Artery of Adamkiewicz

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Artery of Adamkiewicz
Artery of Adamkiewicz CT scan OsiriX.jpg
Coronal slab volume rendering image of CT aortography shows artery of Adamkiewicz entering spinal canal(arrowheads) and joining the anterior spinal artery (arrows) after a hairpin turn.
Details
Source Abdominal aorta, posterior intercostal artery
Branches Anterior dspinal artery [1]
Supplies Lumbar enlargement of lower spinal cord [2]
Identifiers
Latin rami spinales arteriae vertebralis
TA2 4536
Anatomical terminology

In human anatomy, the artery of Adamkiewicz (also arteria radicularis magna) is the largest anterior segmental medullary artery and the dominant segmental feeding vessel to the thoracic cord, supplying the anterior aspect of the cord via the anterior spinal artery. [3] It is a radiculomedullary artery arising from the spinal dorsal branch of the segmental artery (posterior intercostal, subcostal, or lumbar artery), which in turn arises from the descending aorta. [4] It typically arises from a 9th to 12th left posterior intercostal artery, [5] enters through the L2-L3 intervertebral foramen to join the anterior spinal artery and supply much of the inferior half of the spinal cord. [6] The artery is named after pathologist Albert Wojciech Adamkiewicz.

Contents

Nomenclature

The artery is generally eponymic, but it has several other names, including:

Anatomy

The artery has a characteristic "hairpin" turn on the cord surface as it first courses superiorly, then turns inferiorly. In 75% of people, it originates on the left side of the aorta between the T8 and L1 vertebral segments. [11] In addition to being able to be either right or left-sided, the vessel can arise from a lumbar artery instead of from the aorta. [5]

In an extensive literature review, recognition of the AKA using CT and/or MR was achieved in 466 of 555 cases (83.96%) and in 384 (83.3%) cases the AKA originated from a left intercostal artery. [12]

Clinical significance

The artery provides blood supply to the front two-thirds of the lumbar and sacral cord. [13] When damaged or obstructed, it can result in a syndrome of spinal cord ischemia, similar to anterior spinal artery syndrome, [14] with loss of urinary and fecal continence and impaired motor function of the legs; sensory function is often preserved to a degree.

It is important to identify the location of the artery when surgically treating an aortic aneurysm to prevent damage which would result in a loss of blood supply to the spinal cord. [15]

In bronchial artery embolization for treatment of massive lung bleeding, one of the most serious complications is to lose blood flow to the spinal cord caused by accidental closure of the artery of Adamkiewicz. [16] Its location can be identified with computed tomographic angiography. [17]

History

It is named for Albert Wojciech Adamkiewicz. [18] [19] [20]

Related Research Articles

<span class="mw-page-title-main">Interventional radiology</span> Medical subspecialty

Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs both diagnostic and therapeutic procedures through very small incisions or body orifices. Diagnostic IR procedures are those intended to help make a diagnosis or guide further medical treatment, and include image-guided biopsy of a tumor or injection of an imaging contrast agent into a hollow structure, such as a blood vessel or a duct. By contrast, therapeutic IR procedures provide direct treatment—they include catheter-based medicine delivery, medical device placement, and angioplasty of narrowed structures.

<span class="mw-page-title-main">Vascular surgery</span> Medical specialty of the blood/lymph vessels

Vascular surgery is a surgical subspecialty in which vascular diseases involving the arteries, veins, or lymphatic vessels, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialty evolved from general and cardiovascular surgery where it refined the management of just the vessels, no longer treating the heart or other organs. Modern vascular surgery includes open surgery techniques, endovascular techniques and medical management of vascular diseases - unlike the parent specialities. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system excluding the coronaries and intracranial vasculature. Vascular surgeons also are called to assist other physicians to carry out surgery near vessels, or to salvage vascular injuries that include hemorrhage control, dissection, occlusion or simply for safe exposure of vascular structures.

<span class="mw-page-title-main">Aortic aneurysm</span> Excessive enlargement of the human aorta

An aortic aneurysm is an enlargement (dilatation) of the aorta to greater than 1.5 times normal size. Typically, there are no symptoms except when the aneurysm dissects or ruptures, which causes sudden, severe pain in the abdomen and lower back.

<span class="mw-page-title-main">Thoracic aortic aneurysm</span> Medical condition

A thoracic aortic aneurysm is an aortic aneurysm that presents primarily in the thorax.

<span class="mw-page-title-main">Abdominal aorta</span> Largest artery in the abdomen

In human anatomy, the abdominal aorta is the largest artery in the abdominal cavity. As part of the aorta, it is a direct continuation of the descending aorta.

