nach oben

Erschienen in:

Open Access 27.04.2019 | Spinal Neuroradiology

Artery of Adamkiewicz: a meta-analysis of anatomical characteristics

verfasst von: Dominik Taterra, Bendik Skinningsrud, Przemysław A. Pękala, Wan Chin Hsieh, Roberto Cirocchi, Jerzy A. Walocha, R. Shane Tubbs, Krzysztof A. Tomaszewski, Brandon Michael Henry

Erschienen in: Neuroradiology | Ausgabe 8/2019

Abstract

Purpose

The artery of Adamkiewicz (AKA) provides the major blood supply to the anterior thoracolumbar spinal cord and iatrogenic injury or inadequate reconstruction of this vessel during vascular and endovascular surgery can result in postoperative neurological deficit due to spinal cord ischemia. The aim of this study was to provide comprehensive data on the prevalence and anatomical characteristics of the AKA.

Methods

An extensive search was conducted through the major electronic databases to identify eligible articles. Data extracted included study type, prevalence of the AKA, gender, number of AKA per patient, laterality, origin based on vertebral level, side of origin, morphometric data, and ethnicity subgroups.

Results

A total of 60 studies (n = 5437 subjects) were included in the meta-analysis. Our main findings revealed that the AKA was present in 84.6% of the population, and patients most frequently had a single AKA (87.4%) on the left side (76.6%) originating between T8 and L1 (89%).

Conclusion

As an AKA is present in the majority of the population, caution should be taken during vascular and endovascular surgical procedures to avoid injury or ensure proper reconstruction. All surgeons operating in the thoracolumbar spinal cord should have a thorough understanding of the anatomical characteristics and surgical implications of an AKA.

ESM 1 (DOC 64 kb)

Electronic supplementary material

The online version of this article (https://doi.org/10.1007/s00234-019-02207-y) contains supplementary material, which is available to authorized users.

DT and BS contributed equally to this work.

An author's reply to this comment is available online at https://doi.org/10.1007/s00234-019-02228-7.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Introduction

The artery of Adamkiewicz (AKA), also known as the great anterior radiculomedullary artery, is a major artery that joins the anterior spinal artery in the lower one-third of the spinal cord (Fig. 1) [1]. Because of its large role in feeding the spinal cord, many reports have stressed the importance of reattaching the intercostal or lumbar arteries to the AKA in the event of spinal cord ischemia following vascular and endovascular surgery (Fig. 2). Identification of the AKA preoperatively helps surgeons to determine the appropriate range of aortic lesions that require graft replacement [2]. Therefore, accurate localization and detailed anatomical knowledge of the AKA are important when planning surgical and interventional radiological treatments of thoracoabdominal diseases and spinal lesions in order to help reduce the risk of postoperative ischemic spinal complications and paraplegia.

The AKA is the most dominant anterior radiculomedullary artery and is responsible for the arterial blood supply to the spinal cord from T8 to the conus medullaris [3]. Its origin is highly variable and extends from the mid-thoracic level to the lumbar levels, including the bilateral T3-T12 intercostal arteries [4] and L1-L4 lumbar arteries [5]. It typically arises from the T8–L1 neural foramina [6] from the left intercostal or lumbar arteries [7]. The AKA has a diameter of 0.8–1.3 mm, and the distal portion of this artery, together with the anterior spinal artery, forms a characteristic “hairpin” turn [8] (Fig. 3). Various techniques have been devised to preoperatively identify the location and anatomy of this artery. Such techniques include computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA), with the latter considered the gold standard [9].

The most important cause of injury to the AKA is iatrogenic, and in part, this is a factor of the high degree of variability in the anatomical location of this artery [10]. Preoperative AKA identification and its subsequent reconstruction or preservation may aid in reducing the incidence of postoperative neurological deficits and improving the outcomes of thoracolumbar surgical procedures. To this end, the aim of this study was to provide comprehensive data on the prevalence and anatomical characteristics of the AKA.

Materials and methods

Search strategy

A search of all major electronic databases (PubMed, EMBASE, ScienceDirect, China National Knowledge Infrastructure (CNKI), SciELO, BIOSIS, and Web of Science) was performed in order to identify potential articles. The following search terms were employed: artery of Adamkiewicz, arteria radicularis magna (ARM), radicularis magna, great radicular artery of Adamkiewicz, major anterior segmental medullary artery, great anterior segmental medullary artery, artery of the lumbar enlargement, arteria radicularis anterior magna, and great anterior radiculomedullary artery. A search through the references of the initially selected articles was conducted to identify any potential studies that were omitted. The authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines throughout this meta-analysis (Supplement 1).

Eligibility assessment

An eligibility assessment was conducted by two independent reviewers. Studies were included in this meta-analysis if they (1) provided complete data on the prevalence of the AKA or (2) provided data on the anatomy of AKA. The following exclusion criteria were employed: case, case-series, conference abstracts, letters to editors, and studies not published in peer-reviewed journals. Studies that were originally published in languages other than English were translated by medical professionals who are fluent both in English and the original language of the manuscript. All differences of opinion among the reviewers concerning the eligibility of the studies were resolved by consensus through consultation with the author of the respective study.

Data extraction

Two reviewers carried out data extraction independently. The following data was extracted: publication year, country of origin, study type (cadaveric, CTA, MRA, DSA), prevalence data of AKA, number of AKAs per patient, laterality of the AKA, origin of the AKA based on the vertebral level, side of origin, and morphometric data. In cases of incomplete data, the authors of the original articles were contacted for clarification.

Quality assessment

The AQUA tool [11] was used by the reviewers to evaluate quality and reliability of the included studies. In brief, the tool was devised to probe for potential risk of bias. Five domains were evaluated in the analysis: (1) objective(s) and subject characteristics, (2) study design, (3) methodology characterization, (4) descriptive anatomy, and (5) reporting of results; and each domain was categorized as either of “Low,” “High,” or “Unclear” risk of bias. Decision was made that a “No” answer in whichever signaling question within each of the categories arbitrated the domain to be of “High” risk of bias, whereas all answers “Yes” suggested that it presented a “Low” risk of bias. “Unclear” option was chosen when the study with incoherent data did not permit for a clear scrutiny.

Statistical analysis

The prevalence analysis was conducted using MetaXL version 5.8 by EpiGear Pty Ltd. (Wilston, Queensland, Australia). Morphometric analysis using Comprehensive Meta-Analysis version 3.3 yielded the pooled mean diameter of the AKA. Single and multi-categorical pooled prevalence rates were calculated using a random effects model. Heterogeneity was assessed using a chi-squared test and the I² statistic. For the I² statistic, the values of 0–40% indicated that heterogeneity might not be important; values of 30–60% could indicate moderate heterogeneity; values of 50–90% could indicate substantial heterogeneity; and values of 75–100% indicated considerable heterogeneity. A p value below 0.10 for Cochran’s Q suggested significant heterogeneity [12].

