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Preoperative Assessment of the Spinal Cord Vasculature

  • Alexandre Campos Moraes AmatoEmail author
  • Noedir Antonio Groppo Stolf
Chapter

Abstract

Understanding the spinal cord vascular supply is key when treating patients with aortic diseases. The importance of identifying and localizing the artery of Adamkiewicz prior to thoracic and thoracoabdominal surgery in order to prevent spinal cord injury was previously demonstrated using invasive angiography. Currently, computed tomography angiography and magnetic resonance angiography are minimally invasive imaging techniques used to assess the spinal cord blood supply. As endovascular closure of intercostal arteries combined with occlusion of collateral vessels supplying the spinal cord is a risk factor for symptomatic spinal cord ischemia, we propose to evaluate the spinal cord vasculature preoperatively or rely on anatomic studies while planning the procedure.

References

  1. 1.
    Greenberg RK, Lytle B. Endovascular repair of thoracoabdominal aneurysms. Circulation. 2008;117(17):2288–96.PubMedGoogle Scholar
  2. 2.
    Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg. 1993;17(2):357–68.PubMedGoogle Scholar
  3. 3.
    Chiesa R, Melissano G, Bertoglio L, Amato ACM, Tshomba Y, Civilini E, et al. The risk of spinal cord ischemia during thoracic aorta endografting. Acta Chir Belg. 2008;108:492–502.PubMedGoogle Scholar
  4. 4.
    Gottardi R, Dumfarth J, Holfeld J, Schoder M, Funovics M, Laufer G, et al. Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta. Eur J Cardiothorac Surg. 2010;37(5):1081–5.PubMedGoogle Scholar
  5. 5.
    Eggebrecht H, Nienaber CA, Neuhäuser M, Baumgart D, Kische S, Schmermund A, et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J. 2006;27(4):489–98.PubMedGoogle Scholar
  6. 6.
    Czerny M, Funovics M, Sodeck G, Dumfarth J, Schoder M, Juraszek A, et al. Long-term results of thoracic endovascular aortic repair in atherosclerotic aneurysms involving the descending aorta. J Thorac Cardiovasc Surg. 2010;140(6 Suppl):S179–84.PubMedGoogle Scholar
  7. 7.
    Buth J, Harris PL, Hobo R, van Eps R, Cuypers P, Duijm L, Tielbeek X. Neurologic complications associated with endovascular repair of thoracic aortic pathology: incidence and risk factors. A study from the european collaborators on stent/graft techniques for aortic aneurysm repair (EUROSTAR) registry. J Vasc Surg. 2007;46(6):1103–10.PubMedGoogle Scholar
  8. 8.
    Melissano G, Civilini E, Bertoglio L, Calliari F, Campos Moraes Amato A, Chiesa R. Angio-CT imaging of the spinal cord vascularisation: a pictorial essay. Eur J Vasc Endovasc Surg. 2010;39(4):436–40.PubMedGoogle Scholar
  9. 9.
    Amato ACM, Parga Filho JR, Stolf NAG. Influential factors on the evaluation of Adamkiewicz artery using a 320-detector row computed tomography device. Ann Vasc Surg. 2017;44:136–45.PubMedGoogle Scholar
  10. 10.
    Amato ACM, Parga Filho JR, Stolf NAG. Predictors of Adamkiewicz artery and anterior spinal artery detection through computerized tomographic angiography. SAGE Open Med. 2017;5:2050312117711599.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Amato ACM, Stolf NAG. Anatomy of spinal blood supply. J Vasc Bras. 2015;14(3):248–52.Google Scholar
  12. 12.
    Thron AK. Vascular anatomy of the spine. Oxford: Oxford University Press; 2002.Google Scholar
  13. 13.
    Thron AK, Rossberg C. Vascular anatomy of the spinal cord: neuroradiological investigations and clinical syndromes. New York: Springer; 1988.Google Scholar
  14. 14.
