-
BMC Medical Imaging Mar 2022This study was aimed to explore the clinical application of dual-energy computed tomography (DECT) monoenergetic plus (mono+) imaging to evaluate anatomical variations...
A study on spinal level, length, and branch type of the inferior mesenteric artery and the position relationship between the inferior mesenteric artery, left colic artery, and inferior mesenteric vein.
BACKGROUND
This study was aimed to explore the clinical application of dual-energy computed tomography (DECT) monoenergetic plus (mono+) imaging to evaluate anatomical variations in the inferior mesenteric artery (IMA).
METHODS
The clinical and imaging data of 212 patients who had undergone total abdominal DECT were retrospectively analyzed. The post-processing mono+ technique was used to obtain 40-keV single-level images in the arterial phase. Three-dimensional reconstruction was performed to evaluate the relationship between the IMA root position and the spinal level, IMA length, and IMA branch type, as well as the position of the left colic artery (LCA) and inferior mesenteric vein (IMV) at the IMA root level.
RESULTS
The IMA root was located at the L3 level in 78.3% of cases and at the L2/L3 level in 3.3%. The highest vertebral level of IMA origin was L2 (4.2%), and the lowest was L4 (7.1%). The distance from the IMA root to the level of the sacral promontory was 99.58 ± 13.07 mm, which increased with the elevation of the IMA root at the spinal level. Of the patients, 53.8% demonstrated Type I IMA, 23.1% Type II, 20.7% Type III, and 2.4% Type IV. The length of the IMA varied from 13.6 to 66.0 mm. 77.3% of the IMAs belonged to Type A, the adjacent type, and 22.7% to Type B, the distant type.
CONCLUSION
DECT mono+ can preoperatively evaluate the anatomical characteristics of the IMA and the positional relationship between the LCA and IMV at the IMA root level, which would help clinicians plan individualized surgery for patients.
Topics: Abdomen; Arteries; Humans; Mesenteric Artery, Inferior; Mesenteric Veins; Retrospective Studies
PubMed: 35260088
DOI: 10.1186/s12880-022-00764-y -
AJNR. American Journal of Neuroradiology Jan 2023Dominant radiculomedullary arteries such as the artery of lumbar enlargement and the artery of cervical enlargement are well-documented. However, variability exists as...
BACKGROUND AND PURPOSE
Dominant radiculomedullary arteries such as the artery of lumbar enlargement and the artery of cervical enlargement are well-documented. However, variability exists as to the size, number, and location of other radiculomedullary arteries contributing supply to the anterior spinal artery. The aim of this anatomic study was to document the prevalence and characteristics of the dominant anterior thoracic artery in cadaveric specimens.
MATERIALS AND METHODS
Microsurgical dissection of cadaveric human spinal cord specimens ( = 50) was conducted. The artery of lumbar enlargement was injected with colored latex until the small-caliber arterial vessels were filled. The dominant anterior thoracic artery was identified, injected, and filled with diluted industrial paint. The course, diameter, and location of the dominant anterior thoracic artery, artery of lumbar enlargement, and artery of cervical enlargement were documented.
RESULTS
The artery of lumbar enlargement was identified between T3 and L2 in all 50 specimens (100%), and the artery of cervical enlargement was identified in 84% of specimens (42/50). At least 1 dominant anterior thoracic artery distinct from the artery of lumbar enlargement and the artery of cervical enlargement was identified between T1 and T11 in 47 of the 50 specimens (94%). The most frequent origin of the dominant anterior thoracic artery was at the level of T4 on the left. The average size of the dominant anterior thoracic artery was 0.446 mm (range, 0.300-0.759 mm on the left and 0.270-0.569 mm on the right).
CONCLUSIONS
A dominant anterior thoracic artery is present in 94% of individuals. Variations of the arterial supply to the anterior thoracic cord are of great importance due to their implications for ischemic events as well as surgical and endovascular procedures.
