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Conflict of interest: none declared. Figure 1: The anterior view of volume-rendering image with semitransparent skeletal system, aorta and kidney shows that the left ICA 9, which is the origin of the artery of Adamkiewicz (arrow), is occluded proximally at the aorta. This image also shows collateral circulation to the artery of Adamkiewicz via the left inferior epigastric artery (IEA), the left 10th ICA and the muscular branch (arrowhead) between the left ICA 9 and the left ICA 10. Intentional preservation of the collateral circulation is planned by a median laparotomy with abdominal aortic graft replacement with careful wound retraction and cannulation from the left femoral artery for cardiopulmonary circulation. T9: 9th thoracic vertebra; ICA 10: 10th intercostal artery. Figure 2: A curved planar reformatted image shows full continuity from the left inferior epigastric artery (IEA) to the artery of Adamkiewicz (arrow) via the left 10th intercostal artery (ICA10).

european journal of cardio-thoracic surgery

Three-dimensional demonstration of the collateral circulation to the artery of Adamkiewicz via inferior epigastric artery with computed tomography angiography