Selective Reconstruction of Preoperatively Identified Adamkiewicz Artery During Descending and Thoracoabdominal Aortic Aneurysm Repair; What we have Learned

Paraparesis and paraplegia after repair of the descending (TAA) or thoracoabdominal (TAAA) repair remains devastating complication. The purpose of this study was to determine the effects of selective reconstruction of Adamkiewicz artery (ARM) preoperatively identified with MDCT upon neurological outcome. Methods: Sixty two consecutive patients who had aneurysms of the descending (n = 15) or thoracoabdominal aorta (n = 47) were studied prospectively with MDCT to identify ARM before and after surgery. Median age was 62 years (29 to 77) and 37 patients had non-dissecting aneurysm and 23 had aortic dissections. The repair was performed and the segmental intercostals arteries (ICA) connected with ARM were reconstructed selectively according to the identification of ARM with MDCT. Results: MDCT demonstrated the ARM in 57 (91.9%) of the 62 patients. The hospital deaths occurred in 3 patients (4.8%). No paraplegia but 1 paraparesis (1.6 %) occurred in a patients. Major different source of blood supply was identified in 18 (34.6%), and 12/58 (20.6%) reconstructed arteries were occluded with other collateral development. Conclusion: Selective reconstruction of ARM during repair of thoracoabdominal aortic aneurysm is safe and effective reducing the incidence of neurological deficit. Collateral blood supply for spinal cord develops postoperatively and the considerations of collateral source is crucially important.