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Artery of Adamkiewicz Ischaemia — FRCA Final MCQ

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HardCardiothoracic AnaesthesiaArtery of Adamkiewicz IschaemiaFRCA Final

A 65-year-old man undergoes elective AAA repair. The surgeon ligates the inferior mesenteric artery. Post-operatively the patient develops lower limb weakness. MRI shows spinal cord infarction at T12. Which artery's territory has been compromised?

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Correct answer: D — Artery of Adamkiewicz

The artery of Adamkiewicz (arteria radicularis magna) is the largest segmental artery reinforcing the anterior spinal artery. It typically arises from the left side between T8 and L2 (most commonly T9-T12). During aortic surgery, this artery can be inadvertently ligated or its perfusion compromised, causing anterior spinal cord ischaemia. This presents with motor weakness (anterior horn cells), loss of pain and temperature sensation (spinothalamic tracts), and autonomic dysfunction – but preserved proprioception (dorsal columns supplied by posterior spinal arteries).

Reference: RCOA – 2023 – Vascular anaesthesia module; NICE – 2020 – AAA management