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. 2024 Feb 29:18:1-8.
doi: 10.1016/j.xjon.2024.02.016. eCollection 2024 Apr.

Endovascular occlusion of segmental arteries feeding the anterior spinal artery to stage endovascular thoracoabdominal aortic repair

Daniela Branzan  1   2 , Antonia Geisler  1 , Sabine Steiner  2   3 , Dierk Scheinert  3 , Katharina Funk  1 , Andrej Schmidt  3
Affiliations

Endovascular occlusion of segmental arteries feeding the anterior spinal artery to stage endovascular thoracoabdominal aortic repair

Daniela Branzan et al. JTCVS Open. .

Abstract

Objective: Minimally invasive segmental artery coil embolization was introduced to prevent spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms. There is no consensus on whether the endovascular occlusion of segmental arteries feeding directly the anterior radiculomedullary artery and anterior spinal artery can be safely performed without causing spinal cord ischemia. Our aim was to investigate the feasibility and clinical impact of endovascular occlusion of segmental arteries supplying the anterior spinal artery during minimally invasive segmental artery coil embolization in patients with thoracoabdominal aortic aneurysms.

Methods: Between January 2018 and July 2020, 54 patients (36 male; mean age, 71.1 ± 9.3 years) underwent direct embolization of segmental arteries feeding the anterior radiculomedullary artery before endovascular repair of thoracoabdominal aortic aneurysms. End points included technical success of minimally invasive segmental artery coil embolization of segmental arteries, anterior radiculomedullary artery, neurological complications, and in-hospital mortality after minimally invasive segmental artery coil embolization and endovascular repair of thoracoabdominal aortic aneurysms.

Results: The thoracoabdominal aortic aneurysm classification was type I (n = 8), type II (n = 24), type III (n = 11), and type IV (n = 11). During minimally invasive segmental artery coil embolization, 388 segmental arteries were occluded, each patient having 7.2 ± 3.1 coiled segmental arteries occluding 64.5% (25-100%) of open segmental arteries within the treated aortic segment. Altogether, 66 anterior radiculomedullary arteries were seen originating between Th8 and L3 levels from 85 (21.9%) segmental arteries. In 10 patients (18.5%), 2 large anterior radiculomedullary arteries were identified, and 1 patient (1.9%) showed 3 anterior radiculomedullary arteries on the spinal arteriography. No spinal cord ischemia or procedure-related complications occurred after minimally invasive segmental artery coil embolization. After 47.9 ± 39.4 days, all patients received endovascular repair of their thoracoabdominal aortic aneurysms. There was no in-hospital mortality. One male patient developed incomplete temporary spinal cord ischemia after endovascular repair.

Conclusions: Minimally invasive segmental artery coil embolization of segmental arteries feeding the anterior spinal artery in patients with thoracoabdominal aortic aneurysms to prevent spinal cord ischemia after endovascular repair is feasible and clinically safe.

Keywords: coil embolization; great anterior radiculomedullary artery; segmental artery; spinal cord ischemia; thoracoabdominal aortic aneurysm.

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Conflict of interest statement

D.B.: grants: Artivion, Bentley Innomed, COOK Medical, Endologix, Getinge, Medtronic. S.S.: speakers' honorarium: Bayer Medical, research funding: C.R. Bard. D.S.: consultant or advisory board member for Abbott, Biotronik, Boston Scientific, Cook Medical, Cordis, BD, Gardia Medical, Medtronic, TriReme Medical, and Upstream Peripheral Technologies. A.S.: Consulting/speakers honorarium: Abbott Vascular, BD, Boston Scientific, Cook, Cardinal Health/Cordis, Phillips, and Upstream Peripheral. All other 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

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Graphical abstract
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SA feeding the ASA via the collateral network.
Figure 1
Figure 1
Patient flow diagram. Patients presented with TAAA and treated with ER between January 2018 and July 2020 are shown. TAAA, Thoracoabdominal aortic aneurysm; MISACE, minimally invasive segmental artery coil embolization; ER, endovascular repair; ARMA, anterior radiculomedullary artery; ASA, anterior spinal artery.
Figure 2
Figure 2
Staged ER of TAAA with endovascular occlusion of SAs feeding the ASA. A, Lateral view of the 3-dimensional reconstruction of a TAAA. B, Selective transfemoral catheterization and opacification of the SAs originating in the thoracoabdominal area and suppling the ASA via the branch typical of the great anterior radiculomedullary artery. C, Occlusive coils in the origin of SAs originating from the thoracoabdominal aorta after minimally invasive SA coil embolization. D, Completion angiography after ER of a TAAA. E, Lateral view of the 3-dimensional reconstruction of a TAAA after ER.
Figure 3
Figure 3
Arteriogram showing visualization of the great ARMA and ASA (A) directly through the SA, (B) indirectly through the adjacent SA, and (C) indirectly through the contralateral SA. The arrow shows the ASA, the asterisk shows the ARMA, the transparent arrowhead shows the SA, and the blackarrowhead shows the anastomotic circulation.
Figure 4
Figure 4
The origin of the great anterior radiculomedullary artery from the SA. Diagram showing the origin of ARMA between Th8 and L3 levels. ARMA arose on the left side in 75.3% of the vessels.
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