BACKGROUND: Degenerative disease of the aorta usually involves the occlusion of several intercostal and lumbar branches by mural thrombus or atherosclerotic plaques, suggesting that the blood supply to the spinal cord is mainly provided through collateral networks. Patients with previous abdominal aortic aneurysm repair and subsequent thoracoabdominal aortic reconstruction must undergo ligation of a number of these segmental arteries, presenting a greater risk of experiencing spinal cord ischemic injury. METHODS: The records of 18 patients who had experienced abdominal aortic aneurysm graft replacement and who had undergone 19 operations for thoracoabdominal aortic repair were retrospectively evaluated. All patients were male. The mean age was 66 +/- 10 years (range, 36 to 75 years); the mean interval between the two operations was 79 +/- 69 months (range, 1 to 231 months). There were 18 (95%) cases of thoracoabdominal aortic aneurysms, and one (5%) case of acute dissection of the thoracoabdominal aorta. The origin of the Adamkiewicz artery was determined preoperatively by computed tomography. Measures to avoid spinal cord injury included monitoring of evoked spinal cord potentials and selective reconstruction of the intercostal arteries under hypothermic cardiopulmonary bypass. RESULTS: There were three (16%) cases of permanent neurologic injury that included one cerebrovascular accident, one neurogenic bladder, and one paraparesis of the right lower limb. There were no cases of paraplegia or postoperative deaths. CONCLUSIONS: Surgical reconstruction of the thoracoabdominal aorta in patients who previously underwent abdominal aortic graft replacement is not related to an increased probability of developing spinal cord ischemic injury.
BACKGROUND: Degenerative disease of the aorta usually involves the occlusion of several intercostal and lumbar branches by mural thrombus or atherosclerotic plaques, suggesting that the blood supply to the spinal cord is mainly provided through collateral networks. Patients with previous abdominal aortic aneurysm repair and subsequent thoracoabdominal aortic reconstruction must undergo ligation of a number of these segmental arteries, presenting a greater risk of experiencing spinal cord ischemic injury. METHODS: The records of 18 patients who had experienced abdominal aortic aneurysm graft replacement and who had undergone 19 operations for thoracoabdominal aortic repair were retrospectively evaluated. All patients were male. The mean age was 66 +/- 10 years (range, 36 to 75 years); the mean interval between the two operations was 79 +/- 69 months (range, 1 to 231 months). There were 18 (95%) cases of thoracoabdominal aortic aneurysms, and one (5%) case of acute dissection of the thoracoabdominal aorta. The origin of the Adamkiewicz artery was determined preoperatively by computed tomography. Measures to avoid spinal cord injury included monitoring of evoked spinal cord potentials and selective reconstruction of the intercostal arteries under hypothermic cardiopulmonary bypass. RESULTS: There were three (16%) cases of permanent neurologic injury that included one cerebrovascular accident, one neurogenic bladder, and one paraparesis of the right lower limb. There were no cases of paraplegia or postoperative deaths. CONCLUSIONS: Surgical reconstruction of the thoracoabdominal aorta in patients who previously underwent abdominal aortic graft replacement is not related to an increased probability of developing spinal cord ischemic injury.