Intercostal artery embolization and the risk of spinal cord ischemia: Importance of identifying the Adamkiewicz artery-A report of two cases.

Intercostal artery embolization is a useful and minimally invasive procedure for traumatic hemothorax. However, the presence of the Adamkiewicz artery (AKA), which may originate from the intercostal artery, represents a critical risk factor for spinal cord ischemia during intercostal artery embolization. Here, we report two cases of traumatic hemothorax caused by intercostal artery injury that were successfully treated with transcatheter arterial embolization. The AKA was angiographically identified during the procedure in Case 1, whereas it was not recognized in Case 2, as it was located at the edge of the irradiation field. Despite this, embolization was successfully performed without non-target embolization of the AKA, and hemostasis was achieved without neurological complications. The identification of the AKA is crucial because inadvertent embolization may lead to serious spinal cord ischemia. Our cases emphasize the importance of evaluating the AKA during intercostal artery embolization.