An analysis of the subgroups was conducted to determine the source of heterogeneity. The difference between the groups was considered to be insignificant if the confidence intervals (CIs) of specific rates overlapped [13]. Subgroups according to study type, gender, and geographical location were analyzed.

Results

Study identification and characteristics of included studies

The study identification process is presented in Fig. 4. An initial search yielded 747 entries. After thorough analysis, 627 entries were excluded. In total, 120 articles were analyzed, and 60 studies were included in this meta-analysis.

The characteristics of the included studies are presented in Table 1. A total of 60 studies (4317 subjects with AKA) published between 1989 [14] and 2017 [15] were included [1‐10, 14‐62]. The studies originated from North America, Asia and Europe, and from ten different countries.

Table 1

Characteristics of included studies

Study	Country	Type of study	Number of subjects	% prevalence of AKA (no. of subjects with AKA)
Alleyne 1998	USA	Cadaveric	10	90.0 (9)
Amako 2011	Japan	CTA	110	100.0 (110)
Bachet 1996	France	CTA	36	77.8 (28)
Backes 2008	Netherlands	MRA	85	100.0 (85)
Biglioli 2004	Italy	Cadaveric	51	100.0 (51)
Bley 2010	Germany	MRA	68	88.2 (60)
Boll 2006	USA	MDCT angiography	100	100.0 (100)
Bowen 1996	USA	MRA	6	100.0 (6)
Champlin 1994	USA	DSA	61	32.8 (20)
Charles 2011	France	DSA	100	96.0 (96)
Fanous 2015	USA	DSA	34	70.6 (24)
Fereshetian 1989	USA	DSA	12	75.0 (9)
Furukawa 2010	Japan	CTA	37	100.0 (37)
Gailloud 2013	USA	DSA	50	92.0 (46)
Guzinski 2017	Poland	MSCT	200	21.5 (43)
Heinemann 1998	Germany	DSA	46	65.2 (30)
Hyodoh 2005	Japan	MRA	50	84.0 (42)
Hyodoh 2007	Japan	MRA (double subtraction maximum intensity projection)	170	82.4 (140)
Hyodoh 2009	Japan	MRA	82	81.7 (67)
Jaspers 2007	Netherlands	MRA	20	100.0 (20)
Kawaharada 2002	Japan	MRA	40	72.5 (29)
Kawaharada 2004	Japan	MRA	120	82.5 (99)
Kawaharada 2007	Japan	MRA	83	85.5 (71)
Kieffer 1989	France	Arteriography	45	88.9 (40)
Kieffer 2002	France	Arteriography	480	87.3 (419)
Koshino 1999	Japan	Cadaveric	102	88.2 (90)
Kovacs 2009	Germany	CT	51	70.6 (36)
Kroszczynski 2013	USA	Cadaveric	24	95.8 (23)
Kudo 2003	Japan	MDCT	19	68.4 (13)
Matsuda 2010	Japan	MRA and CTA	50	94.0 (47)
Matsuda 2010a	Japan	MRA and CTA	60	80.0 (48)
Melissano 2009	Italy	MDCT	67	67.2 (45)
Mordasini 2012	Switzerland	MRA	24	83.3 (20)
Morishita 2003	Japan	Cadaveric	55	100.0 (55)
Murthy 2010	USA	Spinal angiography	248	46.4 (115)
Nakayama 2008	Japan	CTA	80	56.3 (45)
Nijenhuis 2004	Netherlands	MRA	8	100.0 (8)
Nijenhuis 2007	Netherlands	MRA and CTA	39	100.0 (39)
Nijenhuis 2007a	Netherlands	MRA	60	100.0 (60)
Nishida 2014	Japan	CT	33	75.8 (25)
Nishii 2013	Japan	CTA	160	81.9 (131)
Nojiri 2007	Japan	CTA	27	100.0 (27)
Ogino 2006	Japan	MRA	92	70.7 (65)
Ou 2007	France	CTA	40	95.0 (38)
Polaczek 2014	Poland	Cadaveric	28	100.0 (28)
Rodriguez-Baeza 1991	Spain	Cadaveric	30	100.0 (30)
Schurink 2007	Netherlands	MRA	9	100.0 (9)
Sukeeyamonon 2010	Thailand	MDCT angiography	73	71.2 (52)
Takagi 2015	Japan	MRA and MDCTA	117	89.7 (105)
Takase 2002	Japan	MDCT	70	90.0 (63)
Takase 2007	Japan	MDCT	10	90.0 (9)
Tanaka 2016	Japan	MRA and CTA	1252	87.5 (1096)
Uotani 2008	Japan	CTA	32	78.1 (25)
Utsunomiya 2008	Japan	CTA	80	62.5 (50)
Williams 1991	USA	Retrograde femoral artery catherization	47	55.3 (26)
Yamada 2000	Japan	MRA	26	69.2 (18)
Yingbin 2013	China	MDCT	217	55.8 (121)
Yoshioka 2003	Japan	MRA and CTA	30	90.0 (27)
Yoshioka 2006	Japan	MRA and CTA	30	96.7 (29)
Zhao 2009	China	MDCTA	51	35.3 (18)

Quality assessment

The majority of studies included in this meta-analysis, evaluated by the AQUA tool, revealed domain one (objective(s) and subject characteristics) and domain three (methodology characterization) to be at “High” risk of bias, owing to missing demographic data of the research group and no information regarding experience of the researchers. All studies had a “Low” risk of bias found in domain two (study design) and domain five (reporting of results), and almost all studies had a “Low” risk of bias found in domain four (descriptive anatomy). The AQUA tool evaluation can be found in Table 2.

