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Aneurysm IV: Nursing Management01:22

Aneurysm IV: Nursing Management

Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...

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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Preoperative Spinal Arterial Supply Mapping Using Non-Selective Cone Beam Computed Tomography before Complex Aortic

Baptiste Bonnet1, Hicham Kobeiter1,2,3, Lorenzo Pescatori1

  • 1Service D'imagerie Médicale Diagnostique et Interventionnelle, DMU FIxIT, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), F-94010 Creteil, France.

Journal of Clinical Medicine
|February 10, 2024
PubMed
Summary

Pre-operative spinal arterial mapping using non-selective cone beam CT (CBCT) can identify the Adamkiewicz artery (AKA). This method shows promise in predicting spinal cord ischemia (SCI) risk after complex aortic repair.

Keywords:
Adamkiewicz arteryaortacomputed tomography angiographycone beam computed tomographyendovascular procedures

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Area of Science:

  • Vascular Surgery
  • Radiology
  • Medical Imaging

Background:

  • Spinal cord ischemia (SCI) is a risk following complex aortic repair.
  • Accurate pre-operative spinal arterial mapping is essential for risk assessment.
  • Identifying the Adamkiewicz artery (AKA) is key for understanding spinal cord perfusion.

Purpose of the Study:

  • To evaluate the utility of non-selective cone beam computed tomography (CBCT) for pre-operative spinal arterial mapping.
  • To assess the identification of the Adamkiewicz artery (AKA) using CBCT.
  • To correlate AKA detection with the incidence of postoperative spinal cord ischemia (SCI).

Main Methods:

  • Non-selective dual-phase CBCT was performed in 21 patients undergoing aortic repair.
  • Intra-aortic contrast injection was used for imaging.
  • Image fusion with pre-interventional CT angiography aided AKA origin assessment.
  • CBCT findings were compared with postoperative SCI incidence.

Main Results:

  • The Adamkiewicz artery (AKA) was detected in 67% of patients via CBCT.
  • AKA was predominantly identified originating from T7 to L1 intercostal and lumbar arteries.
  • Spinal cord ischemia (SCI) occurred in 14% of patients; none occurred when AKA was not detected (p < 0.01).

Conclusions:

  • Non-selective aortic CBCT is a safe and feasible method for spinal arterial mapping.
  • This technique shows potential in predicting post-surgical spinal cord ischemia (SCI) risk.
  • CBCT offers promising insights for personalized surgical planning in complex aortic repair.