The Artery of Adamkiewicz: Vascular Anatomy, Clinical Significance and Surgical Considerations

The artery of Adamkiewicz is the only major arterial supply feeding the anterior spinal artery along the lower thoracic, lumbar and sacral spinal cord. This vessel is clinically significant as injury to this vital artery can occur during a variety of procedures, most notably descending/thoracoabdominal aortic repairs. Injury to this artery can cause consequential neurologic damage manifesting as anterior spinal cord syndrome. New research on this topic has supported preoperative identification of the artery of Adamkiewicz prior to thoracic surgery as a means to protect the spinal cord. Numerous radiological imaging techniques, such as digital subtraction angiography, magnetic resonance angiography, and three dimensional reconstruction using computer tomography angiography, have been implemented to localize this vessel prior to surgery, each with their own strengths and weaknesses. Here, we review the variable vascular anatomy supplying the spinal cord, clinical significance of the artery of Adamkiewicz, as well as examine the various radiological imaging techniques currently used to visualize this vessel prior to surgery.