Preoperative localization of Adamkiewicz artery by CT for endovascular descending thoracic aortic repair
- VernacularTitle:根最大动脉CT定位在胸降主动脉腔内修复中的应用
- Author:
Zhihui DONG
;
Weiguo FU
;
Yuqi WANG
;
Daqiao GUO
;
Xin XU
;
Bin CHEN
;
Junhao JIANG
;
Jue YANG
;
Zhenyu SHI
- Publication Type:Journal Article
- Keywords:
Aneurysm;
Tomography, X-ray computed;
Aorta;
Endovascular repair;
Adamkiewicz artery
- From:
Chinese Journal of General Surgery
2001;0(07):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the effect of preoperative localization of Adamkiewicz artery (AKA)by CT for patients undergoing endovascular descending thoracic aortic repair. Methods From May 2003 to April 2005, 12 patients received CT examination for the detection of the AKA before undergoing endovascular descending thoracic aortic repair. Eight patients were of Stanford type B dissecting aortic aneurysm, 2 of Crawford typeⅠthoracoabdominal aortic aneurysm (TAAA) , 1 of descending thoracic aortic pseudoaneurysm and 1 of descending thoracic aortic aneurysm combined with abdominal aortic aneurysm. The inclusion criterion was that the segment from T8 to L1 needed to be partially excluded. The CT assessment accentuated the identification of the level at which the aorta gave rise to the AKA-originating intercostal/lumbar artery and approval of the continuity from the origin of the intercostal/lumbar artery at the aorta to the anterior spinal artery (ASA). Results Thirteen AKAs were identified in 9 patients (75%). A single AKA was visualized in 5 cases and double in 4. Two AKAs arose from the T8 intercostal artery, 2 from T9, 3 from T10, 3 from T11 and 3 from T12. The continuity from the origin of the intercostal artery at the aorta to the ASA was identified in 8 patients. Ultimately, 10 AKAs were preserved while 3 sacrificed. More than 15-mm both proximal and distal landing distance of the stent-graft was achieved in all patients, and no paraplegia occurred perioperatively or during the follow-up raging from 3 to 19 months ( mean 12 months). Complete false lumen thrombosis of the thoracic aorta or aneurysmal thrombosis was evidenced on CT at 3 month in 11 patients while 1 patient with dissecting aneurysm caused by Marian's syndrome died for unknown cause 2 days after being discharged. Conclusion Localization of AKA by CT before stent-grafting in the descending thoracic aorta may enable us to avoid covering the origin of the AKA-originating intercostal/lumbar artery at the aorta, hence, the remaining segment from T8 to L1 could be saved for reliable landing the sten-graft.
