Key result
Artery of Adamkiewicz coverage in endovascular repair is linked to a ~12-fold higher SCI risk.
Why the study?
Preoperative identification of the artery of Adamkiewicz and its targeted reconstruction may reduce spinal cord injury in descending thoracic and thoracoabdominal aortic repair, but its impact requires investigation.
Does preoperative identification of the artery of Adamkiewicz reduce spinal cord injury in patients undergoing descending thoracic and thoracoabdominal aortic repair?
Cohort (n=256)
No
Does preoperative identification of the artery of Adamkiewicz reduce spinal cord injury in patients undergoing descending thoracic and thoracoabdominal aortic repair?
Preoperative identification of the artery of Adamkiewicz helps stratify risk and guide treatment strategies to minimize spinal cord injury during descending and thoracoabdominal aortic repair, particularly by avoiding coverage during endovascular repair.
Answers are grounded in this paper and cite their sources.
Coverage of the artery of Adamkiewicz was associated with higher spinal cord injury rates after endovascular repair; leaves open whether preoperative identification reduces risk.
Background: Some recent reports have demonstrated that preoperative Adamkiewicz artery (AKA) identification and its targeted reconstruction has provided satisfactory outcomes with respect to spinal cord protection. This paper investigates the impact of preoperative identification of the AKA on reducing the incidence of spinal cord injury (SCI) in open repair (OR) and endovascular repair (EVR) of descending thoracic aortic (dTA) and thoracoabdominal aortic aneurysm (TAA) repair. Methods: The clinical data of patients with dTA and TAA treated between 2011 and 2022 were investigated. A total of 256 patients comprising of 201 males and 55 females, with a mean age of 72.1±10.0 years, were included. OR was used in 102 patients and EVR in 154 patients whose distal landing zone was below T8, all of which needed preoperative identification of the AKA. Results: The AKA was identified in 207 (80.9%) patients, and was located in the level between T8 and T12 in 81.2%. In OR, the responsible arteries, including the identified AKA, were promptly reconstructed in 66 (64.7%) patients. In EVR, 65 (42.2%) patients had the AKA covered by an endovascular prosthesis. Deaths prior to 30 days occurred in seven (2.7%, four in OR and three in EVR) patients. In OR, SCI occurred in six (5.9%) patients including three (2.9%) with paraplegia and three (2.9%) with paraparesis, whereas in EVR ten (6.5%) patients had SCI, including two (1.3%) with paraplegia and eight (5.2%) with paraparesis. The incidence of SCI was significantly higher in patients with the AKA covered than those without it covered [13.8% (9 of 65) vs. 1.1% (1 of 89); P=0.002], whereas no significant differences were found between patients with or without the AKA reconstructed. Conclusions: Preoperative identification of the AKA was useful enough to determine treatment strategies with less likelihood of SCI in both OR and EVR for dTA and TAA pathologies.
No takes yet. Share an insight, caveat, or question.
Fujiyoshi et al. (2023) conducted a cohort in Descending thoracic aortic and thoracoabdominal aortic aneurysm (n=256). Coverage of the artery of Adamkiewicz (AKA) by endovascular prosthesis vs. AKA not covered was evaluated on Spinal cord injury (SCI) (p=0.002). In patients undergoing endovascular repair, coverage of the artery of Adamkiewicz significantly increased the incidence of spinal cord injury compared to non-coverage (13.8% vs 1.1%, P=0.002).
Synapse has enriched 10 related papers. Consider them for comparative context: