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Cureus Feb 2024Takayasu arteritis is a chronic, idiopathic, inflammatory disease mainly affecting medium and large vessels with a significant rate of morbidity and mortality. The...
Takayasu arteritis is a chronic, idiopathic, inflammatory disease mainly affecting medium and large vessels with a significant rate of morbidity and mortality. The vessels most frequently affected are the aorta and its branches; branches originating from the aortic arch include right brachiocephalic trunk and its branches, left common carotid artery, left subclavian artery, coronary arteries from the ascending aorta, celiac trunk, right and left renal arteries, superior and inferior mesenteric arteries from the descending aorta, and right and left iliofemoral arteries. Local and systemic inflammation along with end organ ischemia is attributed to severe clinical manifestations associated with this condition. Although Takayasu arteritis is more commonly diagnosed in adults, this study highlights the unusual occurrence of childhood-onset Takayasu arteritis (TAK), presenting a unique set of diagnostic challenges. We present a case of a seven-year-old female patient who manifested atypical symptoms, such as absent pulses and malignant hypertension at an early age, leading to a delayed diagnosis. The patient's clinical course, including diagnostic workup and imaging studies such as CT or MR angiography, is thoroughly discussed. This study emphasizes the importance of recognizing the subtleties of Takayasu arteritis in children. The disease may initially masquerade as other common conditions, such as peripheral arterial disease, coarctation of aorta, renal artery stenosis, chronic renal disease, and increased intracranial pressure, thereby hindering timely diagnosis and appropriate intervention. This case underscores the importance of considering Takayasu arteritis as a differential diagnosis in children, presenting with unexplained constitutional symptoms or signs of systemic vasculitis, emphasizing the need for multidisciplinary collaboration and tailored therapeutic intervention to optimize the outcome in this rare and potentially debilitating condition.
PubMed: 38465111
DOI: 10.7759/cureus.53885 -
Science Progress 2023Guidewire occasionally creates a loop-like appearance between the right subclavian artery and brachiocephalic artery when performing coronary angiography (CAG) with...
A possible mechanism and predictors of forming looped guidewire between the right subclavian and brachiocephalic artery during coronary angiography with right radial artery access: An original paper.
OBJECTIVES
Guidewire occasionally creates a loop-like appearance between the right subclavian artery and brachiocephalic artery when performing coronary angiography (CAG) with right radial artery (RtRA) access. We called this occurrence a looped guidewire at the brachiocephalic artery (looped GW at BA). It is associated with difficulties in catheter manipulation. This study aimed to assess the predictors of forming a looped GW at the BA.
METHODS
We examined 175 (mean age, 71.3 ± 9.5 years; 74.9% men) consecutive patients who underwent elective CAG with the RtRA access. Looped GW at the BA was defined as a loop-like appearance of the 0.035-inch GW between the right subclavian and brachiocephalic artery on a frontal view or left anterior oblique. To identify the predictors of looped GW at BA, patient characteristics and examination data obtained before CAG were compared between patients with and without looped GW at the BA.
RESULTS
The prevalence of looped GW at BA was 10.9%. The cardio-ankle vascular index (CAVI), which reflects arterial stiffness, was significantly different in patients with or without looped GW at BA (9.8 ± 1.0 vs. 8.9 ± 1.5, p= 0.0092). The area under the receiver-operating characteristic curve of CAVI to predict looped GW at BA was 0.745, with 0.94 sensitivity and 0.57 specificity in a cutoff point of CAVI ≥9.0.
CONCLUSIONS
Looped GW at BA can be ruled out by CAVI and is associated with high arterial stiffness.
Topics: Male; Humans; Middle Aged; Aged; Aged, 80 and over; Female; Coronary Angiography; Radial Artery; Brachiocephalic Trunk
PubMed: 37960890
DOI: 10.1177/00368504231213801 -
BMC Cardiovascular Disorders Nov 2023Induction of chondrogenesis is associated with progressive atherosclerosis. Deficiency of the ADCYAP1 gene encoding pituitary adenylate cyclase-activating peptide...
