Ascending and Descending Thoracic Vertebral Arteries

Fellows’ Journal Club

The authors report the angiographic anatomy and clinical significance of 9 cases of descending and 2 cases of ascending thoracic vertebral arteries. Located within the upper costotransverse spaces, ascending and descending thoracic vertebral arteries may have important implications during spine interventional or surgical procedures. They frequently provide radiculomedullary or bronchial branches, so they can also be implicated in spinal cord ischemia, as a supply of vascular malformations, or be a source of hemoptysis.

Summary

Figure 1 from paper
Schematic representation of ascending and descending thoracic vertebral arteries. In its most typical form, a descending thoracic VA (right side) originates from the pretransverse segment (V1) of the cervical VA and curves sharply medially and caudally to enter the last transverse foramen or the first costotransverse space. It then continues caudally, passing through 1 or more costotransverse space, generally branching off a complete set of branches for the second and third thoracic ISAs (T2 and T3) and the medial branch of the first thoracic ISA (T1). In about 50% of cases, a descending thoracic VA provides an important contribution to the spinal cord vascularization. An ascending thoracic VA (left side) is the cranial prolongation of a thoracic ISA, which passes through 1 or more costotransverse space before continuing as a normal cervical VA. Strictly speaking, the thoracic VA segment only corresponds to the portion of the vessel delimited by costotransverse spaces (highlighted in green).

Thoracic vertebral arteries are anastomotic chains similar to cervical vertebral arteries but found at the thoracic level. Descending thoracic vertebral arteries originate from the pretransverse segment of the cervical vertebral artery and curve caudally to pass into the last transverse foramen or the first costotransverse space. Ascending thoracic vertebral arteries originate from the aorta, pass through at least 1 costotransverse space, and continue cranially as the cervical vertebral artery. This report describes the angiographic anatomy and clinical significance of 9 cases of descending and 2 cases of ascending thoracic vertebral arteries. Being located within the upper costotransverse spaces, ascending and descending thoracic vertebral arteries can have important implications during spine interventional or surgical procedures. Because they frequently provide radiculomedullary or bronchial branches, they can also be involved in spinal cord ischemia, supply vascular malformations, or be an elusive source of hemoptysis.

 

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Ascending and Descending Thoracic Vertebral Arteries
jross
Jeffrey Ross • Mayo Clinic, Phoenix

Dr. Jeffrey S. Ross is a Professor of Radiology at the Mayo Clinic College of Medicine, and practices neuroradiology at the Mayo Clinic in Phoenix, Arizona. His publications include over 100 peer-reviewed articles, nearly 60 non-refereed articles, 33 book chapters, and 10 books. He was an AJNR Senior Editor from 2006-2015, is a member of the editorial board for 3 other journals, and a manuscript reviewer for 10 journals. He became Editor-in-Chief of the AJNR in July 2015. He received the Gold Medal Award from the ASSR in 2013.

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