title: Strategy for thoracic endovascular aortic repair based on collateral circulation to the artery of Adamkiewicz.
abstract: OBJECTIVE
  Spinal cord ischemia (SCI) is a serious complication of thoracic endovascular aortic repair (TEVAR). The purpose of this study was to establish if preoperative identification of the artery of Adamkiewicz (AKA) can help prevent post-TEVAR SCI.
  
  
  METHODS
  Of 74 post-TEVAR patients, 51 had the critical segmental artery (CSA) to the AKA pre-identified to help the surgeon deploy stent grafts.
  
  
  RESULTS
  None of these 51 patients suffered permanent paraplegia postoperatively, but 5 (23.8 %) of the remaining 23 patients (2 of whom had pre-existing paraplegia) did suffer permanent SCI. The CSA/AKA was preserved in 43 patients with pre-identification of the CSA/AKA; however, in 8 patients, the CSA was completely or partially occluded by a stent graft. Transient SCI developed in one patient from each group, but both of these patients recovered fully before discharge. No change in the anatomical route was identified in 29 of the patients who had postoperative evaluation of the CSA/AKA. Five of eight patients whose CSA was completely occluded had new collateral circulation to the AKA.
  
  
  CONCLUSIONS
  None of the 51 patients with the CSA/AKA identified before TEVAR suffered permanent paraplegia, whereas 5 of the 23 without pre-identification did suffer permanent SCI. Thus, careful identification of the CSA/AKA may prove useful for preventing postoperative SCI. Preservation of potential collateral circulation may also reduce the risk of postoperative SCI.
authors.affiliation: Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan. tkamada@iwate-med.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kamada
authors.affiliation: Department of Radiology, Iwate Medical University Memorial Heart Center, Morioka, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Yoshioka
authors.affiliation: Department of Radiology, Iwate Medical University Memorial Heart Center, Morioka, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Internal Medicine, Iwate Medical University Memorial Heart Center, Morioka, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Makita
authors.affiliation: Department of Internal Medicine, Iwate Medical University Memorial Heart Center, Morioka, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Abiko
authors.affiliation: Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Mukaida
authors.affiliation: Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Ikai
authors.affiliation: Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Okabayashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001158:Arteries / Q000000981:diagnostic imaging*; D003097:Collateral Circulation / Q000502:physiology*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D057234:Preoperative Period; D012306:Risk; D013116:Spinal Cord / Q000098:blood supply*; D020760:Spinal Cord Ischemia / Q000517:prevention & control*; D015607:Stents; D014057:Tomography, X-Ray Computed
keywords: Artery of Adamkiewicz; Computed tomography; Spinal cord ischemia; Thoracic endovascular aneurysm repair