BACKGROUND
Induction of chondrogenesis is associated with progressive atherosclerosis. Deficiency of the ADCYAP1 gene encoding pituitary adenylate cyclase-activating peptide (PACAP) aggravates atherosclerosis in ApoE deficient (ApoE) mice. PACAP signaling regulates chondrogenesis and osteogenesis during cartilage and bone development. Therefore, this study aimed to decipher whether PACAP signaling is related to atherogenesis-related chondrogenesis in the ApoE mouse model of atherosclerosis and under the influence of a high-fat diet.
METHODS
For this purpose, PACAP/ApoE, PAC1/ApoE, and ApoE mice, as well as wildtype (WT) mice, were studied under standard chow (SC) or cholesterol-enriched diet (CED) for 20 weeks. The amount of cartilage matrix in atherosclerotic lesions of the brachiocephalic trunk (BT) with maximal lumen stenosis was monitored by alcian blue and collagen II staining on deparaffinized cross sections. The chondrogenic RUNX family transcription factor 2 (RUNX2), macrophages [(MΦ), Iba1], and smooth muscle cells (SMC, sm-α-actin) were immunohistochemically analyzed and quantified.
RESULTS
ApoE mice fed either SC or CED revealed an increase of alcian blue-positive areas within the media compared to WT mice. PAC1/ApoE mice under CED showed a reduction in the alcian blue-positive plaque area in the BT compared to ApoE mice. In contrast, PACAP deficiency in ApoE mice did not affect the chondrogenic signature under either diet.
CONCLUSIONS
Our data show that PAC1 deficiency reduces chondrogenesis in atherosclerotic plaques exclusively under conditions of CED-induced hypercholesterolemia. We conclude that CED-related chondrogenesis occurs in atherosclerotic plaques via transdifferentiation of SMCs and MΦ, partly depending on PACAP signaling through PAC1. Thus, PAC1 antagonists or PACAP agonists may offer therapeutic potential against pathological chondrogenesis in atherosclerotic lesions generated under hypercholesterolemic conditions, especially in familial hypercholesterolemia. This discovery opens therapeutic perspectives to be used in the treatment against the progression of atherosclerosis.
Topics: Animals; Mice; Plaque, Atherosclerotic; Pituitary Adenylate Cyclase-Activating Polypeptide; Chondrogenesis; Alcian Blue; Atherosclerosis; Cholesterol; Diet, High-Fat; Apolipoproteins E; Mice, Knockout; Mice, Inbred C57BL
PubMed: 37980508
DOI: 10.1186/s12872-023-03600-5 -
Italian Journal of Pediatrics Jul 2023Tracheal compression (TC) due to vascular anomalies is an uncommon, but potentially serious cause of chronic respiratory disease in childhood. Vascular slings are... (Review)
Review
BACKGROUND
Tracheal compression (TC) due to vascular anomalies is an uncommon, but potentially serious cause of chronic respiratory disease in childhood. Vascular slings are congenital malformations resulting from abnormal development of the great vessels; in this group of disorders the most prevalent entity is the aberrant innominate artery (AIA). Here we provide a report on diagnosis and treatment of AIA in nine children with unexplained chronic respiratory symptoms. We describe the cases, perform a literature review, and provide a discussion on the diagnostic workup and treatment that can help manage AIA.
METHODS
Clinical history, diagnostic procedures and treatment before and after the AIA diagnosis were retrospectively reviewed in nine children (5 boys and 4 girls), who were referred for recurrent-to-chronic respiratory manifestations over 10 years (2012-2022). We performed a comprehensive report on the ongoing clinical course and treatment as well as an electronic literature search on the topic.
