Related Experiment Video
Updated: Mar 16, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Modification of a Standard Thoracoabdominal Incision to Preserve Collaterals to Adamkiewicz Artery
Shingo Takahara1, Keisuke Kanda1, Satoshi Kawatsu1
1Division of Cardiovascular Surgery, Tohoku University, Sendai, Japan.
Insights
A modified surgical incision successfully preserved spinal cord function during thoracoabdominal aortic repair by protecting critical collateral arteries. This approach mitigates risks of paraplegia in complex aortic aneurysm cases.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Neurosurgery
Background:
- Thoracoabdominal aortic repair for chronic dissecting aneurysms (Crawford II) presents challenges due to potential spinal cord ischemia.
- Preoperative imaging revealed extensive intercostal artery thrombosis, highlighting the critical role of collateral circulation.
Observation:
- The Adamkiewicz artery, crucial for spinal cord perfusion, originated from at-risk vessels (left lateral thoracic and subscapular arteries).
- A standard Stoney's incision posed a significant risk to these collateral arteries, potentially leading to paraplegia or paraparesis.
Findings:
- A modified, anteriorly directed lateral thoracic incision was employed during the thoracoabdominal aortic repair.
- This surgical modification successfully preserved the collateral arteries supplying the spinal cord.
Implications:
- The modified incision technique prevented spinal cord ischemia and preserved neurological function in this complex aortic aneurysm case.
- This approach offers a valuable strategy for surgeons managing thoracoabdominal aortic pathologies with compromised collateral circulation.
- Minimally invasive techniques and precise anatomical understanding are key to improving outcomes in complex aortic surgeries.
Abstract:
We report a case of a 35-year-old male who underwent thoracoabdominal aortic repair of a chronic dissecting aortic aneurysm, Crawford extent II. Preoperative computed tomography showed thrombosis of almost all intercostal arteries. Precise diagnostic assessment demonstrated the Adamkiewicz artery originating from the left lateral thoracic artery and subscapular artery, which would have been at risk after using a standard Stoney's incision, thus potentially causing paraplegia or paraparesis due to spinal cord ischemia. We modified the lateral thoracic incision anteriorly and successfully preserved the collateral arteries without impairing the spinal cord function.
