A novel approach to prevent spinal cord ischemia: Inoue stent graft with a side branch of small caliber for the reconstruction of the artery of Adamkiewicz

Purpose: To propose a new simplified technique to occlude multiple segmental arteries for staging and preconditioning of the spinal cord to decrease the potential for spinal cord ischemia after thoracic and thoracoabdominal aortic aneurysm repair. Technique: A thoracic stent-graft that flares out to a maximum of 51 mm is deployed in a standard fashion covering all segmental arteries where graft-wall apposition occurs in the first ~20 cm of the aneurysm. The segmental arteries are always closed at their ostia in contrast to selective coil embolization, where there is a risk of more peripheral closure. Follow-up imaging shows thrombus lining the stent-graft–covered portion of the aneurysm and secondary proximal segmental artery occlusion. Conclusion: A new and fast way of staging and preconditioning the spinal cord using a modified stent-graft prior to definitive repair might be an alternative to segmental artery embolization.

Download Full-text

Spinal cord ischemia after elective stent-graft repair of the thoracic aorta

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70483-4 ◽

2007 ◽

Vol 2007 ◽

pp. 184-185

Author(s):

K. Kasirajan

Keyword(s):

Spinal Cord ◽

Thoracic Aorta ◽

Stent Graft ◽

Spinal Cord Ischemia ◽

Stent Graft Repair

Download Full-text

Evaluation of Spinal Cord Ischemia with a Retrievable Stent Graft Is Useful for Determining the Type of Repair for a Case of Patch Aneurysm

Annals of Vascular Surgery ◽

10.1016/j.avsg.2013.08.024 ◽

2014 ◽

Vol 28 (5) ◽

pp. 1313.e1-1313.e3

Author(s):

Junetsu Akasaka ◽

Kei Takase ◽

Koichi Tabayashi

Keyword(s):

Spinal Cord ◽

Stent Graft ◽

Spinal Cord Ischemia ◽

Retrievable Stent

Download Full-text

Artery of Adamkiewicz and the clinical repercussion of its lesion in thoracoabdominal surgeries: a systematic review

Brazilian Journal of Case Reports ◽

10.52600/2763-583x.bjcr.2021.1.4.9-21 ◽

2021 ◽

Vol 1 (4) ◽

pp. 9-21

Author(s):

Idna Lara Goes de Sena ◽

Maria Regina Cardoso Linhares Oliveira Lima ◽

Lia de Oliveira Jereissati ◽

Rafaella Iughetti da Costa ◽

Victor Oliveira Araújo ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injuries ◽

Spinal Cord Ischemia ◽

Three Dimensional ◽

Clinical Importance ◽

Dimensional Network ◽

Adamkiewicz Artery ◽

Artery Of Adamkiewicz ◽

Pass Through ◽

Preoperative Procedure

The knowledge of the spinal cord irrigation is important for the therapeutic planning of aortic pathologies; however, its vasculature is complex due to the caliber of its arteries that pass through a three-dimensional network with great anatomical variability. Its clinical importance is evidenced during the preoperative procedure of thoracic and thoracoabdominal aortic surgeries, because its identification is essential for the prevention of spinal cord injuries. This study consists of a literature review, in which searches were conducted in the databases - Bireme, Science Direct, Pubmed and Lilacs. Articles published between 1999 and 2020, written in English, Portuguese or Spanish, were selected. The search was conducted using the descriptors Anatomy, Spinal Cord Irrigation and Spinal Cord Ischemia. The Adamkiewicz artery is the main artery responsible for the arterial supply to the lower part of the spinal cord. Thus, paraplegia is a complication of this type of surgical approach resulting from ischemic suffering of the spinal cord during the process. Therefore, further study on these factors should be encouraged, because the preservation of this vessel is relevant given the search for protection of the spinal cord and the maintenance of its functions in this type of procedure.

Download Full-text

Association Between Extent of Stent-Graft Coverage and Thoracic Aortic Remodeling After Endovascular Repair of Type B Aortic Dissection

Journal of Endovascular Therapy ◽

10.1177/1526602820904164 ◽

2020 ◽

Vol 27 (2) ◽

pp. 211-220 ◽

Cited By ~ 4

Author(s):

Yan Xue ◽

Yangyang Ge ◽

Xiaohu Ge ◽

Jianhang Miao ◽

Weidong Fan ◽

...

Keyword(s):

Spinal Cord ◽

Aortic Dissection ◽

Stent Graft ◽

Proportional Hazards Model ◽

Spinal Cord Ischemia ◽

Cox Proportional Hazards Model ◽

Type B ◽

Categorical Variable ◽

Type B Aortic Dissection ◽

Aortic Remodeling

Purpose: To examine the association between the extent of stent-graft coverage and thoracic aortic expansion after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection. Materials and Methods: A retrospective analysis was conducted of 201 patients (mean age 52.4±11.5 years; 178 men) with acute (135, 67.2%) or chronic (66, 32.8%) type B aortic dissection who underwent TEVAR at 4 medical centers. The mean stent-graft length was 157.1±33.3 mm. The percentage of stented descending aorta (PSDA) represented the extent of stent-graft coverage. After using restricted cubic smoothing spline plots to confirm the roughly linear relationship between PSDA and the risk of thoracic aortic expansion, patients were stratified into 2 groups on the median PSDA: the lower group (≤31.3%) and the higher group (>31.3%). Thoracic aortic expansion was defined as a ≥20% increase in the total thoracic aortic volume on the most recent postoperative computed tomography angiography scan compared with the preoperative measurement. The Kaplan-Meier method was used to estimate the cumulative freedom from thoracic aortic expansion after TEVAR; estimates are given with the 95% confidence interval (CI). A multivariable Cox proportional hazards model was used to analyze any independent association of the PSDA as a continuous or categorical variable with the risk of thoracic aortic expansion; results are presented as the hazard ratio (HR) and 95% CI. Results: No patients developed symptoms of spinal cord ischemia during hospitalization. Over a median 12.4 months of imaging follow-up, 34 (16.9%) patients developed thoracic aortic expansion. The estimate of freedom from thoracic aortic expansion at 12 months for the overall PSDA was 84.0% (95% CI 77.8% to 88.6%); between the groups, the freedom from thoracic aortic expansion estimate for the PSDA ≤31.3% group was significantly lower than in the higher group (p=0.032). Regression analysis showed no significant association between the risk of thoracic aortic expansion and the PSDA as a continuous variable (HR 0.97, 95% CI 0.91 to 1.03, p=0.288); however, analyzing the PSDA as a categorical variable indicated a significantly lower risk of thoracic aortic expansion for the PSDA >31.3% group (HR 0.46, 95% CI 0.22 to 0.95, p=0.036) after adjusting for a variety of demographic and anatomical characteristics. Conclusion: More extensive stent-graft coverage appears to improve thoracic aortic remodeling after TEVAR. However, the clinician should balance the benefit of extensive stent-graft coverage and its related risk of spinal cord ischemia.

Download Full-text