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Cochin AP-HP

Adamkiewicz Artery Angiography — Pre-operative Aortic Assessment

Interventional Radiology · Cochin Hospital AP-HP · Paris

️ ri.cch@aphp.fr +33 1 58 41 46 12
IR Home›Adamkiewicz Artery Angiography — Pre-operative Aortic Assessment
🩺 Vascular · Pre-operative

Adamkiewicz Artery Angiography — Paris, Cochin AP-HP

Pre-operative aortic surgery · Femoral access · Local anaesthesia · Teleconsultation required · Day procedure

📖 Why localise the Adamkiewicz artery?

The Adamkiewicz artery (great anterior radiculomedullary artery) is the dominant blood supply to the thoracolumbar spinal cord. During thoraco-abdominal aortic surgery, its accidental sacrifice causes irreversible spinal cord ischaemia — paraplegia. Pre-operative angiographic localisation enables the surgeon to reperfuse or spare the corresponding aortic segment.

The procedure is performed as a day case under local anaesthesia, via right femoral artery puncture. A mandatory teleconsultation with the interventional radiologist is arranged before booking, to verify the indication, review medications, and prescribe blood tests.

🔧 Procedure

1
Teleconsultation (mandatory)

Review of aortic imaging (CT angiography, MRI). Medication adjustment (stop metformin 48h before, anticoagulation bridging). Blood tests prescribed: INR, creatinine, FBC.

2
Day procedure unit admission

Fasting from midnight. IV cannula. ECG monitoring.

3
Local anaesthesia at right groin

Skin and subcutaneous infiltration with lidocaine. Percutaneous femoral artery puncture using Seldinger technique. 5F introducer sheath.

4
Selective intercostal & lumbar artery catheterisation

Sequential catheterisation of intercostal arteries T8–T12 and lumbar arteries L1–L2 bilaterally, under fluoroscopic guidance. Contrast injection — seeking the characteristic "hairpin" loop of the Adamkiewicz artery joining the anterior spinal artery.

5
Duration: 1–3 hours

Variable — depends on how quickly the artery is found. Not identified in 5–15% of cases.

6
4–6h rest and discharge

Manual compression of the femoral puncture. Strict bed rest for 4–6 hours. Pedal pulse check before mobilisation. Accompanied home — driving not permitted on day of procedure.

❓ FAQs

CT angiography and MR angiography can identify the Adamkiewicz artery in 60–80% of cases. Conventional angiography remains the gold standard when non-invasive imaging is inconclusive, or when the surgeon requires absolute certainty with direct visualisation of the anterior spinal artery.
In 5–15% of cases, the Adamkiewicz artery cannot be identified angiographically. This may reflect diffuse collateral supply or a very small calibre vessel. The surgical strategy is adapted accordingly, in discussion with the vascular/cardiac surgical team.
Yes — mandatory. Due to bed rest following femoral arterial puncture and the effects of contrast media, patients must be accompanied home by car or taxi. Driving is not permitted on the day of the procedure.

🔗 Related pages

🇫🇷 This page is also available in French: artere-adamkiewicz.html