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The Impact of Preoperative Identification of the Adamkiewicz Artery on Spinal Cord Protection in Descending and Thoracoabdominal Aortic Repair: A Japanese Multicenter Study.

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  1. The Impact of Preoperative Identification of the Adamkiewicz Artery on Spinal Cord Protection in Descending and Thoracoabdominal Aortic Repair: A Japanese Multicenter Study Hiroshi Tanaka1, Hitoshi Ogino2, 1, Kenji Minatoya1, Yoshiro Matsui3, Tetsuya Higami4, Hitoshi Okabayashi5, Yoshikatsu Saiki6, Shigeyuki Aomi7, Norihiko Shiiya8, Yoshiki Sawa9, Takahiro Katsumata14, Yutaka Okita10, Taijiro Sueda11, Shigeaki Aoyagi12, Yukio Kuniyoshi13, Hitoshi Matsuda1, Hiroaki Sasaki1, Yutaka Iba1 1. Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan. 2. Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan. 3. Department of Cardiovascular Surgery, Hokkaido University , Sapporo, Japan. 4. Second Department of Surgery, Supporo Medical University, Sapporo, Japan. 5. Department of Cardiovascular Surgery, Iwate Medical University, Morioka, Japan. 6. Department of Cardiovascular Surgery, Tohoku Univerisity, Sendai, Japan. 7. Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan. 8. First Department of Surgery, Hamamatsu Medical University, Hamamatsu, Japan. 9. Department of Cardiovascular Surgery, Osaka University, Osaka, Japan. 10. Department of Cardiovascular Surgery, Kobe University, Kobe, Japan. 11. First Department of Surgery, Hiroshima University, Hiroshima, Japan. 12. Department of Surgery, Kurume University, Kurume, Japan. 13. Second Department of Surgery, Ryukyu University, Naha, Japan. 14. Department of Thoracic and Cardiovascular Surgery, Osaka Medical University, Osaka, Japan.

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  3. Objectives To investigate whether preoperative identification of the Adamkiewicz artery could be an adjunct to reduce the incidence of spinal cord injury in descending and thoracoabdominal aortic repair.

  4. Patients and Methods • Multicenter study - 12 Japanese cardiovascular centers • January 2000 – December 2010 • 2,435 descending and thoracoabdominal aortic repairs 1,471 open repairs, 964 endovascular repairs

  5. Detect of the Adamkiewicz Artery (AKA)

  6. Distribution of the location of the AKA Left Right Identified in 1,096 / 1,252 (87.6%)

  7. Patients Profile – Open repair (n=1471) Operative procedures

  8. Risk factors for spinal cord injury (multivariate analysis)

  9. Open repair : 1471 SCI (7.3%) No AKA exam : 593 (6.9) No definite AKA identified : 128 (6.3) Identified AKA : 748 (7.8) Operation involving AKA: 454 (8.6) Operation not involving AKA : 244 (7.4) AKA ligated : 51 Occluded AKA : 54 AKA preserved or reconstructed : 349

  10. Multivariate analysis of risk factors for SCI in open repairs involving AKA

  11. Endovascular Repair (n=964) Hospital mortality 62 / 964 (6.4%) Endovascular repair : 964 SCI (2.9%) No AKA exam : 590 (2.5) No definite AKA identified : 30 (3.3) Identified AKA : 344 (3.5) Operation involving AKA: 62 (3.2) Operation not involving AKA : 282 (3.5) No significant risk factors for SCI

  12. Conclusions In open descending and thoracoabdominal aortic repair involving the origin of the AKA, preoperative identification of the AKA and its following intraoperative reconstruction could be an adjunct for spinal cord protection.

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