Topics: Humans; Spinal Cord; Vertebral Artery; Thoracic Arteries; Dissection; Cadaver
PubMed: 36581455
DOI: 10.3174/ajnr.A7737 -
The Cochrane Database of Systematic... Apr 2022Thoracoabdominal aortic aneurysms (TAAAs) are a life-threatening condition which remain difficult to treat. Endovascular and open surgical repair (OSR) provide treatment... (Review)
Review
BACKGROUND
Thoracoabdominal aortic aneurysms (TAAAs) are a life-threatening condition which remain difficult to treat. Endovascular and open surgical repair (OSR) provide treatment options for patients, however, due to the lack of clinical trials comparing these, the optimum treatment option is unknown.
OBJECTIVES
To assess the effectiveness and safety of endovascular repair versus conventional OSR for the treatment of TAAAs.
SEARCH METHODS
The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 26 April 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations.
SELECTION CRITERIA
We considered all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing endovascular repair to OSR for TAAAs for inclusion in the review. The main outcomes of interest were prevention of aneurysm rupture (participants without aneurysm rupture up to 5 years from intervention), aneurysm-related mortality (30 days and 12 months), all-cause mortality, spinal cord ischaemia (paraplegia, paraparesis), visceral arterial branch compromise causing mesenteric ischaemia or renal failure, and rate of reintervention.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened all titles and abstracts identified from the searches to identify those that met the inclusion criteria. We planned to undertake data collection, risk of bias assessment, and analysis in accordance with Cochrane recommendations. We planned to assess the certainty of the evidence using GRADE.
MAIN RESULTS
No RCTs or CCTs met the inclusion criteria for this review.
AUTHORS' CONCLUSIONS
Due to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of endovascular compared to OSR in patients with TAAAs and are unable to provide any evidence on the optimal surgical intervention for this cohort of patients. High-quality RCTs or CCTs addressing this objective are necessary, however conducting such studies will be logistically and ethically challenging for this life-threatening disease.
Topics: Aortic Aneurysm, Thoracic; Arteries; Endovascular Procedures; Humans
PubMed: 35363887
DOI: 10.1002/14651858.CD012926.pub2 -
Cells Feb 2020Spinal cord ischemia (SCI) is a clinical complication following aortic repair that significantly impairs the quality and expectancy of life. Despite some strategies,... (Review)
Review
Spinal cord ischemia (SCI) is a clinical complication following aortic repair that significantly impairs the quality and expectancy of life. Despite some strategies, like cerebrospinal fluid drainage, the occurrence of neurological symptoms, such as paraplegia and paraparesis, remains unpredictable. Beside the major blood supply through conduit arteries, a huge collateral network protects the central nervous system from ischemia-the paraspinous and the intraspinal compartment. The intraspinal arcades maintain perfusion pressure following a sudden inflow interruption, whereas the paraspinal system first needs to undergo arteriogenesis to ensure sufficient blood supply after an acute ischemic insult. The so-called steal phenomenon can even worsen the postoperative situation by causing the hypoperfusion of the spine when, shortly after thoracoabdominal aortic aneurysm (TAAA) surgery, muscles connected with the network divert blood and cause additional stress. Vessels are a conglomeration of different cell types involved in adapting to stress, like endothelial cells, smooth muscle cells, and pericytes. This adaption to stress is subdivided in three phases-initiation, growth, and the maturation phase. In fields of endovascular aortic aneurysm repair, pre-operative selective segmental artery occlusion may enable the development of a sufficient collateral network by stimulating collateral vessel growth, which, again, may prevent spinal cord ischemia. Among others, the major signaling pathways include the phosphoinositide 3 kinase (PI3K) pathway/the antiapoptotic kinase (AKT) pathway/the endothelial nitric oxide synthase (eNOS) pathway, the Erk1, the delta-like ligand (DII), the jagged (Jag)/NOTCH pathway, and the midkine regulatory cytokine signaling pathways.
Topics: Animals; Aortic Aneurysm, Thoracic; Arteries; Collateral Circulation; Humans; Neovascularization, Physiologic; Nitric Oxide; Nitric Oxide Synthase Type III; Paraplegia; Postoperative Complications; Receptors, Notch; Signal Transduction; Spinal Cord; Spinal Cord Ischemia; Vascular Endothelial Growth Factor A
PubMed: 32098337
DOI: 10.3390/cells9020501 -
Interventional Neuroradiology : Journal... Oct 2023Spinal catheter angiography is commonly performed in the evaluation and treatment of spinal vascular lesions. The typical approach to spinal angiography consists of...
