Intercostal artery

Segmental arteries supply the spine with blood, including the vertebral bodies, paraspinal muscles, dura, nerve roots, and spinal cord. All these tissues, with the exception of the spinal cord, receive their blood supply from segmental arteries (one on each side) or their equivalents. In particular, the segmental supply of the thoracolumbar region is derived from intercostal and lumbar arteries arising from... 

Compared with brain ischemia spinal cord strokes are caused by more diverse etiologies. Up-to-now there is no satisfactory and accepted classification of spinal infarcts. Etiologies include circulatory arterial and venous disorders. From a clinical and pathoanatomical point of view it seems reasonable to differentiate between acute ischemic myelomalacia and subacute to chronic vascular myelopathy (Table 17.1). In most cases MRI enables the differentiation of these two main etiologies. A deficient spinal arterial blood flow generally has various causes, ranging from the occlusion of intercostal or lumbar arteries to affection of the intrinsic arteries of the spinal cord. ... 

Exophytic tumors - Exophytic tumors can be challenging due to their complex vascular supply. Vascular tumors, especially HCC, can parasitize blood flow from many other sources, such as intercostal arteries, renal and adrenal arteries, as well as the splenic artery. A transcatheter CT angiogram can be performed with the catheter in the vessel of interest. Contrast is injected directly into the catheter while CT images of the liver are acquired, giving an extremely accurate view of contrast distribution [8J. If no extra-tumoral blood flow is seen, one can use this vessel to deliver Y microspheres. 

Vujic I, Pyle R, Parker E, et al. (1980) Control of massive hemoptysis hy embolization of intercostal arteries. Radiology 137 617-620... 

Fig. 16.1. Curved multi-planar reconstruction of CT of the thoracic aorta, clearly demonstrating the origin arrowhead) and bifurcation into intercostal branches and bronchial artery arrow) of right inter-costobronchial trunk...

The most commonly occurring complication encountered after bronchial artery embolization is (transient) chest pain, being reported in 24% up to 91% of cases. This is probably related to ischemia of embolized branches, and can be severe when intercostal branches are inadvertently embolized. Pleural pain can be avoided by using superselec-tive embolization techniques, with or without the use of large particles. The second most common complication is dysphagia, caused by embolization of esophageal branches, with a reported occurrence from 0.7% to 18.2% [30]. Spontaneous resolution of symptoms usually occurs. 

Benjamin RS et al. (1992) Preoperative chemotherapy for osteosarcoma with intravenous adriamycin and intra-arterial cis-platinum. Ann Oncol 3 Suppl 2 S3-6 Boriani S et al. (2001) Aneurysmal bone cyst of the mobile spine report on 41 cases. Spine 26 27-35 Botenga ASJ (1970) Selective bronchial and intercostal arteriography. HE Steinfert Kroese NV/Leiden Brasch RC et al. (2000) In vivo monitoring of tumor angiogenesis with MR imaging. Acad Radiol 7 812-823 Brennan M (1987) Adrenocortical carcinoma. CA Cancer J Clin 37 348-365... 

In one case, an asymptomatic intercostal artery injection occurred during vertebroplasty of a hyper-vascularized breast cancer metastasis. Thus, hyper-vascularized lesions should be evaluated by phle-bogram in anteroposterior and lateral views prior to cementoplasty, particularly in the dorsolumbar region (Tll-Ll). 

The ASA is transversely reinforced by branches of deep cervical arteries at the neck and by posterior intercostal (PIA) and upper lumbar arteries at the trunk. Both of the latter derive segmentally from the descending thoracic and abdominal aorta and range between 0.5 and 5mm in diameter (Boll et al. 2006). The PIA and lumbar arteries send rami dorsales, from which again the radicular arteries (synonymous with radicomed-ullary artery or spinal branch) as feeders of the spinal cord originate. The radicular arteries divide soon into anterior and posterior branches that support either the anterior or the posterior spinal arteries. 

Fig. 24.1. Anatomy of feeding arteries of the spinal cord. 1 vertebral artery, 2 left subclavian artery, 3 posterior intercostal artery, 4 anterior spinal artery, 5 Adamkiewicz artery,...

Standard transverse images reconstructed from a 3D data set with overlapping thin slices may be sufficient for visualization of the posterior intercostal and lumbar arteries as well as of their proximal rami dorsales. The AKA or other anterior radicular arteries of significant dimension may be localized on transverse sections as well, if a second vessel with arterial contrast begins to accompany the usually sohtary ASA in the thoracolumbar region (Fig. 24.2). 

Fig. 24.5a,b. Curved MPR before and after endovascular repair. Although occluded by an endograft, the posterior intercostal artery, PIA (arrowhead) remains fully visible on the postoperative study... 

Safi HJ, Miller CC III, Carr C etal. (1998) Importance of intercostal artery reattachment during thoracoabdominal aortic aneurysm repair. J Vase Surg 27 58 66 discussion 66-8... 

Some advanced or superficial tumors may parasitize arterial supply from the arteries of adjacent organs, especially after multiple prior embolization procedures. Such parasitization may require embolization of branches arising from such arteries as the right renal, colonic, gastric, phrenic, internal thoracic, and intercostal arteries. It is important to recognize that not all such parasitized vessels can be safely treated without risk to other important organs. 

Perforating arteries, an important collateral pathway to the kidney, arise from the intraparenchymal branches of the renal artery and exit from the kidney to anastomose with various retroperitoneal arteries [18]. In addition to the main renal artery and perforating arteries, the superior, middle, and inferior capsular arteries should be considered as well. The superior capsular artery may arise from the inferior adrenal artery, main renal artery, or aorta. The middle capsular artery, which may consist of one or more branches, arises from the main renal artery. The inferior capsular artery may originate from the gonadal artery, an accessory or aberrant lower pole, or even the main renal artery. These vessels form a rich capsular network that anastomoses freely with perforating arteries and other retroperitoneal (especially lumbar) arteries and also with internal iliac, intercostal, and mesenteric arteries [18]. 

Fig. 23.11a-d). Coil embolization or surgical ligation of bronchial arteries should be avoided because they hinder subsequent catheterization of the proximally occluded vessel. Careful attention should be paid for the identification of spinal arteries arising from the bronchial or intercostal arteries. The localizing value of emergency bronchoscopy or multidetector CT scanning prior to embolization remains to be evaluated. 

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