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Eur J Cardiothorac Surg 2001;20:527-532
© 2001 Elsevier Science NL

Doppler ultrasonographic identification of the critical segmental artery for spinal cord protection

^a Department of Cardiothoracic Surgery, University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-8655, Japan
^b Department of Public Health and Occupational Medicine, University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-8655, Japan

Received 23 January 2001; received in revised form 15 May 2001; accepted 23 May 2001.

Corresponding author: Tel.: +81-3-5800-8654; fax: +81-3-5684-3989
e-mail: shibata-tho{at}h.u-tokyo.ac.jp

Objective: The purpose of this study is to evaluate the possibility of identifying critical segmental arteries (CSAs) based on Doppler ultrasonographic hemodynamics. Methods: In 18 mongrel dogs, the descending aorta was scanned directly with a 5-MHz linear probe through left thoracotomies and the flow velocities in segmental arteries were measured by pulsed Doppler. The aorta was cross-clamped between Th13 and L1, and flow velocity changes were recorded. According to flow increases, segmental arteries were divided into three groups: arteries with the largest flow increase (L-arteries), arteries with the smallest increase (S-arteries) and other arteries (O-arteries). Animals were divided into three groups. One aortic segment including an L-artery or an S-artery was perfused via a temporary shunt during 30-min aortic cross-clamping distal to the left subclavian artery (Group L or Group S) and neurological outcomes were compared with those of animals without shunting (Group N) after 24 and 48 h. Results: L-arteries had significantly larger flow increases than S- and O-arteries (74.3±33.8, 20.4±9.8 and 33.3±17.8 cm/s, P<0.01). In Group N, five of the six animals were completely paraplegic (Tarlov Grade 0) and the other was Grade 1. In Group S, four animals were Grade 4 and two were Grade 0 after 24 h. However, two animals showed delayed paraplegia. Therefore, four animals were Grade 0 and two were Grade 4 after 48 h. All animals in Group L were neurologically normal (Grade 4) at both after 24 h (vs. Group N, P=0.0013) and 48 h (vs. Group N, P=0.0013; vs. Group S, P=0.019). Conclusions: Flow responses to aortic cross-clamping differed among segmental arteries and selective perfusion of L-arteries completely prevented paraplegia. Therefore, L-arteries were considered to be CSAs. Hemodynamic measurement of segmental arterial flow using Doppler ultrasonography could be clinically useful for spinal cord protection during thoracoabdominal aortic surgery.

Key Words: Doppler ultrasonography • Aortic aneurysm • Paraplegia