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Eur J Cardiothorac Surg 2007;32:187. doi:10.1016/j.ejcts.2007.03.028
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Letters to the Editor

Reply to Hudorovic

^a Department of Radiology, Saga Medical School, 5-1-1 Nabeshima, Saga 849-8501, Japan
^b Department of Thoracic and Cardiovascular Surgery, Saga Medical School, 5-1-1 Nabeshima, Saga 849-8501, Japan

Received 14 March 2007; accepted 19 March 2007.

^_* Corresponding author. Tel.: +81 952 34 2309; fax: +81 952 34 2016. (Email: nojirij{at}cc.saga-u.ac.jp).

Key Words: Adamkiewicz artery • Computed tomographic angiography (CTA) • CTA with intra-arterial contrast injection (IA-CTA)

We thank Dr Hudorovic [1] for the interest in our work [2] and for the comments.

Regrettably, there are two points of misunderstanding in his comments. We did not state that the incidence of complications by general selective angiography (GSA) is much lower than CT angiography with intra-arterial contrast injection (IA-CTA). It is quite opposite. We perform IA-CTA using a pig-tail catheter placed in the aorta. So it is obviously much safer than selective catheterization of the arterial branches. Another point is that we do not apply IA-CTA to all the patients with aortic aneurysms or dissections. We do IA-CTA only when an elective graft surgery is scheduled and the surgeons want to know the exact location of the Adamkiewicz artery to avoid spinal complications. We understand that the spinal cord injury (SCI) rate may be lower in patients treated by endovascular approach, and demonstration of the Adamkiewicz artery may not be required for endovascular treatment.

As shown in our work, we can get much higher concentration of the contrast material in IA-CTA compared with CT angiography with intravenous contrast injection (IV-CTA), which will help to depict small vessels more clearly. A system of combined digital subtraction angiography (DSA) and multi-detector-row CT (AXIOM Artis dTA: Siemens-Asahi Medical Technologies Ltd, Tokyo) is now commercially available and we introduced one to our hospital. We make good use of it in various intra-arterial procedures. Without this system, you can place a catheter in the aorta under portable DSA guide as we reported, or you can place the catheter under fluoroscopic guide and transfer the patient to the CT (preferably, multi-detector row helical CT) room to perform IA-CTA.

Concerning the cost, IA-CTA must be more expensive compared with IV-CTA or compared with DSA alone. We understand there are many different policies in medical economics according to the physicians, the institutions, or the countries. But, we believe as long as surgeons want to know the exact location of the Adamkiewicz artery, an examination with highly diagnostic accuracy and low risk is recommendable.

References

1. Hudorovic N. Detecting the Adamkiewicz artery: is it really necessary in every-day practice?. Eur J Cardiothorac Surg 2007;32:186-187.[Free Full Text]
2. Nojiri J, Matsumoto K, Kato A, Takahiro M, Furukawa K, Ohtsubo S, Itoh T, Kudo S. The Adamkiewicz artery: demonstration by intra-arterial computed tomographic angiography. Eur J Cardiothorac Surg 2007;31:249-255.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tsuyoshi Itoh Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nojiri, J. Articles by Kudo, S. Search for Related Content PubMed Articles by Nojiri, J. Articles by Kudo, S. Related Collections Great vessels