The artery of Adamkiewicz (arteria radicularis magna, great anterior radiculomedullary artery) is the largest anterior radicular artery, providing the dominant blood supply to the lower two-thirds of the spinal cord via the anterior spinal artery. It typically arises from the left intercostal or lumbar arteries between T8 and L2 in approximately 75% of individuals, though its level and side are highly variable. It is identified by its characteristic hairpin turn as it ascends to join the anterior spinal artery.
The artery of Adamkiewicz is the most critical vessel for spinal cord perfusion and is the prime concern during thoracoabdominal aortic aneurysm repair and correction of thoracic scoliosis. Inadvertent ligation during intercostal vessel reimplantation or left thoracotomy causes ischaemia of the lower spinal cord with paraplegia. Preoperative CT angiography identifies its origin level in 90% of cases, allowing preservation strategies in aortic surgery. Intraoperative neuromonitoring with somatosensory and motor evoked potentials detects impending cord ischaemia.
Sacrifice of intercostal arteries including the artery of Adamkiewicz during thoracoabdominal aortic aneurysm repair causes ischaemia of the lower spinal cord, producing delayed or immediate paraplegia managed by CSF drainage, mean arterial pressure augmentation, and reimplantation of critical intercostal vessels.
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