BACKGROUND
Spinal catheter angiography is commonly performed in the evaluation and treatment of spinal vascular lesions. The typical approach to spinal angiography consists of access through the femoral artery with the use of suitably shaped catheters for selective catheterization of the spinal segmental vasculature. The purpose of our study was to evaluate the safety and feasibility of distal transradial access through the "anatomical snuffbox" for targeted spinal angiography, for the investigation and treatment of selected spinal lesions.
METHODS
A retrospective review of patients who underwent transradial spinal angiography and embolization was performed from August 2019 to January 2022. A total of eight patients were identified, who underwent targeted spinal angiography through distal transradial access. Outcome measures were documented in a tabular manner.
RESULTS
Radial access was successful in all patients. Seven patients had vascular tumors of the spinal column and underwent tumor embolization followed by segmental artery occlusion prior to surgery. One patient had a spinal dural AV fistula that could not be embolized due to feeding vessel tortuosity and eventually went on to have a laminectomy. Mean fluoroscopy time was 31.4 min. There were no access site hemorrhagic complications. One patient experienced transient mild hand numbness during the period of hemostasis with the vascular compression device that resolved completely within 24 h.
CONCLUSIONS
Distal transradial access is a feasible and safe option for targeted spinal angiography and treatment in selected patients.
Topics: Humans; Radial Artery; Angiography; Embolization, Therapeutic; Catheters; Hemorrhage; Retrospective Studies
PubMed: 35484816
DOI: 10.1177/15910199221097489 -
The Cochrane Database of Systematic... Apr 2016Controversy exists as to whether revascularisation of the left subclavian artery (LSA) confers improved outcomes in patients undergoing thoracic endovascular aortic... (Review)
Review
BACKGROUND
Controversy exists as to whether revascularisation of the left subclavian artery (LSA) confers improved outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR). Even though preemptive revascularisation of the LSA has theoretical advantages, including a reduced risk of ischaemic damage to vital organs, such as the brain and the spinal cord, it is not without risks. Current practice guidelines recommend routine revascularisation of the LSA in patients undergoing elective TEVAR where achievement of a proximal seal necessitates coverage of the LSA, and in patients who have an anatomy that compromises perfusion to critical organs. However, this recommendation was based on very low-quality evidence.
OBJECTIVES
To assess the comparative efficacy of routine LSA revascularisation versus either selective or no revascularisation in patients with descending thoracic aortic disease undergoing TEVAR with coverage of the LSA origin.
SEARCH METHODS
The Cochrane Vascular Trials Search Co-ordinator (TSC) searched the Specialised Register (June 2015). In addition, the TSC searched the Cochrane Register of Studies (CENTRAL (2015, Issue 5)).Trials databases were also searched (June 2015).
SELECTION CRITERIA
We had planned to consider all randomised controlled trials (RCTs) that compared routine revascularisation of the LSA with selective or no revascularisation, in patients undergoing TEVAR.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the title and abstract of articles identified through literature searches. An independent third review author was consulted in the event of disagreement. We had planned for two review authors to independently extract data and assess the risk of bias of identified trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions.
MAIN RESULTS
We did not identify any RCTs relevant to our review topic. Therefore, no quantitative analysis was conducted.
AUTHORS' CONCLUSIONS
High quality RCT evidence for or against routine or selective revascularisation of the LSA in TEVAR is not currently available. It is not possible to draw conclusions with regard to the optimal management of LSA coverage in TEVAR, and whether routine revascularisation, which was defined as the intervention of interest in our review, confers beneficial effects, as indicated by reduced mortality, cerebrovascular events, and spinal cord ischaemia. This review highlights the need for continued research to provide RCT evidence and define the role of LSA revascularisation in the context of TEVAR with coverage of the LSA.
Topics: Aorta, Thoracic; Endovascular Procedures; Humans; Subclavian Artery
PubMed: 27119426
DOI: 10.1002/14651858.CD011738.pub2 -
The Journal of Spinal Cord Medicine Sep 2021The goal of this study was to identify whether the anterior spinal artery (ASA) is occluded in severe cervical compressive myelopathy (CCM) according to computed...
