The Importance of Subclavian and Hypogastric Arteries of Onset and Recovery of Spinal Cord Injury (Research Study)

Valeriy Arakelyan , Alexsandr Gorogkov, Vasiliy Papitashvili, Vladislav Khon, Yurii Tcygankov , Andrey Agafonov , Shota Zhorzholiani , Nikita Gidaspov, Roman Bukatsello, Inna Chshieva

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

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

Abstract

Objective.Surgical treatment for aneurysms of the thoracoabdominal aorta is always accompanied by a high risk of spinal cord injury(SCI). When the direct blood supply from the segmental arteries is closed, the collateral network of the subclavian and hypogastric arteries acquires great importance.

Materials and methods. In the experimental department of A.N. Bakoulev Scientific Center for Cardiovascular Surgery, 32 intact adult rabbits were operated. The first stage is the clipping of the intercostal arteries (group 1), in the second group clipping of the lumbar arteries, in the third group - one-stage clipping of all segmental arteries. The second stage of the endovascular method with the help a balloon (4-5F) alternately covered the blood flow in the left subclavian artery(LSA), then in the hypogastric arteries, and in the third stage simultaneously in the LSA and hypogastric arteries. At each stage, the motor evoked potentials (MEP) on the lower extremities were assessed in transcortical stimulation, the duration of ischemia and after balloon deflated in each group was 30 minutes.

Results. With isolated closed of the blood flow in the left subclavian or hypogastric arteries, the amplitude of the MEP decreased on average by no more than 20% when measured for 30 minutes in all groups. The one-stage closed blood flow of the LSA and the hypogastric artery significantly decresed MEP(reduced by 84%) and recover( by 45% compared with baseline amplitude) in the group with clipping intercostalis and lumbar arteries.

Conclusions. A main role in the prevention of SCI is not only the critical segmental artery, but also the collateral network of subclavian and hypogastric arteries. With a shortage of blood flow through the segmental arteries, the left subclavian and hypogastric arteries are an alternative source of blood supply to the spinal cord.