LAUSR

Computed tomography (CT) of a 75-year-old woman with hypertension revealed thoracic and abdominal aortic aneurysms (Figures 1 and 2). The patient underwent thoracic endovascular aortic repair between the T4 and T10 levels at one month prior to surgery for abdominal aortic aneurysm (Figure 3(a)). On CT, the artery of Adamkiewicz was detected left of the second lumbar artery (Figure 3(a) and (b)). The artery of Adamkiewicz was difficult to reconstruct because this artery originated from the posterior wall of the aneurysm and its ostium was very thin and athelosclerotic. The artery was ligated intraoperatively; no spinal cord ischemia was observed after surgery. At one week later, one of the collateral networks was functioning as the new artery of Adamkiewicz (i.e. new original source of the artery of Adamkiewicz; Figure 3(c)). The patient was doing well at six postoperative months. This case very clearly supports the assumption of the role of the major artery of Adamkiewicz by the collateral network.