Comparison of intra-aortic computed tomography angiography to conventional angiography in the presurgical visualization of the Adamkiewicz artery: first results in patients with thoracoabdominal aortic aneurysms

• Published in: Neuroradiology Vol. 55; no. 11; pp. 1379 - 1387
• Main Authors: Clarençon, Frédéric, Di Maria, Federico, Cormier, Evelyne, Gaudric, Julien, Sourour, Nader, Gabrieli, Joseph, Iosif, Christina, Jenny, Catherine, Koskas, Fabien, Chiras, Jacques
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2013; Springer Nature B.V
• Subjects: Age; Aged; Aged, 80 and over; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - surgery; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - surgery; Aortography - methods; Female; Humans; Imaging; Interventional Neuroradiology; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Preoperative Care - methods; Radiography, Interventional - methods; Radiology; Reproducibility of Results; Sensitivity and Specificity; Tomography; Tomography, X-Ray Computed - methods; Veins & arteries; CT angiography; Hybrid operating room; Intra-aortic injection; Adamkiewicz artery; Location
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-013-1284-0

Introduction The aim of this study was to compare the sensitivity of intra-aortic computed tomography angiography (IA-CTA) to that of regular spinal digital subtraction angiography for the presurgical location of the Adamkiewicz artery (AKA). Methods Thirty patients (21 males, 9 females; mean age 64 years) had an IA-CTA for the location of the AKA before surgery of aneurysm ( n  = 24) or dissection ( n  = 6) of the thoracoabdominal aorta. After femoral artery puncture, a pigtail catheter was positioned at the origin of the descending aorta. CT acquisition was performed with an intra-aortic iodinated contrast media injection (15 mL/s, 120 mL). The visualization of the AKA and the location of the feeder(s) to the AKA were independently evaluated by two observers. Interrater agreement was calculated using a kappa test. Spinal angiogram by selective catheterization was systematically performed to confirm the results of the IA-CTA. Results The AKA was visualized by the IA-CTA in 27/30 cases (90 %); in 26/31 (84 %) cases, the continuity with the aorta was satisfactorily seen. Interrater agreement was good for the visualization of the AKA and its feeder(s): 0.625 and 0.87, respectively. In 75 % of the cases for which the AKA was visualized, the selective catheterization confirmed the results of the IA-CTA. In the remaining 25 % of the cases, the selective catheterization could not be performed due to marked vessels’ tortuosity or ostium stenosis. Conclusion IA-CTA is a feasible technique in a daily practice that presents a good sensitivity for the location of the AKA.