Intentional preservation of collateral circulation to the artery of Adamkiewicz using axillo-axillary bypass, concomitant with thoracic endovascular aneurysm repair.

Figure 1: The left anterior lateral view of a volume-rendering image with semitransparent skeletal system shows that the left seventh intercostal artery (ICA 7), which is the origin of the artery of Adamkiewicz (arrowed), is occluded proximal to the aorta. This image also shows collateral circulation from the left internal thoracic artery (ITA) and muscular branch of the left ninth intercostal artery (ICA 9) to ICA 7. Figure 2: The left anterior lateral view of a volume-rendering image after the endovascular aneurysm repair shows full continuity from the ITA to the artery of Adamkiewicz (arrowed) via axillo-axillary bypass. Because of the coverage of ICA 9 by the stent graft and the left subclavian artery, axillo-axillary bypass was intentionally performed to preserve collateral circulation. In this case, we performed an axillo-axillary bypass instead of a direct left axillary-left carotid artery bypass or direct anastomosis, owing to concerns over the risk of cerebrovascular events.