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Bonnet B, Kobeiter H, Pescatori L, Zaarour Y, Boughanmi W, Ghosn M, Cochennec F, Mongardon N, Desgranges P, Tacher V, Derbel H. Preoperative Spinal Arterial Supply Mapping Using Non-Selective Cone Beam Computed Tomography before Complex Aortic Repair. J Clin Med 2024; 13:796. [PMID: 38337489 PMCID: PMC10856426 DOI: 10.3390/jcm13030796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/13/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Pre-op spinal arterial mapping is crucial for complex aortic repair. This study explores the utility of non-selective cone beam computed tomography (CBCT) for pre-operative spinal arterial mapping to identify the Adamkiewicz artery (AKA) in patients undergoing open or endovascular repair of the descending thoracic or thoracoabdominal aorta at risk of spinal cord ischemia. Pre-operative non-selective dual-phase CBCT after intra-aortic contrast injection was performed in the aortic segment to be treated. The origin of detected AKA was assessed based on image fusion between CBCT and pre-interventional computed tomography angiography. Then, the CBCT findings were compared with the incidence of postoperative spinal cord ischemia (SCI). Among 21 included patients (median age: 68 years, 20 men), AKA was detected in 67% within the explored field of view, predominantly from T7 to L1 intercostal and lumbar arteries. SCI occurred in 14%, but none when AKA was not detected (p < 0.01). Non-selective CBCT for AKA mapping is deemed safe and feasible, with potential predictive value for post-surgical spinal cord ischemia risk. The study concludes that non-selective aortic CBCT is a safe and feasible method for spinal arterial mapping, providing promising insights into predicting post-surgical SCI risk.
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Affiliation(s)
- Baptiste Bonnet
- Service D’imagerie Médicale Diagnostique et Interventionnelle, DMU FIxIT, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), F-94010 Creteil, France
| | - Hicham Kobeiter
- Service D’imagerie Médicale Diagnostique et Interventionnelle, DMU FIxIT, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), F-94010 Creteil, France
- Faculté de Santé, Université Paris Est-Créteil, F-94010 Creteil, France
- Institut Mondor de Recherche Biomédicale-Inserm U955 Équipe 8, F-94010 Creteil, France
| | - Lorenzo Pescatori
- Service D’imagerie Médicale Diagnostique et Interventionnelle, DMU FIxIT, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), F-94010 Creteil, France
| | - Youssef Zaarour
- Service D’imagerie Médicale Diagnostique et Interventionnelle, DMU FIxIT, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), F-94010 Creteil, France
| | - Wafa Boughanmi
- Service D’imagerie Médicale Diagnostique et Interventionnelle, DMU FIxIT, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), F-94010 Creteil, France
| | - Mario Ghosn
- Service D’imagerie Médicale Diagnostique et Interventionnelle, DMU FIxIT, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), F-94010 Creteil, France
- Faculté de Santé, Université Paris Est-Créteil, F-94010 Creteil, France
| | - Frédéric Cochennec
- Faculté de Santé, Université Paris Est-Créteil, F-94010 Creteil, France
- Institut Mondor de Recherche Biomédicale-Inserm U955 Équipe 8, F-94010 Creteil, France
- Service de Chirurgie Vasculaire, DMU CARE, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), F-94010 Creteil, France
| | - Nicolas Mongardon
- Faculté de Santé, Université Paris Est-Créteil, F-94010 Creteil, France
- Service D’anesthésie-Réanimation Chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, F-94010 Creteil, France
- Institut Mondor de Recherche Biomédicale-Inserm U955 Équipe 3 “Pharmacologie et Technologies Pour les Maladies Cardiovasculaires (PROTECT)”, Inserm, Université Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), F-94700 Maisons-Alfort, France
| | - Pascal Desgranges
- Faculté de Santé, Université Paris Est-Créteil, F-94010 Creteil, France
- Institut Mondor de Recherche Biomédicale-Inserm U955 Équipe 8, F-94010 Creteil, France