<span class="mw-page-title-main">Anterior spinal artery</span> Blood vessel in the front of the spinal cord

In human anatomy, the anterior spinal artery is the artery that supplies the anterior portion of the spinal cord. It arises from branches of the vertebral arteries and courses along the anterior aspect of the spinal cord. It is reinforced by several contributory arteries, especially the artery of Adamkiewicz.

<span class="mw-page-title-main">Conus medullaris</span> Lower part of the spinal cord

The conus medullaris or conus terminalis is the tapered, lower end of the spinal cord. It occurs near lumbar vertebral levels 1 (L1) and 2 (L2), occasionally lower. The upper end of the conus medullaris is usually not well defined, however, its corresponding spinal cord segments are usually S1–S5.

<span class="mw-page-title-main">Aberrant subclavian artery</span> Medical condition

Aberrant subclavian artery, or aberrant subclavian artery syndrome, is a rare anatomical variant of the origin of the right or left subclavian artery. This abnormality is the most common congenital vascular anomaly of the aortic arch, occurring in approximately 1% of individuals.

<span class="mw-page-title-main">Intervertebral foramen</span> Foramen between spinal vertebrae

The intervertebral foramen is an opening between two pedicles of adjacent vertebra in the articulated spine. Each intervertebral foramen gives passage to a spinal nerve and spinal blood vessels, and lodges a posterior (dorsal) root ganglion. Cervical, thoracic, and lumbar vertebrae all have intervertebral foramina.

<span class="mw-page-title-main">Anterior spinal artery syndrome</span> Human spinal cord disorder

Anterior spinal artery syndrome is syndrome caused by ischemia of the area supplied by the anterior spinal artery, resulting in loss of function of the anterior two-thirds of the spinal cord. The region affected includes the descending corticospinal tract, ascending spinothalamic tract, and autonomic fibers. It is characterized by a corresponding loss of motor function, loss of pain and temperature sensation, and hypotension.

<span class="mw-page-title-main">Traumatic aortic rupture</span> Medical condition

Traumatic aortic rupture, also called traumatic aortic disruption or transection, is a condition in which the aorta, the largest artery in the body, is torn or ruptured as a result of trauma to the body. The condition is frequently fatal due to the profuse bleeding that results from the rupture. Since the aorta branches directly from the heart to supply blood to the rest of the body, the pressure within it is very great, and blood may be pumped out of a tear in the blood vessel very rapidly. This can quickly result in shock and death. Thus traumatic aortic rupture is a common killer in automotive accidents and other traumas, with up to 18% of deaths that occur in automobile collisions being related to the injury. In fact, aortic disruption due to blunt chest trauma is the second leading cause of injury death behind traumatic brain injury.

<span class="mw-page-title-main">Endovascular aneurysm repair</span> Surgery used to treat abdominal aortic aneurysm

Endovascular aneurysm repair (EVAR) is a type of minimally-invasive endovascular surgery used to treat pathology of the aorta, most commonly an abdominal aortic aneurysm (AAA). When used to treat thoracic aortic disease, the procedure is then specifically termed TEVAR for "thoracic endovascular aortic/aneurysm repair." EVAR involves the placement of an expandable stent graft within the aorta to treat aortic disease without operating directly on the aorta. In 2003, EVAR surpassed open aortic surgery as the most common technique for repair of AAA, and in 2010, EVAR accounted for 78% of all intact AAA repair in the United States.

<span class="mw-page-title-main">Albert Wojciech Adamkiewicz</span> Polish pathologist

Albert Wojciech Adamkiewicz was a Polish pathologist.

<span class="mw-page-title-main">Anterior spinal veins</span> Blood vessels

Anterior spinal veins are veins that receive blood from the anterior spinal cord.

<span class="mw-page-title-main">Segmental medullary artery</span> Blood vessel

Segmental medullary arteries are arteries of varying size in the thoracolumbar region that arise from segmental arteries of this region and pass through intervertebral foramina to supply the spinal cord. They may join the anterior spinal artery.

Vascular myelopathy refers to an abnormality of the spinal cord in regard to its blood supply. The blood supply is complicated and supplied by two major vessel groups: the posterior spinal arteries and the anterior spinal arteries—of which the Artery of Adamkiewicz is the largest. Both the posterior and anterior spinal arteries run the entire length of the spinal cord and receive anastomotic (conjoined) vessels in many places. The anterior spinal artery has a less efficient supply of blood and is therefore more susceptible to vascular disease. Whilst atherosclerosis of spinal arteries is rare, necrosis in the anterior artery can be caused by disease in vessels originating from the segmental arteries such as atheroma or aortic dissection.

