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The artery of Adamkiewicz, Aorta, Aneurysm, Computed tomography
A 58-year old woman with Marfan syndrome and a suprarenal abdominal aortic aneurysm was hospitalized to undergo operation. She had a history of descending aortic and infrarenal abdominal aortic repair. Computed tomography angiography clearly demonstrated the artery of Adamkiewicz and its collateral circulation via the left inferior epigastric artery (Figs 1 and 2).
The anterior view of volume-rendering image with semitransparent skeletal system, aorta and kidney shows that the left ICA 9, which is the origin of the artery of Adamkiewicz (arrow), is occluded proximally at the aorta. This image also shows collateral circulation to the artery of Adamkiewicz via the left inferior epigastric artery (IEA), the left 10th ICA and the muscular branch (arrowhead) between the left ICA 9 and the left ICA 10. Intentional preservation of the collateral circulation is planned by a median laparotomy with abdominal aortic graft replacement with careful wound retraction and cannulation from the left femoral artery for cardiopulmonary circulation. T9: 9th thoracic vertebra; ICA 10: 10th intercostal artery.
Figure 1:

The anterior view of volume-rendering image with semitransparent skeletal system, aorta and kidney shows that the left ICA 9, which is the origin of the artery of Adamkiewicz (arrow), is occluded proximally at the aorta. This image also shows collateral circulation to the artery of Adamkiewicz via the left inferior epigastric artery (IEA), the left 10th ICA and the muscular branch (arrowhead) between the left ICA 9 and the left ICA 10. Intentional preservation of the collateral circulation is planned by a median laparotomy with abdominal aortic graft replacement with careful wound retraction and cannulation from the left femoral artery for cardiopulmonary circulation. T9: 9th thoracic vertebra; ICA 10: 10th intercostal artery.

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A curved planar reformatted image shows full continuity from the left inferior epigastric artery (IEA) to the artery of Adamkiewicz (arrow) via the left 10th intercostal artery (ICA10).
Figure 2:

A curved planar reformatted image shows full continuity from the left inferior epigastric artery (IEA) to the artery of Adamkiewicz (arrow) via the left 10th intercostal artery (ICA10).

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Funding

This work was supported by Japan Society for the Promotion of Science (JSPS KAKENHI, Grant number 26461803).

Conflict of interest: none declared.

© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Images in cardio-thoracic surgery
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