- Service de Chirurgie Vasculaire, DMU CARE, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), F-94010 Creteil, France
| | - Vania Tacher
- Service D’imagerie Médicale Diagnostique et Interventionnelle, DMU FIxIT, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), F-94010 Creteil, France
- Faculté de Santé, Université Paris Est-Créteil, F-94010 Creteil, France
- Institut Mondor de Recherche Biomédicale-Inserm U955 Équipe 18, F-94010 Creteil, France
| | - Haytham Derbel
- Service D’imagerie Médicale Diagnostique et Interventionnelle, DMU FIxIT, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), F-94010 Creteil, France
- Faculté de Santé, Université Paris Est-Créteil, F-94010 Creteil, France
- Institut Mondor de Recherche Biomédicale-Inserm U955 Équipe 18, F-94010 Creteil, France
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Spinal dural fistula evaluation using 4-Dimensional intra-aortic spinal CTAngiography in a hybrid angiography suite. J Neuroradiol 2021; 48:492-494. [PMID: 33418055 DOI: 10.1016/j.neurad.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/23/2022]
Abstract
Intra-aortic CT Angiography (IA-CTA) is a relatively new technique that shows promise in efficient diagnosis and evaluation of the angioarchitecture of spinal dural arteriovenous fistulae(sdAVF). The authors document the first reported use of a 4D-CT and C-arm fluoroscope in a hybrid interventional suite to evaluate a sdAVF. Time resolved IA-CTA is clinically feasible in the evaluation of sdAVF, has higher temporal resolution as compared to standard IA-CTA and reduced contrast load, radiation dose and potential for procedural complications as compared to standard spinal angiography.
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Pellenc Q, Roussel A, Senemaud J, Cerceau P, Iquille J, Boitet A, Leclere JB, Milleron O, Jondeau G, Castier Y. Staged hybrid repair of type II thoracoabdominal aneurysms. J Vasc Surg 2020; 74:20-27. [PMID: 33340705 DOI: 10.1016/j.jvs.2020.12.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Open repair of type II thoracoabdominal aortic aneurysms (TAAAs) remains a challenging procedure. Staged procedures could decrease the incidence and severity of complications after complex aortic repair. In the present report, we have described a strategy using thoracic endovascular aortic repair (TEVAR) for proximal repair, followed by distal open repair. METHODS From 2014 to 2018, 14 patients had undergone TEVAR, followed by distal open repair, for type II TAAAs. All patients should have a suitable proximal landing zone according to the current guidelines. In cases of chronic dissection, false lumen embolization was performed to achieve total exclusion. RESULTS The mean patient age was 48 ± 15 years. Of the 14 patients, 5 had had Marfan syndrome (36%) and 6 had undergone previous aortic arch repair (43%). Ten patients had had a chronic dissection. The maximal aortic diameter was 73 ± 12 mm. The TEVAR technical success rate was 100%. The aortic length coverage was 211 ± 63 mm. The number of covered segmental arteries was 6 (range, 4-13). Two endoleaks were observed, one type Ib and one type II. The delay between TEVAR and open repair was 12 ± 8 weeks. Cerebrospinal fluid drainage was used in 13 patients. Six patients had undergone segmental artery reattachment during surgery. No spinal cord ischemic event was observed. One patient had died 5 weeks after open repair of multiple organ failure. During the 32 months of follow-up, no aortic-related deaths had occurred. No new aortic procedure was needed. The type Ib endoleak had resolved during open repair, and the type II TAAA had resolved spontaneously. The mean maximal thoracic aortic diameter had significantly decreased to 49 ± 8 mm (P < .0001). Aneurysmal shrinkage of ≥5 mm was observed in 13 patients (93%). CONCLUSIONS Staged hybrid repair of type II TAAAs appears to be efficient, with low morbidity and mortality rates. This technique could improve postoperative outcomes after open repair, and TEVAR might have a role in ischemic preconditioning to protect against spinal cord ischemia.
