Collateral Network Concept in 2023

Authors

Suguru Ohira, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Steven L. Lansman, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
David Spielvogel, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.

Author Type(s)

Faculty

DOI

10.21037/acs-2023-scp-15

Journal Title

Annals of Cardiothoracic Surgery

First Page

450

Last Page

462

Document Type

Article

Publication Date

9-28-2023

Department

Surgery

Abstract

Extensive thoracoabdominal aortic aneurysm repair can cause spinal cord ischemia which significantly impacts survival and quality of life. Although this complication is uncommon, it is important to recognize the pathophysiology and preventative measures. In the 1990s, Dr. Griepp and colleagues proposed the existence of an extensive collateral network that supports spinal cord perfusion, "the collateral network concept". This includes an interconnecting complex of vessels in the intraspinal, paraspinous, and epidural spaces, and in the paravertebral muscles, involving the intercostal and lumbar segmental arteries as well as the subclavian and hypogastric (iliac) arteries. In this concept, as opposed to the one major segmental input model such as the Adamkiewicz artery, recognition of the importance of multiple inputs to the spinal circulation is paramount to maintaining the spinal blood flow and preventing spinal cord ischemia. In this article, we review the current evidence of the collateral concept and its application in aortic surgery.

Recommended Citation

Ohira, S., Lansman, S. L., & Spielvogel, D. (2023). Collateral Network Concept in 2023. Annals of Cardiothoracic Surgery, 12 (5), 450-462. https://doi.org/10.21037/acs-2023-scp-15