Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 1:17:14-22.
doi: 10.1016/j.xjon.2023.11.014. eCollection 2024 Feb.

Covering the intercostal artery branching of the Adamkiewicz artery during endovascular aortic repair increases the risk of spinal cord ischemia

Yoshimasa Seike  1 , Tatsuya Nishii  2 , Kazufumi Yoshida  1 , Koki Yokawa  1 , Kenta Masada  1 , Yosuke Inoue  1 , Tetsuya Fukuda  2 , Hitoshi Matsuda  1
Affiliations

Covering the intercostal artery branching of the Adamkiewicz artery during endovascular aortic repair increases the risk of spinal cord ischemia

Yoshimasa Seike et al. JTCVS Open. .

Abstract

Objectives: This study aimed to determine the relationship between covering the intercostal artery branching of the Adamkiewicz artery (ICA-AKA) and spinal cord ischemia (SCI) during thoracic endovascular aortic repair (TEVAR).

Methods: Patients who underwent TEVAR from 2008 to 2022 were enrolled. Stent grafts covered the ICA-AKA in 108 patients (covered AKA group) and stent grafts didn't cover the ICA-AKA in 114 patients (uncovered AKA group). The characteristics of 58 patients from each group were matched based on propensity scores.

Results: No significant differences in SCI rates were detected between the covered AKA (10%; 11/108) and uncovered AKA (3.5%; 4/114) groups (P = .061). Shaggy aorta (odds ratio [OR], 5.16; 95% confidence interval [CI], 1.74-15.3, P = .003), iliac artery access (OR, 6.81; 95% CI, 2.22-20.9, P = .001), and procedural time (OR, 1.01; 95% CI, 1.00-1.02, P = .003) were risk factors for SCI in the entire cohort. Although covering the ICA-AKA (OR, 2.60; 95% CI, 0.86-7.88, P = .058) was not a significant risk factor, shaggy aorta (OR, 8.15; 95% CI, 2.07-32.1, P = .003), iliac artery access (OR, 9.09; 95% CI, 2.22-37.2, P = .002), and procedural time (OR, 1.01; 95% CI, 1.01-1.02, P = .008) were risk factors for SCI in the covered AKA group. No significant risk factors were detected in the uncovered AKA group.

Conclusions: Covering the ICA-AKA was not an independent risk for SCI in TEVAR. However, covering the ICA-AKA was indirectly associated with the risk of SCI in patients with shaggy aorta, iliac access, and procedural time.

Keywords: Adamkiewicz artery; descending thoracic aortic aneurysm; intercostal artery; spinal cord ischemia; thoracic endovascular aortic repair.

PubMed Disclaimer

Conflict of interest statement

The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

None
Graphical abstract
None
Answer: Yes, but it depends on the situation.
Figure 1
Figure 1
Flowchart of study population. TEVAR, Thoracic endovascular aortic repair.
Figure 2
Figure 2
Identification of the Adamkiewicz artery. The Adamkiewicz artery (black arrow) and collateral vessels arising from the third lumbar artery were identified using computed tomography angiography.
Figure 3
Figure 3
Computed tomography angiography findings of the shaggy aorta. The 3-dimensional and sagittal aortic computed tomography angiography images show a shaggy aorta. White arrows indicate an intimal irregularity with atheroma thickness.
Figure 4
Figure 4
In this study, patients who underwent TEVAR from 2008 to 2022 were enrolled. Stent grafts covered the ICA-AKA in 108 patients and stent grafts didn’t cover the ICA-AKA in 114 patients. Although covering the ICA-AKA was not a significant risk factor, shaggy aorta, iliac artery access, and procedural time were risk factors for SCI in the covered AKA group. No significant risk factors were detected in the uncovered AKA group. Covering the ICA-AKA was not an independent risk for SCI in TEVAR. However, covering the ICA-AKA was indirectly associated with the risk of SCI in patients with shaggy aorta, iliac access, and procedural time. TEVAR, Thoracic endovascular aortic repair; ICA-AKA, intercostal artery branching of the Adamkiewicz artery; OR, odds ratio; CI, confidence interval.
See this image and copyright information in PMC

References

    1. Griepp R.B., Griepp E.B. Spinal cord perfusion and protection during descending thoracic and thoracoabdominal aortic surgery: the collateral network concept. Ann Thorac Surg. 2007;83:S865–S869. - PubMed
    1. Shiiya N., Wakasa S., Matsui K., Sugiki T., Shingu Y., Yamakawa T., et al. Anatomical pattern of feeding artery and mechanism of intraoperative spinal cord ischemia. Ann Thorac Surg. 2009;88:768–772. - PubMed
    1. Shiiya N., Washiyama N., Tsuda K., Yamanaka K., Takahashi D., Yamashita K., et al. Japanese perspective in surgery for thoracoabdominal aortic aneurysms. Gen Thorac Cardiovasc Surg. 2019;67:187–191. - PubMed
    1. Matsuda H., Fukuda T., Iritani O., Nakazawa T., Tanaka H., Sasaki H., et al. Spinal cord injury is not negligible after TEVAR for lower descending aorta. Eur J Vasc Endovasc Surg. 2010;39:179–186. - PubMed
    1. Etz C.D., Kari F.A., Mueller C.S., Silovitz D., Brenner R.M., Lin H.M., et al. The collateral network concept: a reassessment of the anatomy of spinal cord perfusion. J Thorac Cardiovasc Surg. 2011;141:1020–1028. - PMC - PubMed

LinkOut - more resources