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Systematic evaluation of collateral pathways to the artery of Adamkiewicz using computed tomography

Kunihiro Yoshioka1, Ryoichi Tanaka1, Hidenobu Takagi1

  • 1Division of Cardiovascular Radiology, Department of Radiology, Iwate Medical University, Morioka, Japan.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 26, 2018
PubMed

Insights

Multidetector row computed tomography (MDCT) effectively visualizes collateral circulation to the artery of Adamkiewicz in patients with aortic aneurysms. This imaging is crucial for preventing spinal cord injury during aortic repair surgery.

Area of Science:

  • Vascular Surgery
  • Radiology
  • Neurosurgery

Background:

  • Preoperative identification of the artery of Adamkiewicz is vital for preventing spinal cord injury during thoracic and thoraco-abdominal aortic aneurysm repair.
  • Multidetector row computed tomography (MDCT) has shown feasibility for evaluating the artery of Adamkiewicz, but its collateral circulation remains understudied.

Purpose of the Study:

  • To investigate the collateral circulation to the artery of Adamkiewicz using MDCT in patients with thoracic and thoraco-abdominal aortic aneurysms.

Main Methods:

  • Sixty-four patients with descending thoracic and thoraco-abdominal aortic aneurysms and occluded origin of the artery of Adamkiewicz underwent MDCT (64- or 320-detector row).
  • Two independent observers assessed MDCT images for artery of Adamkiewicz visualization and collateral circulation using a 4-point scale.

Main Results:

  • Diagnostic image quality was achieved in 83% of patients (53 out of 64).
  • MDCT identified 75 collateral pathways to the artery of Adamkiewicz in these patients.
  • The majority of pathways (85%) were perispinal, with the remainder (15%) in the thoracic wall.

Conclusions:

  • MDCT successfully visualized collateral pathways to the artery of Adamkiewicz in 83% of patients with thoracic and thoraco-abdominal aortic aneurysms.
  • These collateral pathways, primarily perispinal and thoracic, are important considerations for surgical planning.
Abstract

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