    Thron AK. Vascular anatomy of the spinal cord: neuroradiological investigations and clinical syndromes. New York: Springer-Verlag; 1989.Google Scholar
  15. 15.
    Kudo K, Terae S, Asano T, Oka M, Kaneko K, Ushikoshi S, Miyasaka K. Anterior spinal artery and artery of Adamkiewicz detected by using multi-detector row CT. AJNR Am J Neuroradiol. 2003;24(1):13–7.PubMedGoogle Scholar
  16. 16.
    Uotani K, Yamada N, Kono AK, Taniguchi T, Sugimoto K, Fujii M, et al. Preoperative visualization of the artery of Adamkiewicz by intra-arterial CT angiography. AJNR Am J Neuroradiol. 2008;29(2):314–8.PubMedGoogle Scholar
  17. 17.
    Nojiri J, Matsumoto K, Kato A, Miho T, Furukawa K, Ohtsubo S, et al. The Adamkiewicz artery: demonstration by intra-arterial computed tomographic angiography. Eur J Cardiothorac Surg. 2007;31(2):249–55.PubMedGoogle Scholar
  18. 18.
    Yoshioka K, Niinuma H, Ohira A, Nasu K, Kawakami T, Sasaki M, Kawazoe K. MR angiography and CT angiography of the artery of Adamkiewicz: noninvasive preoperative assessment of thoracoabdominal aortic aneurysm. Radiographics. 2003;23(5):1215–25.PubMedGoogle Scholar
  19. 19.
    Yoshioka K, Niinuma H, Ehara S, Nakajima T, Nakamura M, Kawazoe K. MR angiography and CT angiography of the artery of Adamkiewicz: state of the art. Radiographics. 2006;26(Suppl 1):S63–73.PubMedGoogle Scholar
  20. 20.
    Takase K, Sawamura Y, Igarashi K, Chiba Y, Haga K, Saito H, Takahashi S. Demonstration of the artery of Adamkiewicz at multi- detector row helical CT. Radiology. 2002;223(1):39–45.PubMedGoogle Scholar
  21. 21.
    Melissano G, Amato ACM, Bertoglio L, Civilini E, Civelli V, Coppi G, et al. Demonstration of the Adamkiewicz artery by multidetector computed tomography angiography analysed with open-source software OsiriX. Eur J Vasc Endovasc Surg. 2009;37(4):395–400.PubMedGoogle Scholar
  22. 22.
    Nishimura J, Lee J, Koike S, Kurihara H, Ozawa Y, Abe A, et al. Identification of the segmental artery feeding the anterior spinal artery: correlation between helical CT and angiography. Radiat Med. 2005;23(4):271–6.PubMedGoogle Scholar
  23. 23.
    von Tengg-Kobligk H, Böckler D, Jose TM, Ganten M, Kotelis D, Nagel S, et al. Feeding arteries of the spinal cord at CT angiography before and after thoracic aortic endografting. J Endovasc Ther. 2007;14(5):639–49.Google Scholar
  24. 24.
    Nakayama Y, Awai K, Yanaga Y, Nakaura T, Funama Y, Hirai T, Yamashita Y. Optimal contrast medium injection protocols for the depiction of the Adamkiewicz artery using 64-detector CT angiography. Clin Radiol. 2008;63(8):880–7.PubMedGoogle Scholar
  25. 25.
    Zhao S, Logan L, Schraedley P, Rubin GD. Multi-detector CT angiography for the assessment of anterior spinal artery and artery of Adamkiewicz patency in patients suspected of having thoracic aortic pathology. J Geriatr Cardiol. 2006;3(1):52–6.Google Scholar
  26. 26.
    Ou P, Schmit P, Layouss W, Sidi D, Bonnet D, Brunelle F. CT angiography of the artery of Adamkiewicz with 64-section technology: first experience in children. AJNR Am J Neuroradiol. 2007;28(2):216–9.PubMedGoogle Scholar
  27. 27.
