MDCT images are reviewed on a workstation to investigate the continuity between the ARM and its proximal segmental artery and other collateral blood blow for spinal cord. The repair was performed using partial cardiopulmonary bypass and the segmental intercostals arteries connected with ARM were reconstructed selectively according to the identification of ARM with MDCT. Adjunctive spinal protective measures included distal perfusion, maintenance of high normal pressure, MEP monitoring and cerebrospinal fluid drainage. Postoperative MDCT study was performed in 53 patients at 14.5 ± 17.5 days postoperatively for the comparison with preoperative MDCT.
Results: MDCT demonstrated the ARM in 57(91.9%) of the 62 patients. The hospital deaths occurred in 3 patients (4.8%).No paraplegia but 1 paraparesis ( 1.6 % ) occurred in a patients whose ARM had not been identified and multiple blood supply for the cord was suspected.Comparison between post and preoperative MDCT showed successful reconstruction of ARM compatible with preoperative identification in 36 patients ( 68.1 %), other major different source of blood supply identified in 18 ( 34.6%), and 12/58 (20.6%) reconstructed arteries were occluded with other collateral source development.
Conclusion: 1.Selective reconstruction of preoperatively identified ARM during repair of TAA or TAAA is effective maintaining blood flow for spinal cord to prevent neurological deficit. 2.Collateral blood supply for spinal cord develops immediately after TAA or TAAA repair to compensate the perioperative ischemic changes and careful considerations of collateral source for spinal cord is crucially important.
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