Table 2

The AQUA tool—tabular display

Study	Risk of bias
Study	Objective(s) and study characteristics	Study design	Methodology characterization	Descriptive anatomy	Reporting of results
Alleyne 1998	High	Low	High	Low	Low
Amako 2011	Low	Low	High	Low	Low
Bachet 1996	High	Low	High	High	Low
Backes 2008	High	Low	High	Low	Low
Biglioli 2004	Low	Low	High	High	Low
Bley 2010	Low	Low	High	Low	Low
Boll 2006	High	Low	High	High	Low
Bowen 1996	High	Low	High	Low	Low
Champlin 1994	High	Low	High	Low	Low
Charles 2011	High	Low	High	Low	Low
Fanous 2015	High	Low	High	Low	Low
Fereshetian 1989	High	Low	High	Low	Low
Furukawa 2010	High	Low	High	Low	Low
Gailloud 2013	High	Low	High	Low	Low
Guzinski 2017	High	Low	High	Low	Low
Heinemann 1998	High	Low	High	Low	Low
Hyodoh 2005	High	Low	High	High	Low
Hyodoh 2007	High	Low	High	Low	Low
Hyodoh 2009	High	Low	High	High	Low
Jaspers 2007	High	Low	High	Low	Low
Kawaharada 2002	High	Low	High	Low	Low
Kawaharada 2004	High	Low	High	Low	Low
Kawaharada 2007	High	Low	High	Low	Low
Kieffer 1989	High	Low	High	High	Low
Kieffer 2002	High	Low	High	Low	Low
Koshino 1999	High	Low	High	Low	Low
Kovacs 2009	High	Low	High	Low	Low
Kroszczynski 2013	High	Low	High	Low	Low
Kudo 2003	High	Low	High	Low	Low
Matsuda 2010	High	Low	High	High	Low
Matsuda 2010a	High	Low	High	High	Low
Melissano 2009	High	Low	Low	High	Low
Mordasini 2012	High	Low	Low	High	Low
Morishita 2003	High	Low	High	Low	Low
Murthy 2010	Unclear	Low	High	Low	Low
Nakayama 2008	High	Low	Low	Low	Low
Nijenhuis 2004	High	Low	Unclear	Low	Low
Nijenhuis 2007	High	Low	High	Low	Low
Nijenhuis 2007a	High	Low	High	Low	Low
Nishida 2014	High	Low	Low	High	Low
Nishii 2013	High	Low	Low	High	Low
Nojiri 2007	High	Low	High	Low	Low
Ogino 2006	High	Low	High	High	Low
Ou 2007	High	Low	Unclear	High	Low
Polaczek 2014	High	Low	High	Low	Low
Rodriguez-Baeza 1991	High	Low	High	Low	Low
Schurink 2007	High	Low	High	Low	Low
Sukeeyamonon 2010	High	Low	Low	High	Low
Takagi 2015	High	Low	Low	Low	Low
Takase 2002	High	Low	High	Low	Low
Takase 2007	High	Low	High	High	Low
Tanaka 2016	High	Low	High	Low	Low
Uotani 2008	High	Low	High	Low	Low
Utsunomiya 2008	High	Low	High	Low	Low
Williams 1991	High	Low	High	Low	Low
Yamada 2000	High	Low	High	Low	Low
Yingbin 2013	High	Low	High	Low	Low
Yoshioka 2003	High	Low	High	Low	Low
Yoshioka 2006	High	Low	High	Low	Low
Zhao 2009	High	Low	High	Low	Low

Prevalence of the artery of Adamkiewicz

A total of 60 studies (n = 5437 subjects) reported data on the prevalence of the AKA. The pooled prevalence estimate (PPE) of the AKA was 84.6% (95% CI 79.7–89.0) (Table 3).

Table 3

Overall prevalence of AKA

Subgroup		Number of studies (number of subjects)	Pooled prevalence of AKA: % (95% CI)	I² % (95% CI)	Cochran’s Q, p value
Overall		60 (5437)	84.6 (79.7–89.0)	95.3 (94.5–95.9)	< 0.001
Gender	Males	15 (515)	93.7 (83.3–100.0)	94.0 (91.6–95.7)	< 0.001
Gender	Females	14 (345)	90.4 (68.9–100.0)	96.4 (95.2–97.4)	< 0.001
Type of study	Cadaveric	7 (300)	97.5 (92.4–100.0)	72.2 (38.8–87.1)	0.001
	CTA	9 (602)	88.1 (74.0–97.6)	94.4 (91.4–96.4)	< 0.001
	MRA	16 (943)	88.3 (81.9–93.4)	85.1 (77.3–90.3)	< 0.001
	DSA	6 (303)	75.4 (49.1–94.9)	94.9 (91.2–97.0)	< 0.001
Country of origin	Japan	27 (3017)	85.3 (81.0–89.2)	87.5 (83.0–90.8)	< 0.001
	USA	10 (592)	79.5 (57.0–95.7)	96.3 (94.7–97.4)	< 0.001
	France	5 (701)	89.8 (83.8–94.6)	69.0 (20.4–87.9)	0.012
	Netherlands	6 (221)	99.4 (98.2–100.0)	0.0 (0.0–0.0)	0.972

The subgroup analysis of gender differences showed that the AKA was slightly more prevalent in males (93.7% [95% CI 83.3–100.0]) than females (90.4% [95% CI 68.9–100.0]), although not significantly.

Seven cadaveric studies (n = 300) yielded the highest PPE of the AKA (97.5% [95% CI 92.4–100.0]) among the different study types. This was followed by MRA, CTA, and DSA studies with PPEs of 88.3%, 88.1%, and 75.4%, respectively (Table 3).

The subgroup analysis of geographical origin showed that the AKA was most prevalent in the Netherlands, with a PPE of 99.4% (95% CI 98.2–100.0); France with a PPE of 89.8% (95% CI 83.8–94.6); and Japan, with a PPE of 85.3 (95% CI 81.0–89.2). It was least prevalent in the USA, with a PPE of 79.5% (95% CI 57.0–95.7).

Number of arteries of Adamkiewicz per patient

An analysis of 20 studies (n = 1329 subjects with AKAs) showed that the majority of patients (87.4% [95% CI 83.4–91.9]) had one AKA. Patients presented with two AKAs in 11.3% (95% CI 7.5–15.8) of cases, three AKAs in 0.8% (95% CI 0.0–2.5) of cases, and four AKAs in 0.5% (95% CI 0.0–1.6) of cases.

In patients with two AKAs, the majority (73.3% [95% CI 47.3–93.4]) presented unilaterally as duplications. A total of 26.7% (95% CI 6.6–52.7; I² 66.2%, 95% CI 12.0–87.0; p = 0.019) of patients with two AKAs had bilateral configuration.

Origin of the artery of Adamkiewicz

A total of 56 studies (n = 3316 patients with AKA) analyzed the side of origin of AKA. The results showed that 76.6% (95% CI 73.2–79.9) of AKAs originated from the left side, while 23.4% (95% CI 20.1–26.8; I² 78.5%, 95% CI 72.5–83.2; p < 0.001) from the right side. The analysis of 43 studies (n = 2834 patients with AKA) showed that 89% of arteries originated between T8 and L1 (Table 4). AKA most frequently originated at the level of T9 with PPE of 22.2% (95% CI 18.9–25.4), followed by T10 and T11 with PPE of 21.7% (95% CI 18.5–25.0) and 18.7% (95% CI 15.6–21.8), respectively.

