Intraoperative spinal digital subtraction angiography

Indications, technique, safety, and clinical impact

Emanuele Orru, Danielle E. Sorte, Lydia Gregg, Jean Paul Wolinsky, George Jallo, Ali Bydon, Rafael J Tamargo, Philippe Gailloud

Research output: Contribution to journalArticle

Abstract

Background: Cerebral intraoperative DSA (IODSA) is a well-described, routinely performed procedure that allows the effectiveness of cerebrovascular interventions to be evaluated in the operating room. Spinal IODSA, on the other hand, is infrequently obtained and has received less attention. Objective: To discuss the indications, technique, safety, and clinical impact of spinal IODSA. Materials and methods: Twenty-three patients underwent 45 thoracic and/or lumbar spinal IODSA between 2005 and 2016, either immediately before surgery for lesion localization or after the intervention to evaluate its effectiveness. Indications included 21 vascular malformations and 2 diaphragmatic crus compression syndromes. A long femoral arterial sheath with its hub positioned on the lateral surface of the thigh was used to allow catheter manipulations in the prone position. Results: All targeted intersegmental arteries (ISAs) were successfully catheterized. The course of surgery was changed in 6 instances (26.1%). In 4 cases of epidural or perimedullary arteriovenous fistulae (AVFs), a residual lesion required additional intervention. In one case of epidural AVF, initial IODSA revealed spontaneous resolution of the lesion, preventing unnecessary surgery. Finally, angiography performed in a case of diaphragmatic crus syndrome showed thrombosis of the ISA and non-visualization of the artery of Adamkiewicz. Recanalization was obtained by IA thrombolysis, with excellent clinical outcome. No intraprocedural or postprocedural complication was noted. Conclusions: Spinal IODSA is a safe technique that offers an immediate assessment of the effectiveness of a spinovascular surgical procedure, notably epidural and perimedullary AVFs. Spinal IODSA was technically successful in all cases, influencing the surgical strategy in 6 of 23 patients, including one patient who benefited from intraoperative endovascular therapy.

Original languageEnglish (US)
Pages (from-to)601-606
Number of pages6
JournalJournal of NeuroInterventional Surgery
Volume9
Issue number6
DOIs
StatePublished - Jun 1 2017

Fingerprint

Digital Subtraction Angiography
Arteriovenous Fistula
Arteries
Thigh
Safety
Unnecessary Procedures
Prone Position
Vascular Malformations
Operating Rooms
Angiography
Thrombosis
Thorax
Catheters
Therapeutics

Keywords

  • Angiography
  • Arteriovenous Malformation
  • Fistula
  • Spinal cord
  • Vascular Malformation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Intraoperative spinal digital subtraction angiography : Indications, technique, safety, and clinical impact. / Orru, Emanuele; Sorte, Danielle E.; Gregg, Lydia; Wolinsky, Jean Paul; Jallo, George; Bydon, Ali; Tamargo, Rafael J; Gailloud, Philippe.

In: Journal of NeuroInterventional Surgery, Vol. 9, No. 6, 01.06.2017, p. 601-606.

Research output: Contribution to journalArticle

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abstract = "Background: Cerebral intraoperative DSA (IODSA) is a well-described, routinely performed procedure that allows the effectiveness of cerebrovascular interventions to be evaluated in the operating room. Spinal IODSA, on the other hand, is infrequently obtained and has received less attention. Objective: To discuss the indications, technique, safety, and clinical impact of spinal IODSA. Materials and methods: Twenty-three patients underwent 45 thoracic and/or lumbar spinal IODSA between 2005 and 2016, either immediately before surgery for lesion localization or after the intervention to evaluate its effectiveness. Indications included 21 vascular malformations and 2 diaphragmatic crus compression syndromes. A long femoral arterial sheath with its hub positioned on the lateral surface of the thigh was used to allow catheter manipulations in the prone position. Results: All targeted intersegmental arteries (ISAs) were successfully catheterized. The course of surgery was changed in 6 instances (26.1{\%}). In 4 cases of epidural or perimedullary arteriovenous fistulae (AVFs), a residual lesion required additional intervention. In one case of epidural AVF, initial IODSA revealed spontaneous resolution of the lesion, preventing unnecessary surgery. Finally, angiography performed in a case of diaphragmatic crus syndrome showed thrombosis of the ISA and non-visualization of the artery of Adamkiewicz. Recanalization was obtained by IA thrombolysis, with excellent clinical outcome. No intraprocedural or postprocedural complication was noted. Conclusions: Spinal IODSA is a safe technique that offers an immediate assessment of the effectiveness of a spinovascular surgical procedure, notably epidural and perimedullary AVFs. Spinal IODSA was technically successful in all cases, influencing the surgical strategy in 6 of 23 patients, including one patient who benefited from intraoperative endovascular therapy.",
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T2 - Indications, technique, safety, and clinical impact

AU - Orru, Emanuele

AU - Sorte, Danielle E.

AU - Gregg, Lydia

AU - Wolinsky, Jean Paul

AU - Jallo, George

AU - Bydon, Ali

AU - Tamargo, Rafael J

AU - Gailloud, Philippe

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N2 - Background: Cerebral intraoperative DSA (IODSA) is a well-described, routinely performed procedure that allows the effectiveness of cerebrovascular interventions to be evaluated in the operating room. Spinal IODSA, on the other hand, is infrequently obtained and has received less attention. Objective: To discuss the indications, technique, safety, and clinical impact of spinal IODSA. Materials and methods: Twenty-three patients underwent 45 thoracic and/or lumbar spinal IODSA between 2005 and 2016, either immediately before surgery for lesion localization or after the intervention to evaluate its effectiveness. Indications included 21 vascular malformations and 2 diaphragmatic crus compression syndromes. A long femoral arterial sheath with its hub positioned on the lateral surface of the thigh was used to allow catheter manipulations in the prone position. Results: All targeted intersegmental arteries (ISAs) were successfully catheterized. The course of surgery was changed in 6 instances (26.1%). In 4 cases of epidural or perimedullary arteriovenous fistulae (AVFs), a residual lesion required additional intervention. In one case of epidural AVF, initial IODSA revealed spontaneous resolution of the lesion, preventing unnecessary surgery. Finally, angiography performed in a case of diaphragmatic crus syndrome showed thrombosis of the ISA and non-visualization of the artery of Adamkiewicz. Recanalization was obtained by IA thrombolysis, with excellent clinical outcome. No intraprocedural or postprocedural complication was noted. Conclusions: Spinal IODSA is a safe technique that offers an immediate assessment of the effectiveness of a spinovascular surgical procedure, notably epidural and perimedullary AVFs. Spinal IODSA was technically successful in all cases, influencing the surgical strategy in 6 of 23 patients, including one patient who benefited from intraoperative endovascular therapy.

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KW - Spinal cord

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