Lumbar Artery Branch in Treatment of Thoracoabdominal Aortic Aneurysm to Prevent Spinal Cord Ischemia

Preservation of collateral pathways is understood to be critical in prevention of SCI, although the precise branches necessary are not clear. Lumbar fenestration and hypogastric preservation to reduce risk of SCI is a feasible and valid technique that should be considered when anatomy allows.Clinical ImpactThis case validates the efficacy and safety of using a physician-modified iliac limb to salvage an L5 lumbar artery after endovascular exclusion of a symptomatic extent III thoracoabdominal aortic aneurysm (TAAA). This interventional approach allows for the maintenance of perfusion to the spine and preservation of potentially hemodynamically significant collateral pathways. Our results suggest that this technique to mitigate the risk of spinal cord ischemia is safe and effective and thus may be considered for appropriately-selected cases.