Table 4

Origin of AKA (vertebral levels)

Number of studies (number of subjects with AKA)	T3: % (95% CI)	T4: % (95% CI)	T5: % (95% CI)	T6: % (95% CI)	T7: % (95% CI)	T8: % (95% CI)	T9: % (95% CI)	T10: % (95% CI)	T11: % (95% CI)	T12: % (95% CI)	L1: % (95% CI)	L2: % (95% CI)	L3: % (95% CI)	L4: % (95% CI)	L5: % (95% CI)	I²: % (95% CI)	Cochran’s Q, p value
43 (2834)	0.5 (0.1–1.3)	0.7 (0.2–1.6)	0.8 (0.2–1.7)	0.8 (0.2–1.8)	2.2 (1.2–3.5)	7.3 (5.3–9.4)	22.2 (18.9–25.4)	21.7 (18.5–25.0)	18.7 (15.6–21.8)	12.2 (9.7–14.8)	6.9 (5.0–9.0)	3.8 (2.4–5.5)	1.1 (0.4–2.1)	0.5 (0.1–1.3)	0.5 (0.1–1.2)	74.7 (66.0–81.2)	< 0.001

Continuity of the artery of Adamkiewicz

A total of seven studies (n = 375 patients with AKAs) were included in an analysis of the continuity of the AKA from the aorta to the anterior spinal artery. The results showed that AKA continued from the aorta to the anterior spinal artery in 71.3% of patients (95% CI 45.8–91.6; I² 95.6%, 95% CI 92.8–97.2; p < 0.001).

Morphometric analysis of the artery of Adamkiewicz

Five studies (n = 324 patients with AKA) analyzed the morphometric data of the AKA. The analysis showed a pooled mean diameter of 1.09 mm (95% CI 0.69–1.50; I² 36.2%; p < 0.001).

Discussion

Because the AKA originates from the lumbar arteries, it may be prudent to preserve the blood flow from the lumbar arteries when a thoracoabdominal aortic repair is planned [5, 63]. Concomitant or previous abdominal aortic repair and extensive thoracic aorta exclusion by means of multiple stent grafts are associated with a significantly higher risk of paraplegia [64]. After the interruption of most of the intercostal and lumbar arteries, the residual collateral blood supply is marginal, and in some cases, the spinal cord may become extremely prone to injury due to arterial hypotension or low cardiac output from any cause [65]. During aortic repair, preservation, reattachment, or reconstruction of the intercostal or lumbar arteries can maintain the blood supply to the spinal cord [66, 67]. Depending on the number of intercostal or lumbar arteries that require reconstruction, the ischemic duration may be prolonged during reconstruction. In our study, in patients with an AKA present, 11.3% had two AKAs, with bilateral AKAs present in 26.7% of these patients. The preoperative identification of the AKA and its anatomical characteristics allows for superior surgical planning, such that the surgical time and postoperative spinal complication risk are decreased [31]. Therefore, AKA identification is of interest for surgeons aiming to reconstruct intercostal or lumbar arteries in order to prevent postoperative spinal ischemic complications [3].

With respect to the continuity between the radicular arteries (including the AKA) and the anterior spinal arteries, the AKA continued from the aorta to the anterior spinal artery in 71.3% of the patients in our study. When this continuity is present, blood may drain away from the spinal cord through the anterior spinal arteries and the radicular arteries, acting as stealing channels by rerouting the blood to be distal to an aortic obstruction [5]. During aortic cross-clamping, back-bleeding from the ostia of the posterior intercostal and lumbar arteries may be a clinical manifestation of such rerouting of blood when continuity between the AKA and the anterior spinal arteries is present. This steal phenomenon may further worsen spinal cord ischemia, causing irreversible neurological injuries if the ischemia time is longer than 20 to 30 min [68].

The detection of the AKA can be difficult because of the various possible levels of origins of the artery, its small size, the amount of time needed to obtain the angiogram, and complications that can occur during surgical procedures [14, 26]. In our study, the pooled mean diameter of the AKA was 1.09 mm. Various techniques have been devised to preoperatively identify the location and anatomy of the AKA, such as CTA [55], MRA [7], and DSA [9]. These techniques can be used to identify both the level and the laterality of the artery, which can affect a surgeon’s approach to an aneurysm or spinal lesion. We have included three DSA images with injected contrast into left radicular artery at the level of T4 (Fig. 5), T8 (Fig. 6), and T11 (Fig. 7). In our meta-analysis, cadaveric studies had the highest prevalence of an AKA (97.5%), and among the different imaging modalities, MRA and CTA had the highest prevalence rates (88.3% and 88.1%, respectively), while DSA had the lowest prevalence rate (75.4%). In spite of its apparent success in detecting an AKA, MRA has been shown to be inferior to DSA in terms of evaluating vessel continuity, sharpness, and background homogeneity [7]. Furthermore, compared with CTA, a more limited field of view is a major disadvantage of MRA [61]. As a result, MRA may fail to depict the clinically important collateral vessels to the AKA in some patients, when a collateral source is the internal thoracic artery or the thoracodorsal artery [69]. Despite DSA studies reporting a lower prevalence rate of the AKA than MRA and CTA in our meta-analysis, DSA remains the “gold standard” for identifying spinal cord vasculature as it is both safe and efficient [9]. A possible reason for this discrepancy could be the small number of patients included in our DSA analysis as compared to the number of patients included in our MRA and CTA analyses.

Future studies should examine the blood supply and the collateral circulation of the spinal cord in the presence of degenerative atherosclerotic or dissecting aneurysm, or after a surgical or endovascular aortic procedure. In these patients, the disease and the surgical procedure may occlude several segmental arteries and promote collateral vessels enlargement, significantly altering the normal patterns of blood supply to the spinal cord [5].

Our meta-analysis was limited by the high amount of heterogeneity between the studies. However, the number of included studies and their large sample sizes mitigate this limitation. As cadaveric dissection is the gold standard for anatomical considerations, more cadaveric studies should assess prevalence of AKA, especially performed on subjects poorly represented in our meta-analysis, such as Africa, South America, and Oceania.

Because of the lower prevalence of AKA in radiological studies, surgeons should keep in mind that these results might be false negative. In this case, the risk of iatrogenic injury to the AKA during thoracolumbar surgical procedures is increased. More accurate imaging methods should be developed to assess the true prevalence of AKA.

