Artery of Adamkiewicz

In human anatomy, the artery of Adamkiewicz (also arteria radicularis magna) is the largest anterior segmental medullary artery.[3] It typically arises from a left posterior intercostal artery at the level of the 9th to 12th intercostal artery, which branches from the aorta, and supplies the lower two-thirds of the spinal cord via the anterior spinal artery.[4]

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 spinal artery[1]
Supplieslumbar enlargement of lower spinal cord[2]
Identifiers
Latinrami spinales arteriae vertebralis
Anatomical terminology

The artery is named after Albert Wojciech Adamkiewicz (August 11, 1850 – October 31, 1921), a Polish pathologist born in Żerków. It has several other names, including:

  • Adamkiewicz artery
  • great radicular artery of Adamkiewicz[5]
  • major anterior segmental medullary artery
  • artery of the lumbar enlargement[6]
  • great anterior radiculomedullary artery[7]
  • great anterior segmental medullary artery[8]

Structure

The blood supply of the spinal cord is complex and highly variable.[9] In a study of approximately 70 people that examined the spinal cord's blood supply it was found that:[4]

  1. The Adamkiewicz artery sometimes arises from a lumbar vessel.
  2. In approximately 30% of people it arises from the right side.
  3. One quarter of people have two large anterior segmental medullary arteries.

In 75% of people, the artery of Adamkiewicz originates on the left side of the aorta between the T8 and L1 vertebral segments.[10]

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.[11]

Clinical significance

"Great radicular artery of Adamkiewicz… provides the major blood supply to the lumbar and sacral cord."[12]

When damaged or obstructed, it can result in a syndrome of spinal cord ischemia, similar to anterior spinal artery syndrome,[13] 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 insufficient blood supply to the spinal cord.[14] In bronchial artery embolization for treatment of massive hemoptysis, one of the most serious complications is inadvertent occlusion of the artery of Adamkiewicz.[15] Its location can be identified with computed tomographic angiography.[16]

History

It is named for Albert Wojciech Adamkiewicz.[17][18][19]

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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. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. Melissano, G.; Civilini, E.; Bertoglio, L.; Calliari, F.; Campos Moraes Amato, A.; Chiesa, R. (2010). "Angio-CT Imaging of the Spinal Cord Vascularisation: A Pictorial Essay". European Journal of Vascular and Endovascular Surgery. 39 (4): 436–40. doi:10.1016/j.ejvs.2009.11.026. PMID 20034815.
  10. 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.
  11. 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.
  12. Blumenfeld, Hal (2010). Neuroanatomy Through Clinical Cases (2nd ed.). Sunderland, Mass: Sinauer Associates. ISBN 978-0-87893-058-6.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. synd/2233 at Who Named It?
  19. Kowalczyk, J (2002). "Albert Wojciech Adamkiewicz and his artery". South African Medical Journal. 92 (9): 702. PMID 12382351.
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