The Annals of thoracic surgery · 2006
Combined use of adamkiewicz artery demonstration and motor-evoked potentials in descending and thoracoabdominal repair.
СтатьяНазвание и аннотация: Перевод в очереди
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Ogino Hitoshi, Sasaki Hiroaki, Minatoya Kenji, Matsuda Hitoshi, Yamada Naoaki, Kitamura Soichiro
Аннотация
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.
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.