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Saitoh D, Yamazaki Y, Tsuji T, Sakoda N, Yakuwa K, Tabayashi A, Koizumi J, Ohsawa S, Kin H. Patterns of collateral arteries to the spinal cord after thoraco-abdominal aortic aneurysm repair. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae087. [PMID: 38696750 PMCID: PMC11193310 DOI: 10.1093/icvts/ivae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/30/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES Our goal was to evaluate postoperative patterns of collateral arteries to the spinal cord during occlusion of the segmental arteries supplying the artery of Adamkiewicz (AKA). METHODS Between April 2011 and December 2022, a total of 179 patients underwent thoraco-abdominal aortic aneurysm repair; 141 had an identifiable AKA on preoperative multidetector computed tomography scans, 40 underwent thoraco-abdominal aortic aneurysm replacement (TAAR) and 101 underwent thoracic endovascular aortic repair (TEVAR). New postoperative collateral blood pathways invisible on preoperative contrast-enhanced computed tomography scans were identified in 42 patients (10 patients who had TAAR vs 32 patients who had TEVAR) who underwent preoperative and postoperative multidetector computed tomography scanning for AKA identification. RESULTS The thoracodorsal and segmental arteries were the main collateral pathways in both groups. Th9-initiated collaterals were the most common. Collaterals from the internal thoracic artery were observed in the TEVAR group but not in the TAAR group. One patient in the TEVAR group experienced postoperative paraparesis, which was not observed in the TAAR group. Postoperative paraplegia was more common in the non-Th9-origin group, but this difference was not significant. CONCLUSIONS Thoracodorsal and segmental arteries may be important collateral pathways after TEVAR and TAAR. For thoracodorsal arteries, preserving the thoracodorsal muscle during the approach would be crucial; for segmental arteries, minimizing the area to be replaced or covered would be paramount. An AKA not initiated at the Th9 level poses a high risk of postoperative paraplegia.
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Affiliation(s)
- Daiki Saitoh
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Yuya Yamazaki
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Tatsunori Tsuji
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Naoya Sakoda
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Kazuki Yakuwa
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Azuma Tabayashi
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Junichi Koizumi
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
| | - Satoshi Ohsawa
- Department of Cardiovascular Surgery, San-ai Hospital, Iwate, Japan
| | - Hajime Kin
- Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Deng J, Ma T, Yan J, Wu S, Yan G, Li H, Li Y, Zhao L, Fan X, McClure MA, Bhetuwal A. Effect of Low Tube Voltage (100 kV) Combined with ASIR-V on the Visualization and Image Quality of the Adamkiewicz Artery: A Comparison with 120 kV Protocol. Diagnostics (Basel) 2023; 13:2495. [PMID: 37568857 PMCID: PMC10417362 DOI: 10.3390/diagnostics13152495] [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: 06/01/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE To evaluate the effect of low tube voltage (100 kV) combined with adaptive statistical iterative reconstruction-V (ASIR-V) on the visualization and image quality of the Adamkiewicz artery (AKA). METHODS One hundred patients were prospectively enrolled and randomly assigned into two groups (both n = 50). Group A (100 kV) was reconstructed with filtered back projection (FBP) and ASIR-V from 10% to 100% with 10% intervals. Group B (120 kV) was only reconstructed with FBP. The objective image quality was evaluated by using CT values of the aorta (CTAorta), background noise, signal-to-noise ratio of the descending aorta (SNRAorta), and contrast-to-noise ratio of the spinal cord (CNRSpinal cord). The subjective image quality and visualization scores of the AKA were assessed on a 5-point scale. RESULTS CTAorta was significantly higher in Group A than in Group B (p < 0.001). When ASIR-V weights were ≥60%, significant differences were found in the background noise, SNRAorta, and CNRSpinal cord between the two groups (all p < 0.05). In Group A, compared with FBP, the subjective score gradually increased as ASIR-V increased to 80%, which decreased when ASIR-V exceeded 80%. The visualization scores of the AKA (≥60%) and the ability to detect vessel continuity (≥80%) gradually increased as the ASIR-V weights increased (p < 0.05). The effective radiation dose was reduced by about 40.36% in Group A compared to Group B. CONCLUSIONS compared with conventional scanning protocol, using a combination of low tube voltage (100 kV) and 80% ASIR-V protocol could not only increase the visualization of the AKA, but also improve image quality and reduce the radiation doses.
