A new intercostal artery management strategy for thoracoabdominal aortic aneurysm repair.
OBJECTIVE
The purpose of this study is to describe a new approach for addressing the intraoperative management of intercostal arteries during thoracoabdominal aortic aneurysm (TAAA) repair, using preoperative spinal MRA for detection of intercostal arteries supplying the anterior spinal artery.


METHODS
Patients undergoing TAAA repair from August 2005 to September 2007 were included. Spinal artery MRA was performed to identify the anterior spinal artery, the artery of Adamkiewicz, and its major intercostal source artery (SA-AAK). Intraoperative spinal cord protection was carried out using standard techniques. Important intercostal arteries were either preserved or reimplanted as a button patch after removing aortic clamps. Demographic and perioperative data were collected for review. Analysis was performed with Fisher's exact test or Student's t-test, where applicable, using SAS ver. 8.0 (Cary, NC).


RESULTS
Spinal artery MRA was performed in 27 patients. The SA-AAK was identified in 85% of preoperative studies. Open or endovascular repair was performed in 74% and 26% of patients, respectively. The SA-AAK was preserved or reimplanted in 13 (65%) of patients who underwent open repair. A mean of 1.67 (range 1-3) intercostal arteries were reimplanted. All patients undergoing endovascular repair necessitated coverage of the SA-AAK. No patient developed immediate or delayed paraplegia. Longer mean operative times in the reimplanted cohort were not statistically significant (330 versus 245 min, P = 0.1).


CONCLUSIONS
The SA-AAK identified by MRA can be preserved or safely reimplanted after TAAA repair. Further study is warranted to determine if selective intercostal reimplantation can reduce the risk of immediate or delayed paraplegia.
Mell
Matthew W
MW
Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792, USA. mell@surgery.wisc.edu
Wynn
Martha M
MM
Reeder
Scott B
SB
Tefera
Girma
G
Hoch
John R
JR
Acher
Charles W
CW
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001158:Arteries / Q000601:surgery*; D005260:Female; D006801:Humans; D007238:Infarction / Q000209:etiology / Q000517:prevention & control; D007366:Intercostal Muscles / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012092:Replantation / Q000379:methods; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000517:prevention & control; D013131:Spine / Q000098:blood supply; D014656:Vascular Surgical Procedures / Q000379:methods*