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Strategy for thoracic endovascular aortic repair based on collateral circulation to the artery of Adamkiewicz

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Abstract

Purpose

Spinal cord ischemia (SCI) is a serious complication of thoracic endovascular aortic repair (TEVAR). The purpose of this study was to establish if preoperative identification of the artery of Adamkiewicz (AKA) can help prevent post-TEVAR SCI.

Methods

Of 74 post-TEVAR patients, 51 had the critical segmental artery (CSA) to the AKA pre-identified to help the surgeon deploy stent grafts.

Results

None of these 51 patients suffered permanent paraplegia postoperatively, but 5 (23.8 %) of the remaining 23 patients (2 of whom had pre-existing paraplegia) did suffer permanent SCI. The CSA/AKA was preserved in 43 patients with pre-identification of the CSA/AKA; however, in 8 patients, the CSA was completely or partially occluded by a stent graft. Transient SCI developed in one patient from each group, but both of these patients recovered fully before discharge. No change in the anatomical route was identified in 29 of the patients who had postoperative evaluation of the CSA/AKA. Five of eight patients whose CSA was completely occluded had new collateral circulation to the AKA.

Conclusions

None of the 51 patients with the CSA/AKA identified before TEVAR suffered permanent paraplegia, whereas 5 of the 23 without pre-identification did suffer permanent SCI. Thus, careful identification of the CSA/AKA may prove useful for preventing postoperative SCI. Preservation of potential collateral circulation may also reduce the risk of postoperative SCI.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan

    Takeshi Kamada, Masayuki Mukaida, Akio Ikai & Hitoshi Okabayashi

  2. Department of Radiology, Iwate Medical University Memorial Heart Center, Morioka, Japan

    Kunihiro Yoshioka & Ryoichi Tanaka

  3. Department of Internal Medicine, Iwate Medical University Memorial Heart Center, Morioka, Japan

    Shinji Makita & Akihiko Abiko

Authors
  1. Takeshi Kamada
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  2. Kunihiro Yoshioka
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  3. Ryoichi Tanaka
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  4. Shinji Makita
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  5. Akihiko Abiko
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  6. Masayuki Mukaida
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  7. Akio Ikai
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  8. Hitoshi Okabayashi
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Correspondence to Takeshi Kamada.

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Kamada, T., Yoshioka, K., Tanaka, R. et al. Strategy for thoracic endovascular aortic repair based on collateral circulation to the artery of Adamkiewicz. Surg Today 46, 1024–1030 (2016). https://doi.org/10.1007/s00595-015-1272-6

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  • DOI: https://doi.org/10.1007/s00595-015-1272-6

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