[Prevention of cerebral complications during thoracic aortic aneurysms operation: study of preoperative selective cerebral arteriography]
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K Tsuchida1, A Hashimoto, S Aomi
1Department of Cardiovascular Surgery, Heart Institute of Japan.
Insights
Preoperative cerebral arteriography assesses the circle of Willis in thoracic aortic aneurysm patients. Maintaining left subclavian artery perfusion is crucial for patients with dominant left vertebral arteries and absent collateral circulation to prevent brain ischemia.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Radiology
Background:
- Thoracic aortic aneurysms pose risks to cerebral circulation.
- Assessing the circle of Willis is vital for surgical planning.
- Vertebrobasilar system integrity is critical during aortic procedures.
Purpose of the Study:
- To evaluate the integrity of the circle of Willis in patients with thoracic aortic aneurysms.
- To assess the condition of bilateral vertebrobasilar communications.
- To determine the necessity of left subclavian artery perfusion in specific patient subgroups.
Main Methods:
- Preoperative selective cerebral arteriography was performed.
- Analysis of circle of Willis patency.
- Assessment of vertebrobasilar collateral circulation.
Main Results:
- 86.7% of patients showed good bilateral vertebrobasilar communication.
- 13.3% had poor communication.
- In 2 cases, the left vertebral artery supplied a large area of the posterior cranial fossa, indicating dominance.
Conclusions:
- The circle of Willis integrity is a key consideration in thoracic aortic aneurysm surgery.
- Patients with a dominant left vertebral artery and absent collateral circulation require careful management.
- Perfusion of the left subclavian artery may be necessary to prevent vertebrobasilar ischemia during normothermic aortic aneurysm repair.
Abstract:
Preoperative selective cerebral arteriography is carried out in order to determine if the circle of Willis is intact in the cases of the thoracic aortic aneurysms. As regard to the bilateral vertebrobasilar communications, 26 of 30 patients (86.7%) have good condition, 4 of 30 patients (13.3%) have poor, and in 2 cases the left vertebral artery supplied broad area of posterior cranial fossa. We believe that in the cases in whom the left vertebral artery is dominant, and cross collateral circulation is absent, perfusion of the left subclavian artery is necessary to prevent vertebrobasilar ischemia during aortic aneurysms operation under normothermia.