<span class="mw-page-title-main">Randall B. Griepp</span> American cardiothoracic surgeon (1940–2022)

Randall Bertram Griepp was an American cardiothoracic surgeon who collaborated with Norman Shumway in the development of the first successful heart transplant procedures in the U.S. He had an international reputation for contributions to the surgical treatment of aortic aneurysms and aortic dissection and in heart and lung transplantations. He received nearly $8 million in grants from the National Heart, Lung, and Blood Institute.

<span class="mw-page-title-main">Spinal cord</span> Part of the vertebral column in animals

The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the lower brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal cord is hollow and contains a structure called the central canal, which contains cerebrospinal fluid. The spinal cord is also covered by meninges and enclosed by the neural arches. Together, the brain and spinal cord make up the central nervous system.

<span class="mw-page-title-main">Open aortic surgery</span> Surgical technique

Open aortic surgery (OAS), also known as open aortic repair (OAR), describes a technique whereby an abdominal, thoracic or retroperitoneal surgical incision is used to visualize and control the aorta for purposes of treatment, usually by the replacement of the affected segment with a prosthetic graft. OAS is used to treat aneurysms of the abdominal and thoracic aorta, aortic dissection, acute aortic syndrome, and aortic ruptures. Aortobifemoral bypass is also used to treat atherosclerotic disease of the abdominal aorta below the level of the renal arteries. In 2003, OAS was surpassed by endovascular aneurysm repair (EVAR) as the most common technique for repairing abdominal aortic aneurysms in the United States.

Spinal cord stroke is a rare type of stroke with compromised blood flow to any region of spinal cord owing to occlusion or bleeding, leading to irreversible neuronal death. It can be classified into two types, ischaemia and haemorrhage, in which the former accounts for 86% of all cases, a pattern similar to cerebral stroke. The disease is either arisen spontaneously from aortic illnesses or postoperatively. It deprives patients of motor function or sensory function, and sometimes both. Infarction usually occurs in regions perfused by anterior spinal artery, which spans the anterior two-thirds of spinal cord. Preventions of the disease include decreasing the risk factors and maintaining enough spinal cord perfusion pressure during and after the operation. The process of diagnosing the ischemic and hemorrhagic spinal cord stroke includes applying different MRI protocols and CT scan. Treatments for spinal cord stroke are mainly determined by the symptoms and the causes of the disease. For example, antiplatelet and corticosteroids might be used to reduce the risk of blood clots in ischaemic spinal stroke patients, while rapid surgical decompression is applied to minimize neurological injuries in haemorrhagic spinal stroke patients instead. Patients may spend years for rehabilitation after the spinal cord stroke.

