脊髓动脉造影预防胸主动脉夹层动脉瘤腔内隔绝术后截瘫

Spinal artery angiography preventing paraplegia in endovascular graft exclusion for aortic dissection

目的 :探索在 Stanford B型胸主动脉夹层动脉瘤腔内隔绝术中 ,使用选择性脊髓动脉造影的方法来判断Adamkievicz动脉的起源 ,并评价其预防截瘫的价值。方法 :1例 Stanford B型胸主动脉夹层动脉瘤患者 ,MRA示胸主动脉夹层假腔自 T6 平面发展至腹主动脉 ,在 T8和 T1 0 平面分别有一夹层裂口。术中行两侧椎、甲状颈干、肋颈干、肋间、腰动脉与骶中动脉选择性造影。结果 :造影显示该患者的 Adam kiewicz动脉起源于左侧腰动脉 (L2 ) ,术中用两个 Talent移植物释放后定位于 T6 ～ T1 2 平面 ,夹层完全封闭 ,术后患者下肢感觉运动功能均无异常 ,随访 3个月 ,患者生活如常。结论 :选择性脊髓动脉造影是判断 Adam kiewicz动脉的一种较为成熟的方法 ,对于夹层裂口位于 T8～ T1 0 平面的截瘫高危患者 ,术前进行选择性脊髓动脉造影来判断 Adam kiewicz动脉的起源以指导手术中移植物的定位可以预防截瘫的发生。

Objective: To explore the role of spinal artery angiography in estimating the source of Adamkiewicz artery in endovascular graft exclusion of aortic dissections and in preventing paraplegia. Methods: A 48 years old male patient was admitted for Stanford B type thoracic aortic dissection. MRA showed the false lumen was left to the true lumen, involving the descending aorta from T 6 plane to abdominal aorta, 2 tears appeared in T 8 and T 10 plane. During the operation, the right common femoral artery was punctured and cathetered by Seldinger technique, the vertebral artery, intercostal artery, lumber artery were angiographied selectively. Results: The Adamkievicz artery of patient arose from L 2 lumber artery. In the operation, 2 talent grafts were placed from T 6 to T 12 , the false lumen of dissection was occluded totally. The feeling and movement of the lower extremity remained normal after operation. Conclusion: Selective spinal artery angiography is a reliable method to estimate the source of Adamkievicz artery, but the technique require sophisticated catheter skill and longer operation time, it may not be suitable for regular preoperative examination, but for patients with high risk of post operative paraplegia, it is valuable and feasible.