To ensure spinal cord safety, preoperative AKA identification and its subsequent reconstruction or preservation are effective adjuncts for more secure protection of the spinal cord, along with other adequate management strategies.

Conclusions

Our main findings revealed that the AKA was found to be present in the vast majority of the general population (84.6%), most often as a single vessel (87.4%) originating between T8 and L1 (89%) on the left side (76.6%). Based on our anatomical findings, we recommend that efforts should be made to identify and subsequently reconstruct or preserve the AKA to prevent postoperative neurological deficit due to spinal cord ischemia in vascular and endovascular surgical procedures in the thoracolumbar spinal cord.

Acknowledgements

KAT was supported by the Polish Ministry of Higher Education grant for young scientists.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of meta-analysis study formal consent is not required.

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Unsere Produktempfehlungen

e.Med Interdisziplinär

Kombi-Abonnement

Für Ihren Erfolg in Klinik und Praxis - Die beste Hilfe in Ihrem Arbeitsalltag

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de.

Jetzt testen ¹

e.Med Neurologie & Psychiatrie

Kombi-Abonnement

Mit e.Med Neurologie & Psychiatrie erhalten Sie Zugang zu CME-Fortbildungen der Fachgebiete, den Premium-Inhalten der dazugehörigen Fachzeitschriften, inklusive einer gedruckten Zeitschrift Ihrer Wahl.

Jetzt testen ²

e.Med Neurologie

Kombi-Abonnement

Mit e.Med Neurologie erhalten Sie Zugang zu CME-Fortbildungen des Fachgebietes, den Premium-Inhalten der neurologischen Fachzeitschriften, inklusive einer gedruckten Neurologie-Zeitschrift Ihrer Wahl.

Jetzt testen ³

e.Med Radiologie

Kombi-Abonnement

Mit e.Med Radiologie erhalten Sie Zugang zu CME-Fortbildungen des Fachgebietes Radiologie, den Premium-Inhalten der radiologischen Fachzeitschriften, inklusive einer gedruckten Radiologie-Zeitschrift Ihrer Wahl.

Jetzt testen ⁴

Electronic supplementary material

ESM 1 (DOC 64 kb)

Sukeeyamanon W, Siriapisith T, Wasinrat J (2010) Preoperative localization of Adamkiewicz arteries and their origins by using MDCT angiography. J Med Assoc Thail 93:1430–1436

Ogino H, Sasaki H, Minatoya K, Matsuda H, Yamada N, Kitamura S (2006) Combined use of Adamkiewicz artery demonstration and motor-evoked potentials in descending and thoracoabdominal repair. Ann Thorac Surg 82:592–596. https://doi.org/10.1016/j.athoracsur.2006.03.041 CrossRefPubMed

Takagi H, Ota H, Natsuaki Y, Komori Y, Ito K, Saiki Y, Takase K (2015) Identifying the Adamkiewicz artery using 3-T time-resolved magnetic resonance angiography: its role in addition to multidetector computed tomography angiography. Jpn J Radiol 33:749–756. https://doi.org/10.1007/s11604-015-0490-6 CrossRefPubMed

Gailloud P (2013) The artery of von Haller: a constant anterior radiculomedullary artery at the upper thoracic level. Neurosurgery 73:1034–1043. https://doi.org/10.1227/NEU.0000000000000163 CrossRefPubMed

Biglioli P, Roberto M, Cannata A, Parolari A, Fumero A, Grillo F, Maggioni M, Coggi G, Spirito R (2004) Upper and lower spinal cord blood supply: the continuity of the anterior spinal artery and the relevance of the lumbar arteries. J Thorac Cardiovasc Surg 127:1188–1192. https://doi.org/10.1016/j.jtcvs.2003.11.038 CrossRefPubMed

Koshino T, Murakami G, Morishita K, Mawatari T, Abe T (1999) Does the Adamkiewicz artery originate from the larger segmental arteries? J Thorac Cardiovasc Surg 117:898–905. https://doi.org/10.1016/S0022-5223(99)70369-7 CrossRefPubMed

Yamada N, Okita Y, Minatoya K, Tagusari O, Ando M, Takamiya M, Kitamura S (2000) Preoperative demonstration of the Adamkiewicz artery by magnetic resonance angiography in patients with descending or thoracoabdominal aortic aneurysms. Eur J Cardiothorac Surg 18:104–111CrossRefPubMed

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 23:1215–1225. https://doi.org/10.1148/rg.235025031 CrossRefPubMed

Fanous AA, Lipinski LJ, Krishna C, Roger EP, Siddiqui AH, Levy EI, Leonardo J, Pollina J (2015) The impact of preoperative angiographic identification of the artery of Adamkiewicz on surgical decision making in patients undergoing thoracolumbar corpectomy. Spine (Phila Pa 1976) 40:1194–1199. https://doi.org/10.1097/BRS.0000000000000909 CrossRef

10.

Nijenhuis RJ, Leiner T, Cornips EMJ, Wilmink JT, Jacobs MJ, van Engelshoven JMA, Backes WH (2004) Spinal cord feeding arteries at MR angiography for thoracoscopic spinal surgery: feasibility study and implications for surgical approach. Radiology 233:541–547. https://doi.org/10.1148/radiol.2331031672 CrossRefPubMed

11.

Henry BM, Tomaszewski KA, Ramakrishnan PK, Roy J, Vikse J, Loukas M, Tubbs RS, Walocha JA (2017) Development of the anatomical quality assessment (AQUA) tool for the quality assessment of anatomical studies included in meta-analyses and systematic reviews. Clin Anat 30:6–13. https://doi.org/10.1002/ca.22799 CrossRefPubMed

12.

Higgins J, Green S (eds) (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]

13.

Henry BM, Tomaszewski KA, Walocha JA (2016) Methods of evidence-based anatomy: a guide to conducting systematic reviews and meta-analysis of anatomical studies. Ann Anat 205:16–21. https://doi.org/10.1016/j.aanat.2015.12.002 CrossRefPubMed

14.

Fereshetian A, Kadir S, Kaufman SL, Mitchell SE, Murray RR, Kinnison ML, Williams GM (1989) Digital subtraction spinal cord angiography in patients undergoing thoracic aneurysm surgery. Cardiovasc Intervent Radiol 12:7–9CrossRefPubMed

15.

Guziński M, Bryl M, Ziemińska K, Wolny K, Sąsiadek M, Garcarek J (2017) Detection of the Adamkiewiczartery in computed tomography of the thorax and abdomen. Adv Clin Exp Med 26:31–37. https://doi.org/10.17219/acem/62788 CrossRefPubMed

16.

