Preoperative demonstration of the Adamkiewicz artery by magnetic resonanceangiography in patients with descending or thoracoabdominal aortic aneurysms

Objective: Investigating the possibility of magnetic resonance angiography (MRA) to visualize the Adamkiewicz artery of as a preoperative study of tho racic aortic aneurysms. Methods: From February 1998 to March 1999, 26 conse cutive patients who had aneurysms of the thoracoabdominal or descending aor ta underwent preoperative MRA to visualize the Adamkiewicz artery. Mean age was 60.5 +/- 11.5 years. Fifteen patients had non-dissecting aneurysm and 11 had aortic dissections. Nineteen patients underwent replacement of the a neurysms, four patients underwent endovascular stent-graft repair, and thre e patients were discharged without treatment of aneurysm. MRA was performed on a 1.5-T system (Magnetom, Siemens) and data acquisition was repeated tw o times following injection of gadolinium-DTPA. Source images were reconstr ucted with multiplanar reconstruction and maximum intensity projection. Cri teria for the Adamkiewicz artery of were that the artery ascends from the d orsal branch of the intercostal or lumbar artery to the anterior mid-sagita l surface of the spinal cord in the early phase. Results: The Adamkiewicz a rteries were demonstrated in Is patients (69%). These arteries were origina ted from the left intercostal or lumbar arteries in 13 (72.2%) patients and from the right in 5 (27.8%) and from the Th8 branch in three, Th9 in seven , Th10 in two, Th11 in four, and L1 in two. All patients had graft replacem ent of the aorta using a partial bypass. All intercostal or lumber arteries , which were visualized as the origin of the Adamkiewicz artery, were reatt ached to the grafts. No spinal cord injury occurred. Conclusion: Preoperati ve detection the Adamkiewicz artery was possible by MRA and was very useful to reduce the incidence of ischemic injury of the spinal cord during surge ry of the thoracoabdominal or descending aorta. (C) 2000 Elsevier Science B .V. All rights reserved.