Artery of Adamkiewicz

Artery of Adamkiewicz
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
SourceAbdominal aorta, posterior intercostal artery
BranchesAnterior dspinal artery[2]
SuppliesLumbar enlargement of lower spinal cord[1]
Identifiers
Latinrami spinales arteriae vertebralis
TA24536
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.

Nomenclature

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

  • great radicular artery of Adamkiewicz[7]
  • major anterior segmental medullary artery
  • artery of the lumbar enlargement[8]
  • great anterior radiculomedullary artery[9]
  • great anterior segmental medullary artery[10]
  • great ventral radicular artery[6]

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]

References

  1. ^ 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.
  2. ^ 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.
  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. ^ a b 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. ^ a b 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.