Artery of Adamkiewicz

{{Short description|Largest anterior segmental medullary artery}}

{{Infobox artery

| Name = Artery of Adamkiewicz

| Latin = rami spinales arteriae vertebralis

| Image = Artery of Adamkiewicz CT scan OsiriX.jpg

| Caption = 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.

| BranchFrom = Abdominal aorta, posterior intercostal artery

| BranchTo = Anterior dspinal artery{{cite journal |last1=Koshino |first1=T |last2=Murakami |first2=G |last3=Morishita |first3=K |last4=Mawatari |first4=T |last5=Abe |first5=T |title=Does the adamkiewicz artery originate from the larger segmental arteries? |journal=The Journal of Thoracic and Cardiovascular Surgery |volume=117 |issue=5 |pages=898–905 |year=1999 |pmid=10220681 |doi=10.1016/S0022-5223(99)70369-7|doi-access=free }}

| Vein =

| Supplies = Lumbar enlargement of lower spinal cord{{cite journal |last1=Milen |first1=Mark T. |last2=Bloom |first2=David A. |last3=Culligan |first3=J. |last4=Murasko |first4=K. |title=Albert Adamkiewicz (1850-1921) - his artery and its significance for the retroperitoneal surgeon |journal=World Journal of Urology |volume=17 |issue=3 |pages=168–70 |year=1999 |pmid=10418091 |doi=10.1007/s003450050126|hdl=2027.42/42166 |url=https://deepblue.lib.umich.edu/bitstream/2027.42/42166/1/345-17-3-168_90170168.pdf |hdl-access=free }}

}}

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 (from T8 to the conus medullaris) via the anterior spinal artery.{{cite book|last=Moore|first=Keith|title=Essential Clinical Anatomy, Third Edition|year=2007|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-6274-8|pages=298|author2=Anne Agur}} 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.{{cite journal |last1=Yoshioka |first1=K |last2=Niinuma |first2=H |last3=Ehara |first3=S |last4=Nakajima |first4=T |last5=Nakamura |first5=M |last6=Kawazoe |first6=K |title=MR angiography and CT angiography of the artery of Adamkiewicz: state of the art. |journal=Radiographics |date=October 2006 |volume=26 Suppl 1 |pages=S63-73 |doi=10.1148/rg.26si065506 |pmid=17050520}} It typically arises from a 9th to 11th left posterior intercostal artery,{{cite journal |last1=Takase |first1=K. |last2=Sawamura |first2=Y. |last3=Igarashi |first3=K. |last4=Chiba |first4=Y. |last5=Haga |first5=K. |last6=Saito |first6=H. |last7=Takahashi |first7=S. |year=2002 |title=Demonstration of the Artery of Adamkiewicz at Multi- Detector Row Helical CT |journal=Radiology |volume=223 |issue=1 |pages=39–45 |doi=10.1148/radiol.2231010513 |pmid=11930046}} enters through the L2-L3 intervertebral foramen to join the anterior spinal artery and supply much of the inferior half of the spinal cord.{{Cite book |last1=Patestas |first1=Maria A. |title=A Textbook of Neuroanatomy |last2=Gartner |first2=Leslie P. |publisher=Wiley-Blackwell |year=2016 |isbn=978-1-118-67746-9 |edition=2nd |location=Hoboken, New Jersey |pages=70}} 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{{cite journal |vauthors=Luyendijk W, Cohn B, Rejger V, Vielvoye GJ |title=The great radicular artery of Adamkiewicz in man. Demonstration of a possibility to predict its functional territory |journal=Acta Neurochirurgica |volume=95 |issue=3–4 |pages=143–6 |year=1988 |pmid=3228004 |doi=10.1007/bf01790776}}
major anterior segmental medullary artery
artery of the lumbar enlargement{{cite journal |first1=Alessandra |last1=Biondi |first2=Giuseppe K. |last2=Ricciardia |first3=Tierry |last3=Faillot |first4=Laurent |last4=Capelle |first5=Rémy |last5=Van Effenterre |first6=Jacques |last6=Chiras |title=Hemangioblastomas of the lower spinal region: report of four cases with preoperative embolization and review of the literature |journal=AJNR |volume=26 |issue=4 |pages=936–45 |year=2005 |pmid=15814949 |url=http://www.ajnr.org/cgi/content/full/26/4/936}}
great anterior radiculomedullary artery{{cite journal |vauthors=Nijenhuis RJ, Mull M, Wilmink JT, Thron AK, Backes WH |title=MR angiography of the great anterior radiculomedullary artery (Adamkiewicz artery) validated by digital subtraction angiography |journal=AJNR |volume=27 |issue=7 |pages=1565–72 |year=2006 |pmid=16908582}}
great anterior segmental medullary artery{{cite journal |last1=Greathouse |first1=David G. |last2=Halle |first2=John S. |last3=Dalley |first3=Arthur F. |title=Blood supply to the spinal cord |journal=Physical Therapy |volume=81 |issue=6 |pages=1264–5 |year=2001 |doi=10.1093/ptj/81.6.1264 |pmid=11380281 |url=http://ptjournal.apta.org/content/81/6/1264.full|doi-access=free }}
great ventral radicular artery

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.{{cite journal |last1=Lazorthes |first1=Guy |last2=Gouaze |first2=Andrè |last3=Zadeh |first3=Jean O. |last4=Jacques Santini |first4=Jean |last5=Lazorthes |first5=Yves |last6=Burdin |first6=Phillipe |s2cid=1899816 |title=Arterial vascularization of the spinal cord |journal=Journal of Neurosurgery |volume=35 |pages=253–62 |year=1971 |doi=10.3171/jns.1971.35.3.0253 |pmid=22046635 |issue=3}} 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.

