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ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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vol. 13
Case report

Ischaemia of the medullary cone after stent-graft implantation in a patient with abdominal aortic aneurysm – a case study

Mariusz Wachowski, Michał Polguj, Janusz Ścibór, Agata Majos

Videosurgery Miniinv 2018; 13 (1): 116–121
Online publish date: 2017/09/26
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Preoperative visualization of the Adamkiewicz artery – the vessel which is to a great extent responsible for supplying blood to the medullary cone – is an important step which must be taken before initiating restorative procedures in the aorta. We present a case of a 67-year-old patient who underwent an intravascular stent-graft implantation procedure, due to clinical signs of abdominal aortic aneurysm. Routine pre-operative computed tomography examination failed to demonstrate the Adamkiewicz artery. On the second day after the surgery, as a result of unexpected clinical deterioration, an magnetic resonance imaging examination of the lumbar spine was carried out. Based on the magnetic resonance imaging images and clinical manifestations the diagnosis of ischaemia of the medullary cone was made. In our work we also present a deep analysis of the anatomy of small-sized vessels supplying blood to the spinal cord and discuss effective techniques which enable visualization of the Adamkiewicz artery.

aortic aneurysm, Adamkiewicz artery, spinal cord vascularization, medullary cone

Vargas MI, Gariani J, Sztajzel R, et al. Spinal cord ischemia: practical imaging tips, pearls, and pitfalls. AJNR Am J Neuroradiol 2015; 36: 825-30.
Wong JJ, Dufton J, Mior SA. Spontaneous conus medullaris infarction in a 79 year-old female with cardiovascular risk factors: a case report. J Can Chiropr Assoc 2012; 56: 58-65.
Synowiec T, Warot M, Burchardt M, et al. All dangerous types of endoleaks after endovascular aneurysm repair in a single patient. Videosurgery Miniinv 2015; 10: 290-4.
Wojtaszek M, Wnuk E, Maciag R, et al. Improving the results of transarterial embolization of type 2 endoleaks with the embolic polymer Onyx. Videosurgery Miniinv 2016; 11: 259-67.
Melissano G, Civilini E, Bertoglio L, et al. Angio-CT imaging of the spinal cord vascularisation: a pictorial essay. Eur J Vasc Endovasc Surg 2010; 39: 436-40.
Andrews BT, Kwei U, Greco C, et al. Infarct of the conus medullaris simulating a spinal cord tumor: case report. Surg Neurol 1991; 35: 139-42.
Yoshioka K, Niinuma H, Ohira A, et al. MR angiography and CT angiography of the artery of Adamkiewicz: noninvasive preoperative assessment of thoracoabdominal aortic aneurysm. Radiographics 2003; 23: 1215-25.
Koshino T, Murakami G, Morishita K, et al. Does the Adamkiewicz artery originate from the larger segmental arteries? J Thorac Cardiovasc Surg 1999; 117: 898-905.
Milen MT, Bloom DA, Culligan J, et al. Albert Adamkiewicz (1850-1921): his artery and its significance for the retroperitoneal surgeon. World J Urol 1999; 17: 168-70.
Boll DT, Bulow H, Blackham KA, et al. MDCT angiography of the spinal vasculature and the artery of Adamkiewicz. AJR Am J Roentgenol 2006; 187: 1054-60.
Melissano G, Bertoglio L, Civelli V, et al. Demonstration of the Adamkiewicz artery by multidetector computed tomography angiography analysed with the open-source software OsiriX. Eur J Vasc Endovasc Surg 2009; 37: 395-400.
Takase K, Sawamura Y, Igarashi K, et al. Demonstration of the artery of Adamkiewicz at multi-detector row helical CT. Radiology 2002; 223: 39-45.
Nijenhuis RJ, Mull M, Wilmink JT, et al. MR angiography of the great anterior radiculomedullary artery (Adamkiewicz artery) validated by digital subtraction angiography. AJNR Am J Neuroradiol 2006; 27: 1565-72.
Nojiri J, Matsumoto K, Kato A, et al. The Adamkiewicz artery: demonstration by intra-arterial computed tomographic angiography. Eur J Cardiothorac Surg 2007; 31: 249-55.
Williams GM, Perler BA, Burdick JF, et al. Angiographic localization of spinal cord blood supply and its relationship to postoperative paraplegia. Vasc Surg 1991; 13: 23-33.
Uotani K, Yamada N, Kono AK, et al. Preoperative visualization of the artery of Adamkiewicz by intra-arterial CT angiography. AJNR Am J Neuroradiol 2008; 29: 314-8.
Amako M, Yamamoto Y, Nakamura K, et al. Preoperative visualization of the artery of Adamkiewicz by dual-phase CT angiography in patients with aortic aneurysm. Kurume Med J 2011; 58: 117-25.
Bley TA, Duffek CC, François CJ, et al. Presurgical localization of the artery of Adamkiewicz with time-resolved 3.0-T MR angiography. Radiology 2010; 255: 873-81.
Takagi H, Ota H, Natsuaki Y, et al. Identifying the Adamkiewicz artery using 3-T time-resolved magnetic resonance angiography: its role in addition to multidetector computed tomography angiography. Jpn J Radiol 2015; 33: 749-56.
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