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Collateral network concept in 2023.

Suguru Ohira1, Steven L Lansman1, David Spielvogel1

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Summary
This summary is machine-generated.

Extensive aortic surgery can lead to spinal cord ischemia. Understanding the collateral network concept, involving multiple arteries, is key to preventing this serious complication during thoracoabdominal aortic aneurysm repair.

Keywords:
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Area of Science:

  • Vascular Surgery
  • Neurology
  • Anatomy

Background:

  • Extensive thoracoabdominal aortic aneurysm repair poses a risk of spinal cord ischemia, impacting patient survival and quality of life.
  • The pathophysiology and preventative strategies for this complication require thorough understanding.
  • The Adamkiewicz artery has been traditionally considered a major segmental input, but this view is evolving.

Purpose of the Study:

  • To review the current evidence supporting the collateral network concept in spinal cord perfusion.
  • To discuss the application of the collateral network concept in the context of aortic surgery.
  • To highlight the importance of recognizing multiple arterial inputs for maintaining spinal cord blood flow.

Main Methods:

  • Review of existing literature on spinal cord perfusion during aortic surgery.
  • Analysis of the collateral network concept proposed by Griepp and colleagues.
  • Examination of anatomical and physiological evidence for collateral circulation to the spinal cord.

Main Results:

  • The collateral network concept emphasizes an extensive interconnecting vascular complex supporting spinal cord perfusion.
  • This network involves intraspinal, paraspinous, epidural spaces, and paravertebral muscles.
  • Multiple segmental arterial inputs (intercostal, lumbar) and major artery connections (subclavian, iliac) are crucial.

Conclusions:

  • Recognition of a widespread collateral network is paramount for preventing spinal cord ischemia during extensive aortic repairs.
  • The concept of multiple inputs offers a more comprehensive understanding than single major input models.
  • Applying the collateral network concept is vital for optimizing surgical outcomes in thoracoabdominal aortic aneurysm repair.