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.{{cite journal |last1=Melissano |first1=G. |last2=Bertoglio |first2=L. |last3=Civelli |first3=V. |last4=Moraes Amato |first4=A.C. |last5=Coppi |first5=G. |last6=Civilini |first6=E. |last7=Calori |first7=G. |last8=De Cobelli |first8=F. |last9=Del Maschio |first9=A. |last10=Chiesa |first10=R. |title=Demonstration of the Adamkiewicz Artery by Multidetector Computed Tomography Angiography Analysed with the Open-Source Software OsiriX |journal=European Journal of Vascular and Endovascular Surgery |volume=37 |issue=4 |pages=395–400 |year=2009 |pmid=19230726 |doi=10.1016/j.ejvs.2008.12.022|display-authors=8 |doi-access=free }}

Clinical significance

The artery provides blood supply to the front two-thirds of the lumbar and sacral cord.{{cite book |last=Blumenfeld |first=Hal |title=Neuroanatomy Through Clinical Cases |edition=2nd |publisher=Sinauer Associates |location=Sunderland, Mass |year=2010 |isbn=978-0-87893-058-6}}{{Page needed|date=November 2010}} When damaged or obstructed, it can result in a syndrome of spinal cord ischemia, similar to anterior spinal artery syndrome,{{cite journal |last1=Wan |first1=Innes Y. P. |last2=Angelini |first2=Gianni D. |last3=Bryan |first3=Alan J. |last4=Ryder |first4=Ian |last5=Underwood |first5=Malcolm J. |title=Prevention of spinal cord ischaemia during descending thoracic and thoracoabdominal aortic surgery |journal=European Journal of Cardio-Thoracic Surgery |volume=19 |issue=2 |pages=203–13 |year=2001 |pmid=11167113 |doi=10.1016/S1010-7940(00)00646-1|doi-access=free }} 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.{{cite journal |last1=Yoshioka |first1=K. |last2=Niinuma |first2=H. |last3=Ohira |first3=A. |last4=Nasu |first4=K. |last5=Kawakami |first5=T. |last6=Sasaki |first6=M. |last7=Kawazoe |first7=K. |title=MR Angiography and CT Angiography of the Artery of Adamkiewicz: Noninvasive Preoperative Assessment of Thoracoabdominal Aortic Aneurysm |journal=Radiographics |volume=23 |issue=5 |pages=1215–25 |year=2003 |pmid=12975511 |doi=10.1148/rg.235025031}}

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.{{cite journal|last1=Lopez|first1=January|last2=Lee|first2=Hsin-Yi|title=Bronchial Artery Embolization for Treatment of Life-Threatening Hemoptysis|journal=Seminars in Interventional Radiology|volume=23|issue=3|year=2006|pages=223–229|issn=0739-9529|doi=10.1055/s-2006-948759|pmid=21326768|pmc=3036375}} Its location can be identified with computed tomographic angiography.{{cite journal |last1=Nojiri |first1=Junichi |last2=Matsumoto |first2=Koichi |last3=Kato |first3=Akira |last4=Miho |first4=Takahiro |last5=Furukawa |first5=Koujiro |last6=Ohtsubo |first6=Satoshi |last7=Itoh |first7=Tsuyoshi |last8=Kudo |first8=Sho |title=The Adamkiewicz artery: demonstration by intra-arterial computed tomographic angiography |journal=European Journal of Cardio-Thoracic Surgery |volume=31 |issue=2 |pages=249–55 |year=2007 |pmid=17182250 |doi=10.1016/j.ejcts.2006.11.024|doi-access=free }}

History

It is named for Albert Wojciech Adamkiewicz.{{cite journal |author=Adamkiewicz AA |title=Die Blutgefässe des menschlichen Rückenmarkes. II. Die Gefässe der Rückenmarksoberfläche |journal=Sitzungsberichte der Kaiserlichen Akademie der Wissenschaften. Mathematisch-Naturwissenschaftliche Classe |year=1882 |volume=85 |pages=101–30}}{{WhoNamedIt|synd|2233}}{{cite journal |last1=Kowalczyk |first1=J |title=Albert Wojciech Adamkiewicz and his artery |journal=South African Medical Journal |volume=92 |issue=9 |pages=702 |year=2002 |pmid=12382351}}

References

External links

{{Chorus|00642}}
A video showing the Adamkiewicz artery can be seen here: [http://vascular.cc/aka.html AKA finding using OsiriX]

Category:Arteries