HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hitoshi Ogino Kenji Minatoya Hitoshi Matsuda Soichiro Kitamura Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ogino, H. Articles by Kitamura, S. Search for Related Content PubMed PubMed Citation Articles by Ogino, H. Articles by Kitamura, S. Related Collections Great vessels

Ann Thorac Surg 2006;82:592-596
© 2006 The Society of Thoracic Surgeons

---

Original article: Cardiovascular

Combined Use of Adamkiewicz Artery Demonstration and Motor-Evoked Potentials in Descending and Thoracoabdominal Repair

^a Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan
^b Radiology, National Cardiovascular Center, Suita, Osaka, Japan

Accepted for publication March 3, 2006.

^_* Address correspondence to Dr Ogino, Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan (Email: hogino{at}hsp.ncvc.go.jp).

BACKGROUND: We retrospectively reviewed the outcome of distal descending aortic and thoracoabdominal aortic repair with preoperative identification of the Adamkiewicz artery by magnetic resonance angiography and intraoperative monitoring of transcranial motor-evoked potentials.

METHODS: We began combined use of demonstration of the Adamkiewicz artery and intraoperative recording of motor-evoked potentials for prevention of spinal cord complications in descending and thoracoabdominal aortic aneurysm repair in 1998. Ninety-two consecutive patients were studied, with descending aneurysm in 53 and thoracoabdominal aneurysm in 39 patients. The repair was performed through a left thoracic or thoracoabdominal incision, using partial cardiopulmonary bypass to prevent spinal cord injury. Magnetic resonance angiography revealed the Adamkiewicz artery in 70.7% of cases. During surgery, spinal cord ischemia was monitored using motor-evoked potentials. Anastomoses were performed using a segmental clamp technique to reduce spinal cord ischemic time. Based on the findings of magnetic resonance angiography and motor-evoked potentials, the Adamkiewicz artery and other relevant intercostals and lumbar arteries were revascularized or preserved, or both.

RESULTS: The mean durations of partial cardiopulmonary bypass, cross-clamping, and surgery, respectively, were 144.4 ± 232.2, 106.0 ± 65.5, and 411.8 ± 170.7 minutes. Three hospital deaths (3.3%) occurred in patients with a thoracoabdominal aortic aneurysm. Motor-evoked potentials changed in 9 patients (9.8%), in 8 (88.9%) of whom they were eventually restored. Although paraplegia developed in 1 patient (1.1%) with a mycotic descending aneurysm, the other patients survived without spinal cord injury.

CONCLUSIONS: Combined visualization of the Adamkiewicz artery and determination of motor-evoked potentials are useful in preventing spinal cord injury in descending and thoracoabdominal aortic repair.

This article has been cited by other articles:

				K. Minatoya, H. Ogino, H. Matsuda, H. Sasaki, T. Yagihara, and S. Kitamura Replacement of the descending aorta: recent outcomes of open surgery performed with partial cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg., August 1, 2008; 136(2): 431 - 435. [Abstract] [Full Text] [PDF]

				M. Kawamura, H. Ogino, H. Sasaki, H. Matsuda, K. Minatoya, H. Tanaka, and S. Kitamura Spinal cord malperfusion caused by using the segmental clamp technique during descending aortic repair for chronic type B aortic dissection Interactive CardioVascular and Thoracic Surgery, February 1, 2008; 7(1): 146 - 148. [Abstract] [Full Text] [PDF]

				K. Uotani, N. Yamada, A.K. Kono, T. Taniguchi, K. Sugimoto, M. Fujii, A. Kitagawa, Y. Okita, H. Naito, and K. Sugimura Preoperative Visualization of the Artery of Adamkiewicz by Intra-Arterial CT Angiography AJNR Am. J. Neuroradiol., February 1, 2008; 29(2): 314 - 318. [Abstract] [Full Text] [PDF]

				J. C. Halstead, M. Wurm, C. Etz, N. Zhang, C. Bodian, D. Weisz, and R. B. Griepp Preservation of Spinal Cord Function After Extensive Segmental Artery Sacrifice: Regional Variations in Perfusion Ann. Thorac. Surg., September 1, 2007; 84(3): 789 - 794. [Abstract] [Full Text] [PDF]

				R. A. Kahn, M. E. Stone, and D. M. Moskowitz Anesthetic Consideration for Descending Thoracic Aortic Aneurysm Repair Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2007; 11(3): 205 - 223. [Abstract] [PDF]

				C. D. Etz, T. M. Homann, K. A. Plestis, N. Zhang, M. Luehr, D. J. Weisz, G. Kleinman, and R. B. Griepp Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented? Eur. J. Cardiothorac. Surg., April 1, 2007; 31(4): 643 - 648. [Abstract] [Full Text] [PDF]