Echo-guided identification of key lumbar arteries for the spinal cord: preliminary study in the canine model

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Surgical Anatomy

Background:

• Accurate identification of the artery of Adamkiewicz (or key spinal artery) is crucial to prevent paraplegia during thoracoabdominal aortic surgery.
• Current methods for identifying this artery are often complex or lack reliability.

Purpose of the Study:

• To evaluate the feasibility and adequacy of a novel echocardiography-guided method using saline injection into lumbar arteries for identifying the key spinal cord perfusor.
• To assess the accuracy of this technique in a canine model.

Main Methods:

• The abdominal aorta was accessed in canine models.
• Saline was injected into lumbar arteries while visualizing the spinal cord via echocardiography through the intervertebral disc.
• Lumbar arteries were classified as "positive" (echogenic/Doppler signal detected in spinal cord) or "negative" (no signal).
• Post-mortem resin injection (red for positive, blue for negative) confirmed artery perfusion.

Main Results:

• The echo-guided method correctly identified key arteries supplying the spinal cord in the canine model.
• "Positive" arteries, primarily on the left, accounted for about one-third of lumbar arteries and perfused the spinal cord.
• "Negative" arteries primarily supplied paravertebral muscles.
• Evidence of collateral circulation was observed among "positive" arteries, independent of "negative" arteries.

Conclusions:

• Echocardiography-guided identification of key spinal arteries using lumbar artery saline injection is technically feasible.
• This preliminary canine study demonstrates the technique's accuracy in determining critical spinal cord perfusion.
• This method holds potential as a reliable, non-complicated approach for pre-operative surgical planning.