Original Articles
The Role of Spinal Angiography in Operations on the Thoracic Aorta: Myth or Reality?

Presented at the Poster Session of the Thirty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Feb 3–5, 1997.
https://doi.org/10.1016/S0003-4975(97)01239-3Get rights and content

Abstract

Background. The importance of preserving the artery of Adamkiewicz during replacement of the thoracoabdominal aorta is debated. We report our experience with the use of preoperative spinal angiography and modification of the surgical technique.

Methods. Between September 1993 and March 1996, 46 patients (mean age, 57 years; range, 25 to 73 years) underwent spinal angiography at our institution, 23 for an aneurysm and 23 for chronic dissection. Localization of the artery of Adamkiewicz between T-9 and L-3 was successful in 30 (65%) patients: T-9, left = 2, right = 1; T-10, left = 4; T-11, left = 10, right = 2; T-12, left = 3, right = 1; L-1, left = 1, right = 2; L-2, left = 2, right = 1; and L-3, left = 1. Thirty-one patients subsequently underwent replacement of the descending thoracic aorta and 13 underwent replacement of the thoracoabdominal aorta. Left atrial-femoral artery bypass was used in 23 patients and full extracorporeal circulation was used in 20 patients. Twelve procedures included the reimplantation of crucial intercostal/lumbar branches.

Results. The operative mortality rate was 6.8% (3 of 44 patients) and 1 (2.27%) patient had paraparesis. In addition to the 12 patients who underwent targeted reimplantation of the intercostal branches, evaluation of the spinal cord blood supply influenced the operative technique in 19 other patients.

Conclusions. Selective angiography can demonstrate the spinal cord blood supply even in patients with complex aortic pathology. It is a helpful tool for planning extensive replacement of the thoracic and thoracoabdominal aorta.

Section snippets

Patient Population

Between September 1993 and March 1996, 46 patients underwent angiographic investigation of the spinal cord blood supply during their preoperative evaluation for aortic replacement at our institution. There were 34 men and 12 women with a mean age of 57 years (range, 25 to 73 years). The underlying aortic pathology was an extensive aneurysm (megaaorta) in 23 patients and aortic dissection in 23 patients. Fifteen of the scheduled operations were reoperations, 11 in patients with chronic

Spinal Angiography

The angiographic investigations lasted from 20 to 250 minutes and the total radiation dose varied between 500 and 32,000 cGy/cm3. The origin of the artery of Adamkiewicz was located by spinal angiography in 30 (65.2%) of the 46 patients (Table 2). As expected, it was found between T-9 and L-3, and was on the left side in most patients (23 of 30 patients, 76.66%). The most common source was the left 11th intercostal artery in exactly one third of the patients (10 of 30, 33.33%) (Fig. 1). The

Comment

The blood supply of the spinal cord is very complex and the literature on this subject remains confusing. In 1882, A. Adamkiewicz, then professor of pathology at the University of Krakow, described the preponderance of a single, thicker feeding vessel to the anterior spinal artery in the thoracolumbar region, the “arteria radicularis magna.” Its origin from an intersegmental vessel repeatedly was shown to be variable 1, 2, 9, 10. In 75% of cases, it was found to originate from T-9 to T-12, in

References (25)

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