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Ann Thorac Surg 2003;78:719
© 2003 The Society of Thoracic Surgeons

Images in cardiothoracic surgery

Three-Dimensional demonstration of the artery of Adamkiewicz by multidetector-row computed tomography

Kunihiro Yoshioka, MDa*, Hiroyuki Niinuma, MDb, Atsushi Ohira, MDb, Tomoko Kawakami, MDb, Kohei Kawazoe, MDc

a Department of Radiology and Iwate Medical University, Iwate, Japan
b Second Department of Internal Medicine, Iwate Medical University, Iwate, Japan
c Department of Cardiovascular Surgery, Memorial Heart Center, Iwate Medical University, Iwate, Japan

* Address reprint requests to Dr Yoshioka, Department of Radiology, Memorial Heart Center, Iwate Medical University; 1-2-1, Tyuoudori, Morioka, Iwate, 020-8505, Japan
e-mail: kyoshi{at}iwate-med.ac.jp

A 72-year-old man with a thoracoabdominal aortic aneurysm (TAAA) was hospitalized and scheduled to undergo surgical repair. Enhanced computed tomography (CT) depicted the TAAA with a maximum diameter of 65 mm. Three-dimensional CT angiography (CTA) was obtained by using a four-row detector CT scanner (Aquilion, Toshiba, Tokyo, Japan) from the seventh thoracic vertebra to the second lumbar vertebra, receiving low osmolarity contrast medium via the antecubital vein. All data were transferred to the workstation (ZIO M900; Ziosoft, Tokyo, Japan) for the multiplanar reconstruction (MPR) and three-dimensional demonstration. An oblique coronal MPR image (Fig 1) shows the artery of Adamkiewicz (AdA) (arrow) and the anterior spinal artery (arrowhead). Figure 2 shows the anterior view of the three-dimensional volume rendering of the CTA with semitransparent skeletal systems that revealed clear anatomy of the AdA (arrow) and the left ninth intercostal artery (arrowhead). Figure 3 shows the posterior view of the three-dimensional volume rendering, without the skeletal system, that also clearly revealed the entire continuity of the aorta, the left ninth intercostal artery (arrowhead), the AdA (arrow), and the anterior spinal artery. The aortic repair with the reconstruction of the left ninth intercostal artery was successful without any paraplegia according to preoperative three-dimensional CTA.



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  		Fig 1.
 


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  		Fig 3.
 
The incidence of spinal cord ischemia may be caused by the duration and severity of ischemia and the failure to establish the AdA that supplies the anterior spinal artery during the reconstruction of the intercostal or lumber arteries with thoracoabdominal aortic repair. Therefore, selective angiography of the intercostal and lumbar arteries was undertaken because of its usefulness for the preoperative anatomical evaluation. But selective angiography is considered to be difficult and hazardous due to the risk of paraplegia in cases with aortic aneurysms. On the other hand, recent innovations in CTA are capable of visualizing, in quite good quality and resolution, imaging of the AdA and its anatomy without any risk of paraplegia during examination. Therefore, this method is safe and satisfactory compared with selective angiography. Thus, a three-dimensional CTA of the AdA will be of great help for the management of thoracoabdominal repair without the risk of paraplegia.




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