The goal of this study was to identify whether the anterior spinal artery (ASA) is occluded in severe cervical compressive myelopathy (CCM) according to computed tomography angiography (CTA); occlusion was defined as spinal canal sagittal diameter compression of more than 80%.: A retrospective study.: Xinqiao Hospital, Chongqing, China. The sample comprised 11 patients with spinal canal sagittal diameter compression of more than 80%.: The patient underwent CTA of the ASA after admission. Covisualization of the ASA and the artery of Adamkiewicz was used to identify the ASA.: Spinal cord compression and decompression were determined with 1.5-Tesla magnetic resonance imaging. The neurologic status was evaluated according to the classification of the American Spinal Injury Association (ASIA). No ASA occlusion was found in all 11 severe CCM patients who presented with chronic or acute onset. All patients demonstrated improved neurological status after the anterior cervical decompression and fusion procedure. ASA occlusion was not observed in CCM patients with spinal canal sagittal diameter compression of more than 80%.
Topics: Decompression, Surgical; Humans; Retrospective Studies; Spinal Cord Compression; Spinal Cord Injuries; Vertebral Artery
PubMed: 31791211
DOI: 10.1080/10790268.2019.1693193 -
Annals of Vascular Surgery Jul 2016To retrospectively analyze the role of intercostal artery reconstruction in the spinal cord protection for patients undergoing extensive thoracoabdominal aortic aneurysm...
BACKGROUND
To retrospectively analyze the role of intercostal artery reconstruction in the spinal cord protection for patients undergoing extensive thoracoabdominal aortic aneurysm repair.
METHODS
From August 2007 to 2014, thoracoabdominal aortas (Crawford II) of 81 consecutive patients with mean age 39.4 ± 10.32 years were repaired. Seventy-three of these patients (90.12%) were diagnosed with aortic dissection in our group, 25 (30.86%) with Stanford type A dissection and 48 (59.26%) with Stanford B aortic dissection. All 25 patients with type A dissection have previously undergone surgical procedures which include Bentall's procedures in 11 cases, ascending aortic replacement in 6 cases, and total aortic arch replacement in 8 cases. All procedures were performed under profound hypothermia with interval cardiac arrest after making a thoracoabdominal incision. Extracorporeal circulation was instituted with 2 arterial cannulae and a single venous cannula in the right atrium. T6-T12 intercostal arteries and L1 and L2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8 mm branch for maintaining spinal cord blood perfusion. Visceral arteries were joined into a patch and anastomosed to the end of the main graft. The left renal artery was anastomosed to an 8 mm branch or joined to the patch. The other 10 mm branches were anastomosed to iliac arteries.
RESULTS
With 100% follow-up, early mortality was 7.4%. Six deaths were recorded; 1 patient died of cerebral hemorrhage, 3 of renal failure, 1 of heart failure because of myocardial infarction, and the last one died from the rupture of celiac artery dissection. The rate of postoperative spinal cord deficits was 3.7%, 2 patients with paraplegia and 1 patient with paraparesis. None had bladder or rectum dysfunction. Neo-intercostal arteries were clogged in 12 patients within follow-up period and formed pseudoaneurysm in 2 patients with Marfan syndrome. The mean survival time in this group was 54.22 ± 3.03 months (95% confidence interval 44.37-59.90 months) with survival rate of 92.37% after 1 year, 89.02% after 2 years, and 85.54% after 5 years. All patients were free from spinal cord deficits.
CONCLUSIONS
Intercostal artery reconstruction is an effective technique for spinal cord protection in patients with the thoracoabdominal aortic repair. It can achieve favorable results and avoid spinal cord deficits with long-term follow-up.
Topics: Adult; Anastomosis, Surgical; Aortic Dissection; Aortic Aneurysm, Thoracic; Aortography; Blood Vessel Prosthesis Implantation; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Paraparesis; Paraplegia; Plastic Surgery Procedures; Regional Blood Flow; Retrospective Studies; Risk Factors; Spinal Cord; Spinal Cord Ischemia; Thoracic Arteries; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 27177704
DOI: 10.1016/j.avsg.2015.12.030 -
Journal of Vascular Surgery Feb 2023Aberrant subclavian artery (AScA) with or without associated Kommerell's diverticulum (KD) is the most frequently encountered anomaly of the aortic arch, it may be life... (Review)
Review
BACKGROUND
Aberrant subclavian artery (AScA) with or without associated Kommerell's diverticulum (KD) is the most frequently encountered anomaly of the aortic arch, it may be life threatening, especially when associated with aneurysmal degeneration. The best management is still debated and depends on many clinical and anatomical factors. A systematic review was conducted to assess the current evidence on the treatment options and their efficacy and safety for AscA and KD repairs.
