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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2003 October;44(5):637-45

lingua: Inglese

Blood distribution to the anterior spinal artery from each segment of intercostal and lumbar arteries

Uezu T., Koja K., Kuniyoshi Y., Miyagi K., Shimoji M., Arakaki K., Yamashiro S., Mabuni K., Senaha S.

Second Depart­ment of Sur­gery Faculty of Med­i­cine Uni­ver­sity of the ­Ryukyus, Oki­nawa, ­Japan


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Aim. Pre­ven­tion of par­a­plegia, a ­serious com­pli­ca­tion of sur­gery for thor­a­coab­dom­inal ­aortic aneu­rysm, has ­been ­well doc­u­mented. How­ever no ­assured pro­phy­laxis ­against ­this com­pli­ca­tion has yet ­been ­found. ­Spinal ­ischemia is ­believed to be the ­major ­cause of par­a­plegia. We con­ducted an experi­mental ­study to ­define the devel­op­ment of par­a­plegia ­with ­regard to the ­blood ­supply to the ­spinal ­cord.
­Methods. A por­cine ­model was ­used to eval­uate ­blood dis­tri­bu­tion to the ante­rior ­spinal ­artery. Col­ored ­silastic ­agent was selec­tively ­injected ­into the inter­costal and ­lumbar ­arteries, and dis­tri­bu­tion to the ante­rior ­spinal ­artery was eval­u­ated on 50 ani­mals. The inter­costal and ­lumbar ­arteries ­were ­ligated in the seg­ments ­where the ­blood ­supply to the ante­rior ­spinal ­artery ­would be inter­rupted. ­Whether or not par­a­plegia devel­oped was ­checked 2 ­days ­later.
­Results. Col­ored ­silastic ­agent ­arrived at the ante­rior ­spinal ­artery ­from all seg­ments of the 8th inter­costal to 4th ­lumbar ­arteries. Two of 9 ­pigs (22.2%) ­that under­went liga­tion of the seg­ments ­from the 9th inter­costal to 2nd ­lumbar ­artery suf­fered par­a­plegia. In 3 non-para­plegic ­pigs, col­ored ­silastic ­agent ­injected ­into the pre­served ­arteries was ­found to ­have cov­ered a ­wider ­range.
Con­clu­sion. All the inter­costal and ­lumbar ­arteries sup­plied ­blood to the ante­rior ­spinal ­artery. ­When ­large seg­ments of inter­costal and ­lumbar ­arteries ­were ­ligated, the ­blood ­flow ­from the pre­served seg­ments ­acquired ­increased dom­i­nance. The pos­sibility ­exists ­that any inter­costal and ­lumbar ­artery can ­supply ­blood to the ­spinal ­cord and ­become col­lat­eral cir­cu­la­tion to the ante­rior ­spinal ­artery.

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