The Role of Diagnostic Spinal Angiography for Thoracoabdominal Aortic Aneurysms: A Clinical Case Series in Patients Undergoing Staged Complex Endovascular Repairs

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BACKGROUND AND OBJECTIVES: Spinal cord ischemia affects up to 40% of patients undergoing repair of complex thoracoabdominal aortic aneurysms (TAAAs). Preoperative identification of key segmental spinal artery contributors may guide the design of custom fenestrated graft constructs or extra-anatomic bypass. Despite the high resolution provided by diagnostic spinal angiography, it is infrequently performed. We describe the safety, feasibility, diagnostic, and treatment outcomes for a case series of spinal angiography performed before complex endovascular TAAA repair. METHODS: We retrospectively analyzed data from patients who underwent preoperative spinal angiography before endovascular repair of their aortic aneurysms between July 2022 and December 2023. All patients had previously undergone either open and/or endovascular treatment of their aortic aneurysms. RESULTS: Nine patients (mean age 64.7 ± 9.9 years) underwent spinal angiography before endovascular repair of their TAAA. The anterior spinal artery was identified in 4 (44%) cases and the posterior spinal artery in one (11%) patient. There were no complications attributed to the angiograms. Eight (89%) patients underwent subsequent endovascular aortic repair with one segmental artery (right T11) successfully incorporated into the stent construct. Two (20%) patients had unfavorable branch angles/stenosis at the segmental artery origin for stenting. One (11%) patient had symptomatic postoperative spinal ischemia. CONCLUSION: Diagnostic spinal angiography can safely help identify spinal arterial contributors in complex TAAA patients who have undergone previous aortic intervention. Given improvements in fenestrated endovascular technology and extra-anatomic bypass, there are burgeoning tools to prioritize the preservation of blood flow to the spinal cord in preoperative planning.

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