Alleyne CH, Cawley CM, Shengelaia GG, Barrow DL (1998) Microsurgical anatomy of the artery of Adamkiewicz and its segmental artery. J Neurosurg 89:791–795. https://doi.org/10.3171/jns.1998.89.5.0791 CrossRefPubMed

17.

Amako M, Yamamoto Y, Nakamura K et al (2011) Preoperative visualization of the artery of Adamkiewicz by dual-phase CT angiography in patients with aortic aneurysm. Kurume Med J 58:117–125CrossRefPubMed

18.

Bachet J, Guilmet D, Rosier J et al (1996) Protection of the spinal cord during surgery of thoraco-abdominal aortic aneurysms. Eur J Cardiothorac Surg 10:817–825CrossRefPubMed

19.

Backes WH, Nijenhuis RJ, Mess WH, Wilmink FA, Schurink GWH, Jacobs MJ (2008) Magnetic resonance angiography of collateral blood supply to spinal cord in thoracic and thoracoabdominal aortic aneurysm patients. J Vasc Surg 48:261–271. https://doi.org/10.1016/j.jvs.2008.03.015 CrossRefPubMed

20.

Bley TA, Duffek CC, François CJ, Schiebler ML, Acher CW, Mell M, Grist TM, Reeder SB (2010) Presurgical localization of the artery of Adamkiewicz with time-resolved 3.0-T MR angiography. Radiology 255:873–881. https://doi.org/10.1148/radiol.10091304 CrossRefPubMed

21.

Boll DT, Bulow H, Blackham KA, Aschoff AJ, Schmitz BL (2006) MDCT angiography of the spinal vasculature and the artery of Adamkiewicz. AJR Am J Roentgenol 187:1054–1060. https://doi.org/10.2214/AJR.05.0562 CrossRefPubMed

22.

Bowen BC, DePrima S, Pattany PM, Marcillo A, Madsen P, Quencer RM (1996) MR angiography of normal intradural vessels of the thoracolumbar spine. AJNR Am J Neuroradiol 17:483–494PubMed

23.

Champlin AM, Rael J, Benzel EC, Kesterson L, King JN, Orrison WW, Mirfakhraee M (1994) Preoperative spinal angiography for lateral extracavitary approach to thoracic and lumbar spine. AJNR Am J Neuroradiol 15:73–77PubMed

24.

Charles YP, Barbe B, Beaujeux R, Boujan F, Steib JP (2011) Relevance of the anatomical location of the Adamkiewicz artery in spine surgery. Surg Radiol Anat 33:3–9. https://doi.org/10.1007/s00276-010-0654-0 CrossRefPubMed

25.

Furukawa K, Kamohara K, Nojiri J, Egashira Y, Okazaki Y, Kudo S, Morita S (2010) Operative strategy for descending and thoracoabdominal aneurysm repair with preoperative demonstration of the Adamkiewicz artery. Ann Thorac Surg 90:1840–1846. https://doi.org/10.1016/j.athoracsur.2010.07.056 CrossRefPubMed

26.

Heinemann MK, Brassel F, Herzog T et al (1998) The role of spinal angiography in operations on the thoracic aorta: myth or reality? Ann Thorac Surg 65:346–351CrossRefPubMed

27.

Hyodoh H, Kawaharada N, Akiba H, Tamakawa M, Hyodoh K, Fukada J, Morishita K, Hareyama M (2005) Usefulness of preoperative detection of artery of Adamkiewicz with dynamic contrast-enhanced MR angiography. Radiology 236:1004–1009. https://doi.org/10.1148/radiol.2363040911 CrossRefPubMed

28.

Hyodoh H, Shirase R, Akiba H, Tamakawa M, Hyodoh K, Yama N, Shonai T, Hareyama M (2007) Double-subtraction maximum intensity projection MR angiography for detecting the artery of Adamkiewicz and differentiating it from the drainage vein. J Magn Reson Imaging 26:359–365. https://doi.org/10.1002/jmri.21024 CrossRefPubMed

29.

Hyodoh H, Shirase R, Kawaharada N et al (2009) MR angiography for detecting the artery of Adamkiewicz and its branching level from the aorta. Magn Reson Med Sci 8:159–164CrossRefPubMed

30.

Jaspers K, Nijenhuis RJ, Backes WH (2007) Differentiation of spinal cord arteries and veins by time-resolved MR angiography. J Magn Reson Imaging 26:31–40. https://doi.org/10.1002/jmri.20940 CrossRefPubMed

31.

Kawaharada N, Morishita K, Fukada J, Yamada A, Muraki S, Hyodoh H, Abe T (2002) Thoracoabdominal or descending aortic aneurysm repair after preoperative demonstration of the Adamkiewicz artery by magnetic resonance angiography. Eur J Cardiothorac Surg 21:970–974CrossRefPubMed

32.

Hachiro Y, Kawaharada N, Morishita K, Fukada J, Fujisawa Y, Kurimoto Y, Abe T (2004) Thoracoabdominal aortic aneurysm repair after detection of the Adamkiewicz artery by magnetic resonance angiography; a way to shorten operating time and improve outcome. Kyobu Geka 57:280–283PubMed

33.

Kawaharada N, Morishita K, Kurimoto Y et al (2007) Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta. Eur J Cardiothorac Surg 31:998–1003. https://doi.org/10.1016/j.ejcts.2007.01.069 CrossRefPubMed

34.

Kieffer E, Richard T, Chiras J, Godet G, Cormier E (1989) Preoperative spinal cord arteriography in aneurysmal disease of the descending thoracic and thoracoabdominal aorta: preliminary results in 45 patients. Ann Vasc Surg 3:34–46. https://doi.org/10.1016/S0890-5096(06)62382-0 CrossRefPubMed

35.

Kieffer E, Fukui S, Chiras J, Koskas F, Bahnini A, Cormier E (2002) Spinal cord arteriography: a safe adjunct before descending thoracic or thoracoabdominal aortic aneurysmectomy. J Vasc Surg 35:262–268CrossRefPubMed

36.

Kovács A, Schiller W, Gerhards HM, Welz A, Willinek W, Schild H, Urbach H, Flacke S (2009) Visualization of the Adamkiewicz artery in patients with acute Stanford A dissections: a prospective 64-row multi-detector CT study. Rofo 181:870–874. https://doi.org/10.1055/s-0028-1109441 CrossRefPubMed

37.

Kroszczynski AC, Kohan K, Kurowski M, Olson TR, Downie SA (2013) Intraforaminal location of thoracolumbar anterior medullary arteries. Pain Med 14:808–812. https://doi.org/10.1111/pme.12056 CrossRefPubMed

38.

