Maria Lucia Madariaga, MD, Lawrence F. Borges, MD, James D

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Presentation transcript:

Angiography Before Posterior Mediastinal Tumor Resection: Selection Criteria and Patient Outcomes Maria Lucia Madariaga, MD, Lawrence F. Borges, MD, James D. Rabinov, MD, David C. Chang, PhD, Michael Lanuti, MD, Douglas J. Mathisen, MD, Henning A. Gaissert, MD The Annals of Thoracic Surgery Volume 105, Issue 4, Pages 1000-1007 (April 2018) DOI: 10.1016/j.athoracsur.2017.12.028 Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Evaluation tree for preoperative angiography in patients with posterior mediastinal tumors. (CT = computed tomography; MRI = magnetic resonance imaging.) The Annals of Thoracic Surgery 2018 105, 1000-1007DOI: (10.1016/j.athoracsur.2017.12.028) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Embolization of thoracic schwannoma. (A) Coronal computed tomography angiogram shows right T3, T4, and T5 branches are encased in a paravertebral schwannoma (patient 7). (B) Unsubtracted angiogram of the T5 segmental artery shows multiple, large tumor vessels. (C) Unsubtracted angiogram of the T5 segmental artery after embolization with polyvinyl alcohol and embolic coils shows vascular occlusion. The Annals of Thoracic Surgery 2018 105, 1000-1007DOI: (10.1016/j.athoracsur.2017.12.028) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Schwannoma sharing blood supply with the spinal cord. (A) Axial and (B) coronal magnetic resonance images, T1 weighted sequences with gadolinium, show enhancement of a 6-cm schwannoma (patient 10). The lesion encases the left T3 to T4 segmental artery. Note is made of a large vein encased at the margin of the tumor that drains into an enlarged accessory hemiazygous vein. (C) Left T3 to T4 segmental artery angiogram demonstrates vascular supply to the left thoracic tumor. The lesion was not embolized because of shared supply to the anterior (white arrow) and posterior (black arrow) spinal artery branches. The Annals of Thoracic Surgery 2018 105, 1000-1007DOI: (10.1016/j.athoracsur.2017.12.028) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Increasing use of angiography in candidates for posterior mediastinal tumor resection over time (2002 to 2016): patients who did not undergo preoperative angiography (n = 77, black diamonds), patients who underwent preoperative angiography, followed by tumor resection (n = 9, white diamonds), and 1 patient who underwent preoperative angiography that demonstrated contraindications to tumor resection (grey circle). The Annals of Thoracic Surgery 2018 105, 1000-1007DOI: (10.1016/j.athoracsur.2017.12.028) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions