The impact of spinal angiography on the neurological outcome after surgery on the descending thoracic and thoracoabdominal aorta.
BACKGROUND
Neurologic complications remain one of the major concerns in surgery on the descending thoracic and thoracoabdominal aorta. The impact of preoperative spinal angiography on postoperative neurologic outcome was assessed.


METHODS
Between September 1993 and December 1999, 109 patients (mean age, 58.2 years; range, 24 to 77) underwent preoperative spinal angiography: 50 (45.9%) for aneurysm and 59 (54.1%) for chronic dissection. Sixty-one patients (56.0%) underwent replacement of the descending thoracic aorta whereas the thoracoabdominal aorta was replaced in 48 (44.0%) patients. All intercostal or lumbar arteries that had previously been visualized as the origin of the great radicular artery (GRA) were preserved.


RESULTS
The origin of the GRA was located by spinal angiography in 65 of the 109 patients (59.6%). It was found between level T-5 and L-3 and on the left side in 75.4% (49 of 65) patients. In patients with aneurysms, it was identified less frequently (48%) compared with patients with chronic dissection (69.5%, p = 0.02). The overall operative mortality rate was 5.5% (6 of 109 patients). There were 7 patients (6.4%) with postoperative paraplegia. In 3 of them the origin of the GRA had been reimplanted.


CONCLUSIONS
Even in patients with an identified and subsequently reimplanted GRA, postoperative paraplegia could not always be prevented. Spinal angiography has no impact on the neurologic outcome of thoracic and thoracoabdominal aortic replacement.
Minatoya
Kenji
K
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
Karck
Matthias
M
Hagl
Christian
C
Meyer
Anna
A
Brassel
Friedhelm
F
Harringer
Wolfgang
W
Haverich
Axel
A
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012039:Regional Blood Flow / Q000502:physiology; D012307:Risk Factors; D013116:Spinal Cord / Q000098:blood supply*; D020760:Spinal Cord Ischemia / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*