Operative Strategy for Descending and Thoracoabdominal Aneurysm Repair with Preoperative Demonstration of the Adamkiewicz Artery

Background: Our study aimed to demonstrate the efficacy of preoperative intraarterial computed tomographic angiography to identify the Adamkiewicz artery (AKA). We also aimed to investigate the impact of identification of the AKA on the strategy for preventing spinal cord injury.

Methods: Thirty-seven patients (24 cases of descending aortic aneurysms and 13 cases of thoracoabdominal aortic aneurysms), were studied. Average age was 63.8 years old. A pigtail catheter was inserted into the descending aorta and its tip was located immediately below the left subclavian artery. Subsequently, intraarterial computed tomographic angiography was performed and the segmental artery to the AKA was identified. Aneurysms were replaced electively with prosthetic graft in all cases. In cases where the aortic segment that supplied the AKA was cross-clamped, the identified segmental artery-AKA was selectively perfused. In these cases, the segmental artery-AKA was reconstructed with an interposition graft.

Results: Intraarterial computed tomographic angiography successfully identified the segmental artery-AKA in all patients. The average number of AKA observed per patient was 1.3± 0.6 AKAs. Selective perfusion of preoperatively identified segmental artery-AKAs was performed in 11 cases. The average number of reconstructed segmental arteries was 0.5 in descending aortic aneurysms and 1.7 in thoracoabdominal aortic aneurysms. Although paraparesis occurred in two patients (5%), the remaining 35 patients did not suffer spinal cord injury.

Conclusions: Intraarterial computed tomographic angiography reliably identifies the segmental-AKA. Furthermore, selective perfusion of the segmental artery-AKA, based on accurate preoperative identification, might be one option for preventing intraoperative spinal cord ischemia.