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Affiliation(s)
- Jiantao Deng
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Ting Ma
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Jing Yan
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Siyi Wu
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Gaowu Yan
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Hongwei Li
- Department of Radiology, The Third Hospital of Mianyang and Sichuan Mental Health Center, Mianyang 621000, China
| | - Yong Li
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Linwei Zhao
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Xiaoping Fan
- Department of Radiology, Suining Central Hospital, Suining 629000, China
| | - Morgan A. McClure
- Department of Radiology and Imaging, Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong 637000, China
| | - Anup Bhetuwal
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6561271. [DOI: 10.1093/ejcts/ezac196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/23/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
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Busch DR, Lin W, Goh CC, Gao F, Larson N, Wahl J, Bilfinger TV, Yodh AG, Floyd TF. Towards rapid intraoperative axial localization of spinal cord ischemia with epidural diffuse correlation monitoring. PLoS One 2021; 16:e0251271. [PMID: 33970932 PMCID: PMC8109798 DOI: 10.1371/journal.pone.0251271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/23/2021] [Indexed: 11/19/2022] Open
Abstract
Spinal cord ischemia leads to iatrogenic injury in multiple surgical fields, and the ability to immediately identify onset and anatomic origin of ischemia is critical to its management. Current clinical monitoring, however, does not directly measure spinal cord blood flow, resulting in poor sensitivity/specificity, delayed alerts, and delayed intervention. We have developed an epidural device employing diffuse correlation spectroscopy (DCS) to monitor spinal cord ischemia continuously at multiple positions. We investigate the ability of this device to localize spinal cord ischemia in a porcine model and validate DCS versus Laser Doppler Flowmetry (LDF). Specifically, we demonstrate continuous (>0.1Hz) spatially resolved (3 locations) monitoring of spinal cord blood flow in a purely ischemic model with an epidural DCS probe. Changes in blood flow measured by DCS and LDF were highly correlated (r = 0.83). Spinal cord blood flow measured by DCS caudal to aortic occlusion decreased 62%. This monitor demonstrated a sensitivity of 0.87 and specificity of 0.91 for detection of a 25% decrease in flow. This technology may enable early identification and critically important localization of spinal cord ischemia.
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Affiliation(s)
- David R. Busch
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Wei Lin
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, United States of America
| | - Chia Chieh Goh
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, United States of America
| | - Feng Gao
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Nicholas Larson
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Joseph Wahl
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Thomas V. Bilfinger
- Department of Surgery, Stony Brook University, Stony Brook, New York, United States of America
| | - Arjun G. Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Thomas F. Floyd
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- * E-mail:
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Fukui T, Takaki J, Okamoto K. Collateral Formation from Left Lateral Thoracic Artery to the Adamkiewicz Artery. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 8:175-177. [PMID: 33761561 PMCID: PMC8043810 DOI: 10.1055/s-0040-1721748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 68-year-old man who had undergone descending thoracic aortic replacement was referred to our hospital with a thoracoabdominal aortic aneurysm. During the original surgery, the Adamkiewicz artery was directly reconstructed. However, multidetector row computed tomography showed occlusion of the reconstructed artery at its orifice, with supply by a collateral vessel from the left lateral thoracic artery. With careful incision to avoid damage to the collateral vessel, no postoperative neurological deficit was observed.
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Affiliation(s)
- Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Jun Takaki
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Ken Okamoto
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
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Khachatryan Z, Haunschild J, von Aspern K, Borger MA, Etz CD. Ischemic spinal cord injury - experimental evidence and evolution of protective measures. Ann Thorac Surg 2021; 113:1692-1702. [PMID: 33434541 DOI: 10.1016/j.athoracsur.2020.12.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND Paraplegia remains one of the most devastating complications of descending and thoracoabdominal aortic repair. The aim of this review is to outline the current state of art in the rapidly developing field of spinal cord injury (SCI) research. METHODS A review of PubMed and Web of Science databases was performed using the following terms and their combinations: spinal cord, injury, ischemia, ischemia-reperfusion, ischemic spinal cord injury, paraplegia, paraparesis. Articles published before July 2019 were screened and included if considered relevant. RESULTS The review focuses on the topic of SCI and the developments concerning methods of monitoring, diagnostics and prevention of SCI. CONCLUSIONS Translation of novel technologies from bench to bedside and into everyday clinical practice is challenging, however each of the developing areas hold great promise in SCI prevention.
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Affiliation(s)
- Zara Khachatryan
- University Department for Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Konstantin von Aspern
- University Department for Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany.
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Commentary: Left subclavian artery revascularization during zone 2 thoracic endovascular aortic repair: Bypass versus transposition? Just do it! J Thorac Cardiovasc Surg 2019; 159:1228-1230. [PMID: 31280896 DOI: 10.1016/j.jtcvs.2019.05.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 11/22/2022]
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