SURGICAL METHODS OF PROTECTING THE SPINAL ORD DURING RECONSTRUCTIVE OPERATIONS ON THE THORACIC AND THORACOABDOMINAL PORTIONS OF THE AORTA

Bokeriya L.A., Arakelayan V.S., Papitashvili V.G., Gamzaev N.R., Zatevakhina M.V., Pyshakov A.V.
Scientific Centre for Cardiovascular Surgery named after A.?N. Bakulev under the Russian Academy of Medical Sciences,
Moscow, Russia

Background. Restoration of the spinal blood flow during operations on the thoracoabdominal portion of the aorta is one of the basic and decisive methods of protecting the spinal cord from ischaemia.

Objective. To decrease the incidence rate of spinal complications during interventions on the thoracic and thoracoabdominal portions of the aorta at the expense of choosing an appropriate option of aortic reconstruction, determined by preoperative diagnosis of peculiarities of blood supply of the spinal cord.

Materials and methods. From November 2005 to April 2007, a total of 34 patients were operated on at the Department of Arterial Pathology. To determine the spinal blood flow, all the patients were subjected to multispiral CT angiography. In 35% of patients underwent prosthetic repair of the thoracic and abdominal portions of the aorta with leaving a nondilated portion part from which originated the identified "critical" artery. In 45% of the reconstructions the verified "critical" artery was included into the distal oblique anastomosis. In 10% of cases, restoration of the blood flow of the spinal cord was performed at the expense of reimplantation of the segmental artery into the graft on the platform. In cases when the "critical" arteries were not involved into the pathological process, we performed isolated prosthetic repair of the aortic portion affected.

Results. The great anterior radiculo-medullary artery was visualized in 26 (76.5%) patients, and the anterior spinal artery – in 34 (100%) patients. The overall operative mortality rate amounted to 8.8%. Spinal complications were observed in 2.9% of cases (one patient was subjected to ligation of the 10th intercostal artery preoperatively defined as "critical").

Conclusion. Blood flow along the diagnosed "critical" segmental arteries should be restored in all operations on the thoracic and thoracoabdominal portions of the aorta.

KEY WORDS: thoracoabdominal aneurysms, spinal blood, protecting the spinal cord from ischaemia.

P. 93-99

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