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Affiliation(s)
- Quentin Pellenc
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France; Laboratory for Vascular Translational Science, Inserm U1148, Université de Paris, Paris, France.
| | - Arnaud Roussel
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Jean Senemaud
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Pierre Cerceau
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Jules Iquille
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Auréline Boitet
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Jean-Baptiste Leclere
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Olivier Milleron
- Cardiology Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Laboratory for Vascular Translational Science, Inserm U1148, Université de Paris, Paris, France
| | - Guillaume Jondeau
- Cardiology Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France; Laboratory for Vascular Translational Science, Inserm U1148, Université de Paris, Paris, France
| | - Yves Castier
- Vascular and Thoracic Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Centre de Référence pour le Syndrome de Marfan et apparentés, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Université de Paris, Paris, France; Laboratory for Vascular Translational Science, Inserm U1148, Université de Paris, Paris, France
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Shimoyama S, Nishii T, Watanabe Y, Kono AK, Kagawa K, Takahashi S, Sugimura K. Advantages of 70-kV CT Angiography for the Visualization of the Adamkiewicz Artery: Comparison with 120-kV Imaging. AJNR Am J Neuroradiol 2017; 38:2399-2405. [PMID: 28912277 DOI: 10.3174/ajnr.a5372] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 07/07/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Preprocedural identification of the Adamkiewicz artery is crucial in patients with aortic diseases. This study aimed to compare 70-kV CTA with conventional 120-kV CTA for the identification of the Adamkiewicz artery, examining differences in radiation dose and image quality. MATERIALS AND METHODS We retrospectively analyzed 2 equal groups of 60 patients who had undergone 70-kV or 120-kV CTA to detect the Adamkiewicz artery before aortic repair. Size-specific dose estimate, the CT number of the aorta, and the contrast-to-noise ratio of the anterior spinal artery to the spinal cord were recorded. Furthermore, detectability of the Adamkiewicz artery was evaluated by using a 4-point continuity score (3, definite to 0, undetectable). RESULTS There was significantly lower radiation exposure with 70-kV CTA than 120-kV CTA (median size-specific dose estimate, 23.1 versus 61.3 mGy, respectively; P < .001). CT number and contrast-to-noise ratio were both significantly higher in the 70-kV CTA group than the 120-kV group (999.1 HU compared with 508.7 HU, and 5.6 compared with 3.4, respectively; P < .001 for both). Detectability of the Adamkiewicz artery was not impaired in the 70-kV CTA group (90.0% versus 83.3% in the 120-kV group, P = .28). Moreover, the Adamkiewicz artery was detected with greater confidence with 70-kV CTA, reflected by a significantly superior continuity score (median, 3) compared with 120-kV CTA (median, 2; P = .001). CONCLUSIONS Seventy-kilovolt CTA has substantial advantages for the identification of the Adamkiewicz artery before aortic repair, with a significantly lower radiation exposure and superior image quality than 120-kV CTA.
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Affiliation(s)
- S Shimoyama
- From the Department of Radiology (S.S., T.N., Y.W., A.K.K., S.T., K.S.), Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - T Nishii
- From the Department of Radiology (S.S., T.N., Y.W., A.K.K., S.T., K.S.), Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Y Watanabe
- From the Department of Radiology (S.S., T.N., Y.W., A.K.K., S.T., K.S.), Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
- Department of Radiology (Y.W., A.K.K.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - A K Kono
- From the Department of Radiology (S.S., T.N., Y.W., A.K.K., S.T., K.S.), Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
- Department of Radiology (Y.W., A.K.K.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - K Kagawa
- Division of Radiology (K.K.), Center for Radiology and Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - S Takahashi
- From the Department of Radiology (S.S., T.N., Y.W., A.K.K., S.T., K.S.), Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - K Sugimura
