The Artery of Adamkiewicz: Vascular Anatomy, Clinical Significance and Surgical Considerations

Hoehmann, Christopher L.; Hitscherich, Kyle; Cuoco, Joshua A.

doi:10.4172/2324-8602.1000284

Cited by 12 publications

(11 citation statements)

References 11 publications

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“…48 In addition, the thyrocervical trunk arising from the left subclavian artery, supplies the cervical spinal cord through anterior and posterior radiculomedullary arteries (Figure 4). 49 More than 40% of patients undergoing TEVAR have thoracic aortic pathology in close proximity to the LSA, which requires its intentional coverage. 50 C overage of the left subclavian artery increases the risk of vertebrobasilar stroke and arm ischemia as shown in a meta-analysis by Rizvi et al 51 (OR, 10.8; CI, 3.2 to 36.7; I 2 =0% for stroke) and (OR, 47.7; CI, 9.9 to 229.3; I 2 =72% for arm ischemia).…”

Section: Risk Factors For Spinal Cord Injury After Tevarmentioning

confidence: 99%

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Awad

Ramadan

Sayed

et al. 2017

Can J Anesth/J Can Anesth

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Purpose Thoracic endovascular aortic aneurysm repair (TEVAR) has become a mainstay of therapy for aneurysmal and other disorders of the thoracic aorta. The purpose of this narrative review article is to summarize the current literature on the risk factors, pathophysiology of spinal cord injury (SCI) following TEVAR, and to discuss various intraoperative monitoring and treatment strategies. Source Articles considered in this review were identified through PubMed using the following search terms: thoracic aortic aneurysm, TEVAR, paralysis+TEVAR, risk factors+TEVAR, spinal cord ischemia+TEVAR, neuromonitoring+thoracic aortic aneurysm, spinal drain, cerebrospinal fluid drainage, treatment of spinal cord ischemia. Principal findings Spinal cord injury continues to be a challenging complication after TEVAR. Its incidence after TEVAR is not significantly reduced compared to open TAAA repair. However, compared to open procedures, delayed paralysis/paresis is the predominant presentation of SCI after TEVAR. The pathophysiology of SCI is complex and remains not fully understood though the evolving concept of the importance of the spinal cord’s collateral blood supply network and its imbalance after TEVAR is emerging as a leading factor in the development of SCI. Cerebrospinal fluid drainage, optimal blood pressure management, and newer surgical techniques are important components of the most current spinal cord protection strategies. Conclusion Further experimental and clinical research is needed to aid in the discovery of novel neuroprotective strategies for protection and treatment of SCI following TEVAR.

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Section: Risk Factors For Spinal Cord Injury After Tevarmentioning

confidence: 99%

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Awad

Ramadan

Sayed

et al. 2017

Can J Anesth/J Can Anesth

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“…Weakness occurs due to disruption of descending corticospinal tracts. Involvement of ventral grey matter may manifest as lower motor neuron type of weakness 4. Other symptoms vary such as autonomic dysfunction, bladder or bowel disturbance 5…”

Section: Discussionmentioning

confidence: 99%

“…This area is more susceptible to ischaemia because the branches are end arteries and have no anastomoses 4 64. Other major causes of disruption of blood flow in ASA are occlusion due to emboli or atheroma, aortic dissection, aneurysm, trauma or syphilitic arteries 4.…”

Section: Discussionmentioning

confidence: 99%

“…Anterior spinal artery infarction may also occur due to impairment of perfusion via the great anterior radicular artery of Adamkiewicz, which is the major contributor to the caudal two-thirds of ASA in the region of lower thoracic and lumbar (T5 to L2) segment of the spinal cord 4. Other major causes of disruption of blood flow in ASA are occlusion due to emboli or atheroma, aortic dissection, aneurysm, trauma or syphilitic arteries 4. However, these causes are less likely to occur in our patients, as he did not have any risk factors.…”

Section: Discussionmentioning

confidence: 99%

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Anterior spinal cord syndrome as a rare complication of acute bacterial meningitis in an adult

Halim

2018

BMJ Case Reports

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Acute bacterial meningitis is not an uncommon central nervous system infection. In severe cases, it can be associated with various neurological or systemic complications. However, acute spinal cord dysfunction rarely occurs. We report a case of bacterial meningitis complicated with spinal cord infarction despite adequate treatment with antibiotics and corticosteroid therapy. He had residual paraplegia and was fully dependent in the activity of daily living.

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“…Such reflux could readily track into a more inferiorly located intercostal artery that, in turn, gives rise to the principle arterial supply to the lower thoracic anterior spinal artery (arteria radicularis magna; aka, the artery of Adamkiewicz) (Fig 1). The latter usually arises from the thoracic T6-T12 level and thus at or closely inferior to most bronchial arteries, which generally arise at the T5-T6 level (24).…”

mentioning

confidence: 99%

Spinal Arterial Blood Supply Does Not Arise from the Bronchial Arteries: A Detailed Analysis of Angiographic Studies Performed for Hemoptysis

Befera

Ronald

Kim

et al. 2019

Journal of Vascular and Interventional Radiology

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Purpose: To determine the angiographic prevalence of spinal arteries originating directly from the bronchial arteries in the setting of embolization for hemoptysis. Materials and Methods:Over a 14-year interval, 205 patients underwent angiography for hemoptysis. Twenty-five patients were excluded because their bronchial arteries were not visualized. The remaining 180 patients underwent a total of 254 angiographic procedures (range, 1-8 per patient). Images were reviewed jointly by 2 interventional radiologists with formal fellowship training in both peripheral and neurological interventional radiology. All catheterized arteries were evaluated for arterial contribution to the spinal cord. For patients with multiple studies, each unique artery was reported only once. Embolization was performed during at least 1 procedure in 158 patients (88%). Electronic record review was used to assess neurological sequelae after the procedure.

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The Artery of Adamkiewicz: Vascular Anatomy, Clinical Significance and Surgical Considerations

Cited by 12 publications

References 11 publications

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Spinal cord injury after thoracic endovascular aortic aneurysm repair

Anterior spinal cord syndrome as a rare complication of acute bacterial meningitis in an adult

Spinal Arterial Blood Supply Does Not Arise from the Bronchial Arteries: A Detailed Analysis of Angiographic Studies Performed for Hemoptysis

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