References

  1. ↑ Koshino, T; Murakami, G; Morishita, K; Mawatari, T; Abe, T (1999). "Does the adamkiewicz artery originate from the larger segmental arteries?". The Journal of Thoracic and Cardiovascular Surgery. 117 (5): 898–905. doi: 10.1016/S0022-5223(99)70369-7 . PMID   10220681.
  2. ↑ Milen, Mark T.; Bloom, David A.; Culligan, J.; Murasko, K. (1999). "Albert Adamkiewicz (1850-1921) - his artery and its significance for the retroperitoneal surgeon" (PDF). World Journal of Urology. 17 (3): 168–70. doi:10.1007/s003450050126. hdl: 2027.42/42166 . PMID   10418091.
  3. ↑ Moore, Keith; Anne Agur (2007). Essential Clinical Anatomy, Third Edition. Lippincott Williams & Wilkins. p. 298. ISBN   978-0-7817-6274-8.
  4. ↑ Yoshioka, K; Niinuma, H; Ehara, S; Nakajima, T; Nakamura, M; Kawazoe, K (October 2006). "MR angiography and CT angiography of the artery of Adamkiewicz: state of the art". Radiographics. 26 Suppl 1: S63-73. doi:10.1148/rg.26si065506. PMID   17050520.
  5. 1 2 Takase, K.; Sawamura, Y.; Igarashi, K.; Chiba, Y.; Haga, K.; Saito, H.; Takahashi, S. (2002). "Demonstration of the Artery of Adamkiewicz at Multi- Detector Row Helical CT". Radiology. 223 (1): 39–45. doi:10.1148/radiol.2231010513. PMID   11930046.
  6. 1 2 Patestas, Maria A.; Gartner, Leslie P. (2016). A Textbook of Neuroanatomy (2nd ed.). Hoboken, New Jersey: Wiley-Blackwell. p. 70. ISBN   978-1-118-67746-9.
  7. ↑ Luyendijk W, Cohn B, Rejger V, Vielvoye GJ (1988). "The great radicular artery of Adamkiewicz in man. Demonstration of a possibility to predict its functional territory". Acta Neurochirurgica. 95 (3–4): 143–6. doi:10.1007/bf01790776. PMID   3228004.
  8. ↑ Biondi, Alessandra; Ricciardia, Giuseppe K.; Faillot, Tierry; Capelle, Laurent; Van Effenterre, Rémy; Chiras, Jacques (2005). "Hemangioblastomas of the lower spinal region: report of four cases with preoperative embolization and review of the literature". AJNR. 26 (4): 936–45. PMID   15814949.
  9. ↑ Nijenhuis RJ, Mull M, Wilmink JT, Thron AK, Backes WH (2006). "MR angiography of the great anterior radiculomedullary artery (Adamkiewicz artery) validated by digital subtraction angiography". AJNR. 27 (7): 1565–72. PMID   16908582.
  10. ↑ Greathouse, David G.; Halle, John S.; Dalley, Arthur F. (2001). "Blood supply to the spinal cord". Physical Therapy. 81 (6): 1264–5. doi: 10.1093/ptj/81.6.1264 . PMID   11380281.
  11. ↑ Lazorthes, Guy; Gouaze, Andrè; Zadeh, Jean O.; Jacques Santini, Jean; Lazorthes, Yves; Burdin, Phillipe (1971). "Arterial vascularization of the spinal cord". Journal of Neurosurgery. 35 (3): 253–62. doi:10.3171/jns.1971.35.3.0253. PMID   22046635. S2CID   1899816.
  12. ↑ Melissano, G.; Bertoglio, L.; Civelli, V.; Moraes Amato, A.C.; Coppi, G.; Civilini, E.; Calori, G.; De Cobelli, F.; et al. (2009). "Demonstration of the Adamkiewicz Artery by Multidetector Computed Tomography Angiography Analysed with the Open-Source Software OsiriX". European Journal of Vascular and Endovascular Surgery. 37 (4): 395–400. doi: 10.1016/j.ejvs.2008.12.022 . PMID   19230726.
  13. ↑ Blumenfeld, Hal (2010). Neuroanatomy Through Clinical Cases (2nd ed.). Sunderland, Mass: Sinauer Associates. ISBN   978-0-87893-058-6.[ page needed ]
  14. ↑ Wan, Innes Y. P.; Angelini, Gianni D.; Bryan, Alan J.; Ryder, Ian; Underwood, Malcolm J. (2001). "Prevention of spinal cord ischaemia during descending thoracic and thoracoabdominal aortic surgery". European Journal of Cardio-Thoracic Surgery. 19 (2): 203–13. doi: 10.1016/S1010-7940(00)00646-1 . PMID   11167113.
  15. ↑ Yoshioka, K.; Niinuma, H.; Ohira, A.; Nasu, K.; Kawakami, T.; Sasaki, M.; Kawazoe, K. (2003). "MR Angiography and CT Angiography of the Artery of Adamkiewicz: Noninvasive Preoperative Assessment of Thoracoabdominal Aortic Aneurysm". Radiographics. 23 (5): 1215–25. doi:10.1148/rg.235025031. PMID   12975511.
  16. ↑ Lopez, January; Lee, Hsin-Yi (2006). "Bronchial Artery Embolization for Treatment of Life-Threatening Hemoptysis". Seminars in Interventional Radiology. 23 (3): 223–229. doi:10.1055/s-2006-948759. ISSN   0739-9529. PMC   3036375 . PMID   21326768.
  17. ↑ Nojiri, Junichi; Matsumoto, Koichi; Kato, Akira; Miho, Takahiro; Furukawa, Koujiro; Ohtsubo, Satoshi; Itoh, Tsuyoshi; Kudo, Sho (2007). "The Adamkiewicz artery: demonstration by intra-arterial computed tomographic angiography". European Journal of Cardio-Thoracic Surgery. 31 (2): 249–55. doi: 10.1016/j.ejcts.2006.11.024 . PMID   17182250.
  18. ↑ Adamkiewicz AA (1882). "Die Blutgefässe des menschlichen Rückenmarkes. II. Die Gefässe der Rückenmarksoberfläche". Sitzungsberichte der Kaiserlichen Akademie der Wissenschaften. Mathematisch-Naturwissenschaftliche Classe. 85: 101–30.
  19. ↑ synd/2233 at Who Named It?
  20. ↑ Kowalczyk, J (2002). "Albert Wojciech Adamkiewicz and his artery". South African Medical Journal. 92 (9): 702. PMID   12382351.
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