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J Thorac Cardiovasc Surg 1999;118:17-25
© 1999 Mosby, Inc.

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

PRESERVATION OF INTERCOSTAL ARTERIES DURING THORACOABDOMINAL AORTIC ANEURYSM SURGERY: A RETROSPECTIVE STUDY

From the Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia Health Sciences Center, Charlottesville, Va.

Read at the Twenty-fourth Annual Meeting of The Western Thoracic Surgical Association, Whistler, British Columbia, June 24-27, 1998.

Address for reprints: Curtis G. Tribble, MD, Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Box 3111, MR4 Building, University of Virginia Health Sciences Center, Charlottesville, VA 22908.

Objective: The purpose of this article was to examine the influence of reimplantation of patent intercostal and lumbar arteries on the incidence of postoperative paraplegia/paraparesis in patients undergoing clamp-and-sew surgical repair of thoracoabdominal aortic aneurysms.
Methods: Data from January 1987 through December 1997 were retrospectively collected on 132 patients. Ninety-one patients in group I underwent aneurysm repairs before January 1995 and did not undergo intercostal artery reimplantation. Group II included the more recent 41 patients who had vessels between the eighth thoracic intercostal and the second lumbar arteries reimplanted to the graft or preserved at the aortic anastomoses.
Results: The operative mortality rate was 13.2% (12/91) in group I and 4.9% (2/41) in group II (P = .22). The incidence of postoperative paraplegia was significantly lower in the more recent cohort of patients (8.8% [8/91] in group I vs 0% [0/41] in group II, P = .05). The overall rate of spinal cord dysfunction was lowered from 9.9% (9/91) in group I to 2.4% (1/41) in group II (P = .17). However, a multivariable logistic regression analysis identified only aneurysm extent (Crawford type I and type II) as a predictor of less postoperative spinal cord injury (P = .08). The average aortic crossclamp time in group I was 30.3 ± 11.5 (SD) minutes, and the time of aortic occlusion in group II was not significantly prolonged, with an average crossclamp time of 31.0 ± 21.0 (SD) minutes (P = .88).
Conclusions: An aggressive approach to maintain intercostal artery patency during clamp-and-sew repair of thoracoabdominal aortic aneurysms may effectively lower the incidence of spinal cord injury without prolonging aortic crossclamp time.

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