Intercostal branch

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...

Fig. 16.16a-c. a Selective catherization of right intercostobronchial trunk with Simmons type 1 catheter notice non-reformed shape, with point of catheter pointing upwards (arrowhead) filling of both intercostal and bronchial branches, b Same patient as in (a), after advancement of microcatheter (arrow) through 4-F diagnostic catheter (arrowhead), c Superselective angiography through microcatheter no flow into intercostal branches is seen, with clear depiction of bronchial vasculature (arrow)... 

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. 

FIGURE 43-1 Motor endplates from rabbit intercostal muscle stained with Lowit s gold chloride method, a, terminal axonal arborization b, nucleus d, region where the myelin sheath ends n, neural branch. (From Ramon y Cajal, S. Textura del sistema nervioso del hombre y los vertebrados. Madrid N. Moya, 1899.)... 

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. 

Surgical acute pain amitriptyline may be beneficial for adjunctive use for pain control as well as nighttime sedation. Patients recovering from amputation, traumatic or surgical nerve injuries (intercostal nerves, branches of the brachial plexus, inguinal and genitofemoral nerve, etc.). Consider starting dose of 12.5-25 mg qhs and increase to 50 mg as tolerated. Monitor for urinary retention/constipation that may coincide with post-operative symptoms. Consider nortriptyline or desipramine to reduce side effects. 

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]. 

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