[Thoracoabdominal aortic aneurysm repair after detection of the Adamkiewicz artery by magnetic resonance angiography; a way to shorten operating time and improve outcome].
Surgical results were compared between 18 patients (group A) who underwent preoperative anatomic characterization of the Adamkiewicz artery by magnetic resonance angiography (MRA) and 38 patients (group B) without such imaging. In group A, intercostal or lumbar arteries related to the aneurysm were reattached to the graft only when they represented the origin of the Adamkiewicz artery. In group B, reconstruction from the Th 7 intercostal and the L2 lumbar arteries was performed whenever possible. In-hospital mortality was 16.7% in group A and 15.8% in group B. Total aortic clamp time and operating time were only 84 and 437 min in group A, compared with 134 and 589 min in group B. Three patients showed postoperative paraplegia in group B. No spinal cord injury occurred in patients whose artery had been detected preoperatively. Preoperative anatomic delineation of the Adamkiewicz artery by MRA can reduce risk of ischemic injury to the spinal cord and decrease operating time required for repair of thoracoabdominal aortic aneurysms.
Hachiro
Y
Y
Department of Second Surgery, Sapporo Medical University, Sapporo, Japan.
Kawaharada
N
N
Morishita
K
K
Fukada
J
J
Fujisawa
Y
Y
Kurimoto
Y
Y
Abe
T
T
D000328:Adult; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001158:Arteries / Q000033:anatomy & histology*; D003250:Constriction; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D013116:Spinal Cord / Q000098:blood supply*; D020760:Spinal Cord Ischemia / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures