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The spinal cord receives its vascular supply from 3 main arteries. The anterior spinal artery supplies the anterior 2/3, while the 2 posterolateral spinal arteries supply the posterior 3rd.[1] The anterior spinal artery originates from the 2 vertebral arteries at the level of the foramen magnum. Anterior segmental medullary vessels from the aorta provide additional supply, with the largest being the artery of Adamkiewicz, also known as the arteria radicularis magna or the great anterior radiculomedullary artery (see Image. Artery of Adamkiewicz). The artery of Adamkiewicz serves as the primary arterial supply to the anterior spinal artery along the lower thoracic, lumbar, and sacral segments of the spinal cord. Injury to this artery can cause neurologic deficits, including fecal and urinary incontinence and impaired motor function, while sensory function is typically preserved (see Image. Spinal Cord Fasciculi).[2] Identifying the location of this blood vessel preoperatively is essential in thoracoabdominal aortic surgery to minimize the risk of ischemic spinal cord injury. Understanding this artery's anatomy and function is essential for preventing ischemic spinal cord injury during surgical procedures, particularly thoracoabdominal aortic repair.