Original ArticlesThe Role of Spinal Angiography in Operations on the Thoracic Aorta: Myth or Reality?
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
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Cited by (73)
Neuromonitoring during descending aorta procedures
2022, Handbook of Clinical NeurologyCitation Excerpt :It is also more time-consuming than MRA. Furthermore, as the MRA quality has significantly improved, angiography for preoperative planning is now rarely used (Heinemann et al., 1998; Kieffer et al., 2002; Minatoya et al., 2002). In summary, regardless of the imaging technique used, identifying the artery of Adamkiewicz and patent segmental arteries and collaterals, in conjunction with the information on the type and extent of the aneurysm is important for preoperative planning.
The impact of preoperative identification of the Adamkiewicz artery on descending and thoracoabdominal aortic repair
2016, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :The Polish pathologist Adamkiewicz demonstrated the arterial vascular system of the spinal cord and the major radicular artery (today known as the AKA) in the 19th century,2 and most of his observations have been fully confirmed by our current knowledge of the system. Preoperative radiographic investigations of the AKA in aortic surgery, including arteriography, magnetic resonance arteriography, and CT arteriography, have been reported,6,7,9 elucidating the spinal cord circulation system. Subsequently, preoperative anatomic consideration has been well advanced; however, the importance of the arteries responsible for spinal cord protection in aortic surgeries remains unclear.
Invited commentary
2015, Annals of Thoracic SurgeryAortic aneurysm surgery: Long-term patency of the reimplanted intercostal arteries
2012, Annals of Vascular SurgeryOpen repair of extensive thoracoabdominal and thoracic aneurysm: A preliminary single-center experience with femorofemoral distal aortic perfusion with oxygenator and without cerebrospinal fluid drainage
2011, Annals of Vascular SurgeryCitation Excerpt :Most authors recommend intercostal artery reattachment to the graft during surgery. In recent years, methods for identification of segmental arteries destined to spinal artery have been developed to preserve critical arteries during the surgery.3-6 Left heart bypass and cerebrospinal fluid drainage (CSFD) have been shown to be effective and safe in major series to reduce postoperative spinal cord injury.7,8