Kudo K, Terae S, Asano T, Oka M, Kaneko K, Ushikoshi S, Miyasaka K (2003) Anterior spinal artery and artery of Adamkiewicz detected by using multi-detector row CT. AJNR Am J Neuroradiol 24:13–17PubMed

39.

Matsuda H, Fukuda T, Iritani O, Nakazawa T, Tanaka H, Sasaki H, Minatoya K, Ogino H (2010) Spinal cord injury is not negligible after TEVAR for lower descending aorta. Eur J Vasc Endovasc Surg 39:179–186. https://doi.org/10.1016/j.ejvs.2009.11.014 CrossRefPubMed

40.

Matsuda H, Ogino H, Fukuda T, Iritani O, Sato S, Iba Y, Tanaka H, Sasaki H, Minatoya K, Kobayashi J, Yagihara T (2010) Multidisciplinary approach to prevent spinal cord ischemia after thoracic endovascular aneurysm repair for distal descending aorta. Ann Thorac Surg 90:561–565. https://doi.org/10.1016/j.athoracsur.2010.04.067 CrossRefPubMed

41.

Melissano G, Bertoglio L, Civelli V, Moraes Amato AC, Coppi G, Civilini E, Calori G, de Cobelli F, del Maschio A, Chiesa R (2009) Demonstration of the Adamkiewicz artery by multidetector computed tomography angiography analysed with the open-source software OsiriX. Eur J Vasc Endovasc Surg 37:395–400. https://doi.org/10.1016/j.ejvs.2008.12.022 CrossRefPubMed

42.

Mordasini P, El-Koussy M, Schmidli J et al (2012) Preoperative mapping of arterial spinal supply using 3.0-T MR angiography with an intravasal contrast medium and high-spatial-resolution steady-state. Eur J Radiol 81:979–984. https://doi.org/10.1016/J.EJRAD.2011.02.025 CrossRefPubMed

43.

Morishita K, Murakami G, Fujisawa Y, Kawaharada N, Fukada J, Saito T, Abe T (2003) Anatomical study of blood supply to the spinal cord. Ann Thorac Surg 76:1967–1971CrossRefPubMed

44.

Murthy NS, Maus TP, Behrns CL (2010) Intraforaminal location of the great anterior radiculomedullary artery (artery of Adamkiewicz): a retrospective review. Pain Med 11:1756–1764. https://doi.org/10.1111/j.1526-4637.2010.00948.x CrossRefPubMed

45.

Nakayama Y, Awai K, Yanaga Y, Nakaura T, Funama Y, Hirai T, Yamashita Y (2008) Optimal contrast medium injection protocols for the depiction of the Adamkiewicz artery using 64-detector CT angiography. Clin Radiol 63:880–887. https://doi.org/10.1016/j.crad.2008.01.009 CrossRefPubMed

46.

Nijenhuis RJ, Jacobs MJ, Schurink GW, Kessels AGH, van Engelshoven JMA, Backes WH (2007) Magnetic resonance angiography and neuromonitoring to assess spinal cord blood supply in thoracic and thoracoabdominal aortic aneurysm surgery. J Vasc Surg 45:71–77; discussion 77-8. https://doi.org/10.1016/j.jvs.2006.08.085 CrossRefPubMed

47.

Nijenhuis RJ, Jacobs MJ, Jaspers K, Reijnders M, van Engelshoven JMA, Leiner T, Backes WH (2007) Comparison of magnetic resonance with computed tomography angiography for preoperative localization of the Adamkiewicz artery in thoracoabdominal aortic aneurysm patients. J Vasc Surg 45:677–685. https://doi.org/10.1016/j.jvs.2006.11.046 CrossRefPubMed

48.

Nishida J, Kitagawa K, Nagata M, Yamazaki A, Nagasawa N, Sakuma H (2014) Model-based iterative reconstruction for multi-detector row CT assessment of the Adamkiewicz artery. Radiology 270:282–291. https://doi.org/10.1148/radiol.13122019 CrossRefPubMed

49.

Nishii T, Kono AK, Negi N, Hashimura H, Uotani K, Okita Y, Sugimura K (2013) The feasibility of a 64-slice MDCT for detection of the Adamkiewicz artery: comparison of the detection rate of intravenous injection CT angiography using a 64-slice MDCT versus intra-arterial and intravenous injection CT angiography using a 16-slice MDCT. Int J Cardiovasc Imaging 29(Suppl 2):127–133. https://doi.org/10.1007/s10554-013-0301-z CrossRefPubMed

50.

Nojiri J, Matsumoto K, Kato A, Miho T, Furukawa K, Ohtsubo S, Itoh T, Kudo S (2007) The Adamkiewicz artery: demonstration by intra-arterial computed tomographic angiography. Eur J Cardiothorac Surg 31:249–255. https://doi.org/10.1016/j.ejcts.2006.11.024 CrossRefPubMed

51.

Ou P, Schmit P, Layouss W, Sidi D, Bonnet D, Brunelle F (2007) CT angiography of the artery of Adamkiewicz with 64-section technology: first experience in children. AJNR Am J Neuroradiol 28:216–219PubMed

52.

Polaczek M, Maslanka M, Skadorwa T, Ciszek B (2014) How does Adamkiewicz artery influence blood supply to the fetal spinal cord? Ital J Anat Embryol 119:255–262PubMed

53.

Rodriguez-Baeza A, Muset-Lara A, Rodriguez-Pazos M, Domenech-Mateu JM (1991) The arterial supply of the human spinal cord: a new approach to the arteria radicularis magna of Adamkiewicz. Acta Neurochir 109:57–62CrossRefPubMed

54.

Schurink GWH, Nijenhuis RJ, Backes WH, Mess W, de Haan MW, Mochtar B, Jacobs MJ (2007) Assessment of spinal cord circulation and function in endovascular treatment of thoracic aortic aneurysms. Ann Thorac Surg 83:S877–S881. https://doi.org/10.1016/j.athoracsur.2006.11.028 CrossRefPubMed

55.

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 223:39–45. https://doi.org/10.1148/radiol.2231010513 CrossRefPubMed

56.

Takase K, Akasaka J, Sawamura Y (2007) Preoperative MDCT evaluation of the artery of Adamkiewicz and its origin. J Vasc Surg 45:1086. https://doi.org/10.1016/j.jvs.2007.03.005 CrossRef

57.