- From the Department of Radiology (S.S., T.N., Y.W., A.K.K., S.T., K.S.), Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Bonci G, Steigner ML, Hanley M, Braun AR, Desjardins B, Gaba RC, Gage KL, Matsumura JS, Roselli EE, Sella DM, Strax R, Verma N, Weiss CR, Dill KE. ACR Appropriateness Criteria® Thoracic Aorta Interventional Planning and Follow-Up. J Am Coll Radiol 2017; 14:S570-S583. [DOI: 10.1016/j.jacr.2017.08.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022]
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Vargas MI, Barnaure I, Gariani J, Boto J, Pellaton A, Dietemann JL, Kulcsar Z. Vascular Imaging Techniques of the Spinal Cord. Semin Ultrasound CT MR 2017; 38:143-152. [DOI: 10.1053/j.sult.2016.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Clarençon F, Di Maria F, Sourour NA, Gabrieli J, Nouet A, Shotar E, Cormier E, Fahed R, Cornu P, Chiras J. Evaluation of intra-aortic CT angiography performances for the visualisation of spinal vascular malformations' angioarchitecture. Eur Radiol 2016; 26:3336-44. [DOI: 10.1007/s00330-015-4204-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/12/2015] [Accepted: 12/30/2015] [Indexed: 11/29/2022]
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Deng X, Wang K, Wu L, Yang C, Yang T, Zhao L, Yang J, Wang G, Fang J, Xu Y. Intraspinal hemangioblastomas: analysis of 92 cases in a single institution. J Neurosurg Spine 2014; 21:260-9. [DOI: 10.3171/2014.1.spine13866] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Intraspinal hemangioblastomas are relatively uncommon benign tumors. The surgical strategies remain controversial, and the risk factors with regard to clinical outcome are unclear. The purpose of this study was to analyze the clinical characteristics, imaging findings, surgical strategies, and functional outcomes associated with intraspinal hemangioblastomas.
Methods
A series of 92 patients who underwent 102 operations for resection of 116 intraspinal hemangioblastomas at a single institution during 2007–2011 were consecutively enrolled in this study. Of these, 60 patients (65.2%) had sporadic hemangioblastomas and 32 (34.8%) had von Hippel-Lindau disease. Preoperatively, 13 patients underwent digital subtraction angiography (DSA), 15 patients underwent 3D CT angiography (3D CTA), and none underwent preoperative embolization. Clinical characteristics, imaging findings, and operative records were analyzed. The advantages and disadvantages of DSA and 3D CTA were compared. For identification of risk factors that affect prognosis, logistic analysis was performed.
Results
The male/female patient ratio was 1.8:1.0 (59 male and 33 female patients). Of the tumors, 41% were intramedullary, 37% were intramedullary-extramedullary, and 22% were primarily extramedullary. Three-dimensional CTA and DSA did not differ significantly in the ability to identify the feeding arteries (p = 1.000) and image qualities (p = 0.367). However, compared with 3D CTA, the effective x-ray dose of spinal DSA was 2.73 times higher and the mean amount of contrast media injected was 1.88 times higher. Spinal DSA was more time consuming (mean 120 minutes) than 3D CTA (scanning time < 1 minute). No complications were observed after 3D CTA; acute paraparesis developed in 1 patient after DSA.
Gross-total resection was achieved for 109 tumors (94.0%), and resection was subtotal for 7 tumors. Mean duration of follow-up was 50 months (range 24–78 months). At the most recent follow-up visit, the functional outcome was improved for 38 patients (41.3%), remained stable for 40 (43.5%), and deteriorated for 14 (15.2%). Logistic analysis showed that subtotal resection was a risk factor affecting prognosis (p = 0.003, OR 12.833, 95% CI 2.429–67.806).
Conclusions
The authors' study suggests that safe and effective treatment of intraspinal hemangioblastomas can be achieved for most patients, even without preoperative embolization. Gross-total resection, when safe to perform, leads to better outcomes. Compared with spinal DSA, 3D CTA is a promising technique because it is noninvasive, takes less time to perform, requires lower x-ray doses and less contrast media, results in fewer complications, and offers high accuracy for delineating the feeding arteries.
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Affiliation(s)
| | - Kai Wang
- 2Neuroradiology, Beijing Tiantan Hospital, Capital Medical University; and
| | - Liang Wu
- Departments of 1Neurosurgery and
| | | | - Tao Yang
- Departments of 1Neurosurgery and
| | - Lei Zhao
- Departments of 1Neurosurgery and
| | - Jun Yang
- Departments of 1Neurosurgery and
| | | | - Jingyi Fang
- 3Department of Neuro-pathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yulun Xu
- Departments of 1Neurosurgery and
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