    Takase K, Akasaka J, Sawamura Y, Ota H, Sato A, Yamada T, et al. Preoperative MDCT evaluation of the artery of Adamkiewicz and its origin. J Comput Assist Tomogr. 2006;30(5):716–22.PubMedGoogle Scholar
  28. 28.
    Melissano G, Chiesa R. Advances in imaging of the spinal cord vascular supply and its relationship with paraplegia after aortic interventions. A review. Eur J Vasc Endovasc Surg. 2009;38(5):567–77.PubMedGoogle Scholar
  29. 29.
    Griepp RB, Griepp EB. Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: the collateral network concept. Ann Thorac Surg. 2007;83(2):S865–9.PubMedGoogle Scholar
  30. 30.
    Czerny M, Eggebrecht H, Sodeck G, Verzini F, Cao P, Maritati G, et al. Mechanisms of symptomatic spinal cord ischemia after TEVAR: insights from the european registry of endovascular aortic repair complications (eurec). J Endovasc Ther. 2012;19(1):37–43.PubMedGoogle Scholar
  31. 31.
    Griepp R, Luozzo GD, Schray D, Stefanovic A, Geisbüsch S, Randall BRB. The anatomy of the spinal cord collateral circulation. Ann Cardiothorac Surg. 2012;1(3):350–7.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Kieffer E, Richard T, Chiras J, Godet G, Cormier E. Preoperative spinal cord arteriography in aneurysmal disease of the descending thoracic and thoracoabdominal aorta: preliminary results in 45 patients. Ann Vasc Surg. 1989;3(1):34–46.PubMedGoogle Scholar
  33. 33.
    Chiesa R, Melissano G, Marrocco-Trischitta MM, Civilini E, Setacci F. Spinal cord ischemia after elective stent-graft repair of the thoracic aorta. J Vasc Surg. 2005;42(1):11–7.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Forbes G, Nichols DA, Jack CR, Ilstrup DM, Kispert DB, Piepgras DG, et al. Complications of spinal cord arteriography: prospective assessment of risk for diagnostic procedures. Radiology. 1988;169(2):479–84.PubMedGoogle Scholar
  35. 35.
    Schurink GW, Nijenhuis RJ, Backes WH, Mess W, de Haan MW, Mochtar B, Jacobs MJ. Assessment of spinal cord circulation and function in endovascular treatment of thoracic aortic aneurysms. Ann Thorac Surg. 2007;83(2):S877–81.PubMedGoogle Scholar
  36. 36.
    Yamada N, Okita Y, Minatoya K, Tagusari O, Ando M, Takamiya M, Kitamura S. Preoperative demonstration of the Adamkiewicz artery by magnetic resonance angiography in patients with descending or thoracoabdominal aortic aneurysms. Eur J Cardiothorac Surg. 2000;18(1):104–11.PubMedGoogle Scholar
  37. 37.
    Kawaharada N, Morishita K, Fukada J, Yamada A, Muraki S, Hyodoh H, Abe T. Thoracoabdominal or descending aortic aneurysm repair after preoperative demonstration of the Adamkiewicz artery by magnetic resonance angiography. Eur J Cardiothorac Surg. 2002;21(6):970–4.PubMedGoogle Scholar
  38. 38.
    Nijenhuis RJ, Gerretsen S, Leiner T, Jacobs MJ, van Engelshoven JM, Backes WH. Comparison of 0.5-M gd-dtpa with 1.0-M gadobutrol for magnetic resonance angiography of the supplying arteries of the spinal cord in thoracoabdominal aortic aneurysm patients. J Magn Reson Imaging. 2005;22(1):136–44.PubMedGoogle Scholar
  39. 39.
    Hyodoh H, Shirase R, Akiba H, Tamakawa M, Hyodoh K, Yama N, et al. Double-subtraction maximum intensity projection MR angiography for detecting the artery of Adamkiewicz and differentiating it from the drainage vein. J Magn Reson Imaging. 2007;26(2):359–65.PubMedGoogle Scholar
  40. 40.
