Dorsal False Lumen: Segmental Communicating Artery and Spinal Cord Ischemia in Type A Acute Aortic Dissection

Shinya Takahashi, Keijiro Katayama, Seimei Go, Shohei Morita, Tatsuya Kurosaki, Kazuki Maeda, Taijiro Sueda

Hiroshima University Hospital, Hiroshima, Japan

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – B

Abstract

Background

Spinal cord ischemia (SCI) and paraplegia are complications after surgery for type A acute aortic dissection (TAAAD). The segmental artery plays a key role in SCI; however, the dorsal segment of the false lumen of the descending aorta (dorsal false lumen, DFL), defined by number of segmental arteries directly communicating with false lumen and its occlusion, has not been evaluated.

Methods

From January 2011 to January 2016, 101 consecutive TAAAD patients (mean age, 66+/-13; range, 34 to 89 years) undergoing surgical treatment were included. The diagnosis and orifice of the intercostal and lumber arteries were confirmed by preoperative computed tomography (CT). Patients were divided into two groups according to the number of intercostal arteries directly communicating with dissected false lumen at Th10-L2 level (>=6, DFL at Th10-L2 group, n=15; =<5, non-DFL at Th10-L2 group, n=86). Peri- and postoperative findings were compared among groups.

Results

Aortic surgery included replacement of the ascending aorta (n=59), total arch replacement with (n=29) or without (n=13) frozen elephant trunk (FET). Univariate analysis showed that diabetes mellitus, DFL at Th5-9, DFL at Th10-L2, preoperative limb ischemia, frozen elephant trunk technique, false lumen thrombosis at middle of thoracic aorta were predictors of SCI, and multivariate analysis showed DFL at Th10-L2 and diabetes mellitus were independent risk factors of SCI (Odds ratio [OR], 20.4; 95% confidence interval [95%CI], 3.34-124.9; p value = .0011; OR, 22.3; 95%CI,1.69-294.5; p=.0184).

Conclusions

DFL at the Th10-L2 level on preoperative CT may be a risk of SCI, and the operative procedure should be carefully selected.