METHODS
A literature search in PubMed and Cochrane Library was performed, and articles that were published from January 1947 to August 2021 reporting on AscA and KD management were identified. Multicenter studies, single-center series, and case series with three or more patients were considered eligible in the present review. A comparison of outcomes of patients who underwent open surgery (OS), a hybrid approach (HA), and total endovascular repair (ER) (ie, 30-day mortality and stroke were analyzed when available and compared among the three groups (P < .05; Benjamini and Hochberg-adjusted P < .05; Bonferroni-adjusted P < .05). Titles, abstracts, and full texts were evaluated by two authors independently. Primary outcomes included survival rate, perioperative stroke, arm ischemia, and spinal cord ischemia. Endoleak, in the case of HA and ER, and reintervention rates were considered outcomes.
RESULTS
Three hundred thirty-one articles were initially evaluated and 30 studies, totaling 426 patients treated for AScA with 324 KD, were included. Of the 426 patients, 241 were male (56.5%), and the mean patient age was 57.9 ± 12.0 years. The approach was OS in 228 patients, HA in 147 patients, and ER in 51. Dysphagia was the most common presentation in 133 cases. Aortic rupture was observed in 16 of the 426 patients (3.8%), including 14 AScA/KD (3.3%) aneurysm rupture. KD maximum diameter varied widely from 12.6 to 63.6 mm. The overall 30-day mortality was 20 (4.7%) (OS group 8/228 [3.5%]; HA group 10/147 [6.8%]; ER 2/51 [3.9%]; P = NS). The overall stroke rate was 4.9% (21/426) (OS group 10/228 [4.4%]; HA group 6/147 [4.1%]; ER group 5/51 [9.8%]; P = NS), including nine transient and nondisabling neurological deficits. Overall secondary procedures for complications were reported in 36 of the 426 cases (8.4%), mostly owing to endoleak. Follow-up varied from 13 to 74 months.
CONCLUSIONS
This systematic review assessed the current outcomes of the three types of therapeutic management for AScA and KD and demonstrated that they are all relatively safe and effective, providing satisfactory early and midterm outcomes. Long-term outcomes are warranted, especially for total ERs since the long-term durability of stent grafts remains unknown.
Topics: Humans; Male; Middle Aged; Aged; Female; Endoleak; Aorta, Thoracic; Subclavian Artery; Aortic Rupture; Endovascular Procedures; Diverticulum; Treatment Outcome
PubMed: 35850164
DOI: 10.1016/j.jvs.2022.07.010 -
AJNR. American Journal of Neuroradiology Feb 2017Thoracic vertebral arteries are anastomotic chains similar to cervical vertebral arteries but found at the thoracic level. Descending thoracic vertebral arteries...
Thoracic vertebral arteries are anastomotic chains similar to cervical vertebral arteries but found at the thoracic level. Descending thoracic vertebral arteries originate from the pretransverse segment of the cervical vertebral artery and curve caudally to pass into the last transverse foramen or the first costotransverse space. Ascending thoracic vertebral arteries originate from the aorta, pass through at least 1 costotransverse space, and continue cranially as the cervical vertebral artery. This report describes the angiographic anatomy and clinical significance of 9 cases of descending and 2 cases of ascending thoracic vertebral arteries. Being located within the upper costotransverse spaces, ascending and descending thoracic vertebral arteries can have important implications during spine interventional or surgical procedures. Because they frequently provide radiculomedullary or bronchial branches, they can also be involved in spinal cord ischemia, supply vascular malformations, or be an elusive source of hemoptysis.
Topics: Angiography; Female; Humans; Male; Thoracic Vertebrae; Vertebral Artery
PubMed: 27932511
DOI: 10.3174/ajnr.A5016