Anatomical pattern of feeding artery and mechanism of intraoperative spinal cord ischemia.

Full Abstract

BACKGROUND: We evaluated correlation between anatomical pattern of the spinal cord feeding artery, detected by preoperative multidetector row computed tomography, and the mechanism of spinal cord ischemia during aortic surgery. METHODS: One hundred sixteen patients underwent multidetector row computed tomography before descending or thoracoabdominal replacement. Segmental arteries feeding the spinal cord were detected in 92 patients (79%), and were classified into "critical" (isolated hairpin shaped) or "supplemental" (confluence-shaped or multiple). Spinal cord ischemia was monitored together with distal aortic perfusion in 53 of them by motor-evoked potentials, evoked spinal cord potentials, or both. The relationship between monitoring results and operative management to the detected feeding arteries was analyzed. RESULTS: When no feeding segmental artery was involved in the extent of replacement (n = 18), spinal cord ischemia was detected in 1 (6%), which was due to cross-clamping the subclavian artery. When a supplemental feeding artery was involved (n = 15), ischemia was detected in 7 patients (47%), and was reversed by stopping back-bleeding. When a critical feeding artery was involved (n = 20), ischemia was detected in 6 (30%). In 3 of them, ischemia was reversed by stopping back-bleeding, whereas it was reversed only after reconstruction of the critical feeder in the remaining 3. Paraparesis occurred in 1 of the latter 3, and the incidence of spinal cord injury was 2% (1 of 53). CONCLUSIONS: When the involved feeding artery is a supplemental one, the steal phenomenon is the predominant mechanism of ischemia. Conversely, blood flow interruption to the critical feeding artery may cause spinal cord ischemia without steal phenomenon.

Author information

Author/s: Shiiya, Norihiko (N); Wakasa, Satoru (S); Matsui, Kinya (K); Sugiki, Takashi (T); Shingu, Yasushige (Y); Yamakawa, Tomoshi (T); Matsui, Yoshiro (Y);

Affiliation: Department of Cardiovascular Surgery, Hokkaido University Hospital, Sapporo, Japan. shiyanor(-atsign-)med.hokudai.ac.jp

Journal and publication information

Publication Type: Journal Article

Journal: The Annals of thoracic surgery (Ann Thorac Surg), published in Netherlands. (Language: eng)

Reference: 2009-Sep; vol 88 (issue 3) : pp 768-71; discussion 772

Dates: Created 2009/08/24; Completed 2009/09/14;

PMID: 19699895, status: MEDLINE (last retrieval date: 9/14/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.