Tanaka H, Ogino H, Minatoya K, Matsui Y, Higami T, Okabayashi H, Saiki Y, Aomi S, Shiiya N, Sawa Y, Okita Y, Sueda T, Akashi H, Kuniyoshi Y, Katsumata T (2016) The impact of preoperative identification of the Adamkiewicz artery on descending and thoracoabdominal aortic repair. J Thorac Cardiovasc Surg 151:122–128. https://doi.org/10.1016/j.jtcvs.2015.07.079 CrossRefPubMed

58.

Uotani K, Yamada N, Kono AK, Taniguchi T, Sugimoto K, Fujii M, Kitagawa A, Okita Y, Naito H, Sugimura K (2008) Preoperative visualization of the artery of Adamkiewicz by intra-arterial CT angiography. AJNR Am J Neuroradiol 29:314–318. https://doi.org/10.3174/ajnr.A0812 CrossRefPubMed

59.

Williams GM, Perler BA, Burdick JF, Osterman FA Jr, Mitchell S, Merine D, Drenger B, Parker SD, Beattie C, Reitz BA (1991) Angiographic localization of spinal cord blood supply and its relationship to postoperative paraplegia. J Vasc Surg 13:23–33 discussion 33–5CrossRefPubMed

60.

Yingbin J, Jiefei M, Jian L, Yonghui S, Haiyan P, Baimeng Z, Weigoo F (2013) Evaluation of the thoracic aortic dissection treated by endografts covering a longer distance of aorta according to the location of the Adamkiewicz artery. Thorac Cardiovasc Surg 61:569–574. https://doi.org/10.1055/s-0032-1322629 CrossRefPubMed

61.

Yoshioka K, Niinuma H, Ehara S, Nakajima T, Nakamura M, Kawazoe K (2006) MR angiography and CT angiography of the artery of Adamkiewicz: state of the art. Radiographics 26(Suppl 1):S63–S73. https://doi.org/10.1148/rg.26si065506 CrossRefPubMed

62.

Zhao S, Logan L, Schraedley P, Rubin GD (2009) Assessment of the anterior spinal artery and the artery of Adamkiewicz using multi-detector CT angiography. Chin Med J 122:145–149PubMed

63.

Griepp RB, Ergin MA, Galla JD, Lansman S, Khan N, Quintana C, McCollough J, Bodian C (1996) Looking for the artery of Adamkiewicz: a quest to minimize paraplegia after operations for aneurysms of the descending thoracic and thoracoabdominal aorta. J Thorac Cardiovasc Surg 112:1202–1213 discussion 1213–5CrossRefPubMed

64.

Buffolo E, da Fonseca JHP, de Souza JAM, Alves CMR (2002) Revolutionary treatment of aneurysms and dissections of descending aorta: the endovascular approach. Ann Thorac Surg 74:S1815–S1817 discussion S1825-32CrossRefPubMed

65.

Ishimaru S, Kawaguchi S, Koizumi N, Obitsu Y, Ishikawa M (1998) Preliminary report on prediction of spinal cord ischemia in endovascular stent graft repair of thoracic aortic aneurysm by retrievable stent graft. J Thorac Cardiovasc Surg 115:811–818. https://doi.org/10.1016/S0022-5223(98)70360-5 CrossRefPubMed

66.

Safi HJ, Miller CC, Carr C, Iliopoulos DC, Dorsay DA, Baldwin JC (1998) Importance of intercostal artery reattachment during thoracoabdominal aortic aneurysm repair. J Vasc Surg 27:58–66 discussion 66–8CrossRefPubMed

67.

Wadouh F, Wadouh R, Hartmann M, Crisp-Lindgren N (1990) Prevention of paraplegia during aortic operations. Ann Thorac Surg 50:543–552CrossRefPubMed

68.

Taira Y, Marsala M (1996) Effect of proximal arterial perfusion pressure on function, spinal cord blood flow, and histopathologic changes after increasing intervals of aortic occlusion in the rat. Stroke 27:1850–1858CrossRefPubMed

69.

Yoshioka K, Niinuma H, Kawazoe K, Ehara S (2005) Three-dimensional demonstration of the collateral circulation to the artery of Adamkiewicz via internal thoracic artery with 16-row multi-slice CT. Eur J Cardiothorac Surg 28:492. https://doi.org/10.1016/j.ejcts.2005.04.043 CrossRefPubMed

Titel: Artery of Adamkiewicz: a meta-analysis of anatomical characteristics
verfasst von: Dominik Taterra
Bendik Skinningsrud
Przemysław A. Pękala
Wan Chin Hsieh
Roberto Cirocchi
Jerzy A. Walocha
R. Shane Tubbs
Krzysztof A. Tomaszewski
Brandon Michael Henry
Publikationsdatum: 27.04.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Neuroradiology / Ausgabe 8/2019
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-019-02207-y

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

23.04.2024 | Demenz | Nachrichten

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Electronic supplementary material

Publisher’s note

Introduction

Materials and methods

Search strategy

Eligibility assessment

Data extraction

Quality assessment

Statistical analysis

Results

Study identification and characteristics of included studies

Quality assessment

Prevalence of the artery of Adamkiewicz

Number of arteries of Adamkiewicz per patient

Origin of the artery of Adamkiewicz

Continuity of the artery of Adamkiewicz

Morphometric analysis of the artery of Adamkiewicz

Discussion

Conclusions

Acknowledgements

Compliance with ethical standards

Conflict of interest

Ethical approval

Informed consent

Publisher’s note

Unsere Produktempfehlungen

e.Med Interdisziplinär

e.Med Neurologie & Psychiatrie

e.Med Neurologie

e.Med Radiologie

Electronic supplementary material

Weitere Artikel der Ausgabe 8/2019

Letter regarding “Artery of Adamkiewicz: a meta-analysis of anatomical characteristics”

Hypothalamic malformations in patients with X-linked deafness and incomplete partition type 3

Diagnostic assessment of foetal brain malformations with intra-uterine MRI versus perinatal post-mortem MRI

Evaluation of multiparametric MRI differentiating sinonasal angiomatous polyp from malignant tumors

Dysregulation of resting-state functional connectivity in patients with Cushing’s disease

Differentiation of lymphomatous, metastatic, and non-malignant lymphadenopathy in the neck with quantitative diffusion-weighted imaging: systematic review and meta-analysis

Leitlinien kompakt für die Neurologie

Neu im Fachgebiet Neurologie

Demenzkranke durch Antipsychotika vielfach gefährdet

Parkinson-Therapie im Wandel – aktuelle Leitlinie im Fokus

Auf diese Krankheiten bei Geflüchteten sollten Sie vorbereitet sein

Hustenstiller lindert Agitation bei Alzheimer

Update Neurologie