    Hyodoh H, Kawaharada N, Akiba H, Tamakawa M, Hyodoh K, Fukada J, et al. Usefulness of preoperative detection of artery of Adamkiewicz with dynamic contrast-enhanced MR angiography. Radiology. 2005;236(3):1004–9.PubMedGoogle Scholar
  41. 41.
    Nijenhuis RJ, Jacobs MJ, Schurink GW, Kessels AG, van Engelshoven JM, Backes WH. Magnetic resonance angiography and neuromonitoring to assess spinal cord blood supply in thoracic and thoracoabdominal aortic aneurysm surgery. J Vasc Surg. 2007;45(1):71–7.PubMedGoogle Scholar
  42. 42.
    Katz RC, Wilson L, Frazer N. Anxiety and its determinants in patients undergoing magnetic resonance imaging. J Behav Ther Exp Psychiatry. 1994;25(2):131–4.PubMedGoogle Scholar
  43. 43.
    Murakami H, Kawahara N, Tomita K, Demura S, Kato S, Yoshioka K. Does interruption of the artery of Adamkiewicz during total en bloc spondylectomy affect neurologic function? Spine (Phila Pa 1976). 2010;35(22):E1187–92.Google Scholar
  44. 44.
    Fattori R, Nienaber CA, Rousseau H, Beregi JP, Heijmen R, Grabenwöger M, et al. Results of endovascular repair of the thoracic aorta with the talent thoracic stent graft: the talent thoracic retrospective registry. J Thorac Cardiovasc Surg. 2006;132(2):332–9.PubMedGoogle Scholar
  45. 45.
    Yingbin J, Jiefei M, Jian L, Yonghui S, Haiyan P, Baimeng Z, Weigoo F. Evaluation of the thoracic aortic dissection treated by endografts covering a longer distance of aorta according to the location of the Adamkiewicz artery. Thorac Cardiovasc Surg. 2013;61(07):569–74.PubMedGoogle Scholar
  46. 46.
    Amato ACM, Melissano G, Giovanni C, Civilini E, Civelli V, Calori G, et al. Available from: http://vascular.cc/aka.html. Accessed 18 Dec 2012.
  47. 47.
    Nijenhuis RJ, Jacobs MJ, Jaspers K, Reinders M, Reijnders M, van Engelshoven JM, et al. Comparison of magnetic resonance with computed tomography angiography for preoperative localization of the Adamkiewicz artery in thoracoabdominal aortic aneurysm patients. J Vasc Surg. 2007;45(4):677–85.PubMedGoogle Scholar
  48. 48.
    Boll DT, Bulow H, Blackham KA, Aschoff AJ, Schmitz BL. MDCT angiography of the spinal vasculature and the artery of Adamkiewicz. AJR Am J Roentgenol. 2006;187(4):1054–60.PubMedGoogle Scholar
  49. 49.
    Nijenhuis RJ, Mull M, Wilmink JT, Thron AK, Backes WH. MR angiography of the great anterior radiculomedullary artery (Adamkiewicz artery) validated by digital subtraction angiography. AJNR Am J Neuroradiol. 2006;27(7):1565–72.PubMedGoogle Scholar
  50. 50.
    Nijenhuis RJ, Jacobs MJ, van Engelshoven JM, Backes WH. MR angiography of the Adamkiewicz artery and anterior radiculomedullary vein: postmortem validation. AJNR Am J Neuroradiol. 2006;27(7):1573–5.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alexandre Campos Moraes Amato
    • 1
    • 2
    Email author
  • Noedir Antonio Groppo Stolf
    • 3
  1. 1.Vascular SurgerySanto Amaro UniversitySão PauloBrazil
  2. 2.Amato—Instituto de Medicina AvançadaSão PauloBrazil
  3. 3.Thoracic and Cardiovascular SurgerySchool of Medicine, University of São PauloSão PauloBrazil

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