Impact of Reconstructing Intercostal Artery on Spinal Cord Circulation During Open Surgery for Thoracoabdominal Aortic Aneurysm

ABSTRACT Introduction: We evaluated the outcomes of the selective intercostal artery reconstruction for preventing spinal cord injury during thoracoabdominal aortic aneurysm repair. Methods: We retrospectively assessed 84 consecutive patients who underwent thoracoabdominal aortic aneurysm repairs between 2004 and 2016. The mean age of the patients was 57.3 years. We performed preoperative multidetector computed tomography in 74 patients (88.0%) to identify the Adamkiewicz artery. Spinal cord injury preventive measures included motor evoked potential monitoring, hypothermia induction, Adamkiewicz artery or other intercostal artery reconstruction, and cerebrospinal fluid drainage. Results: The hospital death rate was 5.9%, and paraplegia occurred in four patients (4.7%). The Adamkiewicz artery or other intercostal arteries were reconstructed selectively in 46 patients (54.7%). Of these patients, 41 underwent postoperative multidetector computed tomography, which revealed occlusion of the reconstructed grafts in 23 patients (56.0%). There was no paraplegia in the patients who underwent reconstruction of the Adamkiewicz artery, which was patent on postoperative multidetector computed tomography. Univariate analysis showed no significant effect of various risk factors on the development of spinal cord injury. Conclusion: Outcome of open surgery for thoracoabdominal aortic aneurysm in our institution regarding spinal cord injury was satisfactory. The benefits of Adamkiewicz artery reconstruction remain inconclusive, and further larger studies are required to identify its validation for spinal cord protection in thoracoabdominal aortic aneurysm repair.摘要 引言：本研究评估了选择性肋间动脉重建术在胸腹主动脉瘤（thoracoabdominal aortic aneurysm）修复术中预防脊髓损伤的临床效果。 方法：本研究回顾性分析了2004年至2016年间连续接受胸腹主动脉瘤修复术的84例患者，患者平均年龄为57.3岁。其中74例（88.0%）患者术前接受多排计算机断层扫描（multidetector computed tomography）以定位Adamkiewicz动脉（Adamkiewicz artery）。脊髓损伤预防措施包括运动诱发电位（motor evoked potential）监测、诱导低温、Adamkiewicz动脉或其他肋间动脉重建术以及脑脊液引流（cerebrospinal fluid drainage）。 结果：本队列住院死亡率为5.9%，4例患者（4.7%）出现截瘫。46例患者（54.7%）接受了Adamkiewicz动脉或其他肋间动脉的选择性重建术。其中41例患者术后接受多排计算机断层扫描复查，结果显示23例患者（56.0%）的重建移植物发生闭塞。术后复查提示Adamkiewicz动脉通畅的患者中，无一例出现截瘫。单因素分析显示，各类危险因素对脊髓损伤的发生均无显著影响。 结论：本中心开展的胸腹主动脉瘤开放手术在脊髓损伤防控方面的效果令人满意。Adamkiewicz动脉重建术的获益仍不明确，尚需开展更大规模的研究以明确其在胸腹主动脉瘤修复术中用于脊髓保护的有效性。