The impact of preoperative identification of the Adamkiewicz artery on descending and thoracoabdominal aortic repair.
OBJECTIVE
To investigate the impact of preoperative identification of the Adamkiewicz artery (AKA) on prevention of spinal cord injury (SCI) through the multicenter Japanese Study of Spinal Cord Protection in Descending and Thoracoabdominal Aortic Repair (JASPAR) registry.


METHODS
Between January 2000 and October 2011, 2435 descending/thoracoabdominal aortic repairs were performed, including 1998 elective repairs and 437 urgent repairs, in 14 major centers in Japan. The mean patient age was 67 ± 13 years, and 74.2% were males. There were 1471 open repairs (ORs), including 748 descending and 137 thoracoabdominal extent [Ex] I, 136 Ex II, 194 Ex III, 115 Ex IV, and 138 Ex V, and 964 endovascular repairs (EVRs). Of the 2435 patients, 1252 (51%) underwent preoperative magnetic resonance or computed tomography angiography to identify the AKA.


RESULTS
The AKA was identified in 1096 of the 1252 patients who underwent preoperative imaging (87.6%). Hospital mortality was 9.2% (n = 136) in those who underwent OR and 6.4% (n = 62) in those who underwent EVR. The incidence of SCI was 7.3% in the OR group (descending, 4.2%; Ex I, 9.4%; Ex II, 14.0%; Ex III, 14.4%; Ex IV, 4.2 %; Ex V, 7.2%) and 2.9% in the EVR group. The risk factors for SCI in ORs were advanced age, extended repair, emergency, and occluded bilateral hypogastric arteries. In ORs of the aortic segment involving the AKA, having no AKA reconstruction was a significant risk factor for SCI (odds ratio, 2.79, 95% confidence interval, 1.14-6.79; P = .024).


CONCLUSIONS
In descending/thoracoabdominal aortic repairs, preoperative AKA identification with its adequate reconstruction or preservation, especially, in ORs of aortic pathologies involving the AKA, would be a useful adjunct for more secure spinal cord protection.
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan.
Hiroshi
H
Tanaka
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan; Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan. Electronic address: hogino@tokyo-med.ac.jp.
Hitoshi
H
Ogino
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan.
Kenji
K
Minatoya
Department of Cardiovascular Surgery, Hokkaido University, Sapporo, Japan.
Yoshiro
Y
Matsui
Second Department of Surgery, Sapporo Medical University, Sapporo, Japan.
Tetsuya
T
Higami
Department of Cardiovascular Surgery, Iwate Medical University, Morioka, Japan.
Hitoshi
H
Okabayashi
Department of Cardiovascular Surgery, Tohoku University, Sendai, Japan.
Yoshikatsu
Y
Saiki
Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Shigeyuki
S
Aomi
First Department of Surgery, Hamamatsu Medical University, Hamamatsu, Japan.
Norihiko
N
Shiiya
Department of Cardiovascular Surgery, Osaka University, Osaka, Japan.
Yoshiki
Y
Sawa
Department of Cardiovascular Surgery, Kobe University, Kobe, Japan.
Yutaka
Y
Okita
First Department of Surgery, Hiroshima University, Hiroshima, Japan.
Taijiro
T
Sueda
Department of Surgery, Kurume University, Kurume, Japan.
Hidetoshi
H
Akashi
Second Department of Surgery, Ryukyu University, Nishihara, Japan.
Yukio
Y
Kuniyoshi
Department of Thoracic and Cardiovascular Surgery, Osaka Medical University, Osaka, Japan.
Takahiro
T
Katsumata
D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013116:Spinal Cord / Q000098:blood supply*; D020760:Spinal Cord Ischemia / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Adamkiewicz artery; aorta; spinal cord protection