RESULTS
Diagnoses at referral, before AIA was identified, were chronic dry barking cough associated with recurrent pneumonia (n = 8, 89%), lobar/segmental atelectasis (n = 3, 33%), atopic/non atopic asthma (n = 3, 33%); pneumomediastinum with subcutaneous emphysema complicated the clinical course in one case. When referred to our Unit, all patients had been previously treated with repeated antibiotic courses (n = 9, 100%), alone (n = 6, 67%) or combined with prolonged antiasthma medications (n = 3, 33%) and/or daily chest physiotherapy (n = 2, 22%), but reported only partial clinical benefit. Median ages at symptom onset and at AIA diagnosis were 1.5 [0.08-13] and 6 [4-14] years, respectively, with a relevant delay in the definitive diagnosis (4.5 years). Tracheal stenosis at computed tomography (CT) was ≥ 51% in 4/9 cases and ≤ 50% in the remaining 5 subjects. Airway endoscopy was performed in 4 cases with CT evidence of tracheal stenosis ≥ 51% and confirmed CT findings. In these 4 cases, the decision of surgery was made based on endoscopy and CT findings combined with persistence of clinical symptoms despite medical treatment. The remaining 5 children were managed conservatively.
CONCLUSIONS
TC caused by AIA may be responsible for unexplained chronic respiratory disease in childhood. Early diagnosis of AIA can decrease the use of expensive investigations or unsuccessful treatments, reduce disease morbidity, and accelerate the path toward a proper treatment.
Topics: Male; Child; Female; Humans; Brachiocephalic Trunk; Retrospective Studies; Tracheal Stenosis; Cough; Asthma; Disease Progression
PubMed: 37480082
DOI: 10.1186/s13052-023-01473-0 -
Journal of Veterinary Science Mar 2024Aortic arch (AA) branching patterns vary among different mammalian species. Most previous studies have focused on dogs, whereas those on raccoon dogs remain unexplored.
BACKGROUND
Aortic arch (AA) branching patterns vary among different mammalian species. Most previous studies have focused on dogs, whereas those on raccoon dogs remain unexplored.
OBJECTIVES
The objective of this study was to describe the AA branching pattern in raccoon dogs and compare their morphological features with those of other carnivores.
METHODS
We prepared silicone cast specimens from a total of 36 raccoon dog carcasses via retrograde injection through the abdominal aorta. The brachiocephalic trunk (BCT) branching patterns were classified based on the relationship between the left and right common carotid arteries. The subclavian artery (SB) branching pattern was examined based on the order of the four major branches: the vertebral artery (VT), costocervical trunk (CCT), superficial cervical artery (SC), and internal thoracic artery (IT).
RESULTS
In most cases (88.6%), the BCT branched off from the left common carotid artery and terminated in the right common carotid and right subclavian arteries. In the remaining cases (11.4%), the BCT formed a bicarotid trunk. The SB exhibited various branching patterns, with 26 observed types. Based on the branching order of the four major branches, we identified the main branching pattern, in which the VT branched first (98.6%), the CCT branched second (81.9%), the SC branched third (62.5%), and the IT branched fourth (52.8%).
CONCLUSIONS
The AA branching pattern in raccoon dogs exhibited various branching patterns with both similarities and differences compared to other carnivores.
Topics: Animals; Raccoon Dogs; Aorta, Thoracic; Subclavian Artery; Carotid Artery, Common; Cadaver
PubMed: 38568833
DOI: 10.4142/jvs.23305 -
Surgical and Radiologic Anatomy : SRA Jul 2023The current cadaveric report describes a rare case of a thyroidea ima artery (TIA) with multiple branching pattern over the trachea.
PURPOSE
The current cadaveric report describes a rare case of a thyroidea ima artery (TIA) with multiple branching pattern over the trachea.
METHODS
A cadaver dissection of the neck and thorax region of a formalin-embalmed 90-year-old male cadaver of a body donor took place. The body donation was made after a signed informed consent.
RESULTS
The TIA variant originated from the brachiocephalic artery before its bifurcation into the right common carotid artery (CCA) and right subclavian artery (SCA). TIA further divided into three anterior and two posterior branches, with subsequent multiple division into smaller branches. All branches were located anterior and right side to the trachea. The anterior branches supplied the infrahyoid muscles and the posterior ones supplied the thyroid gland inferior lobes and the inferior parathyroid glands. The TIA coexisted with a brachiocephalico-carotid trunk, derived after the left CCA and brachiocephalic artery fusion.
CONCLUSION
The presence of multiple arterial branches over the trachea creates a high risk for excessive bleeding during tracheotomy or cricothyroidotomy.
Topics: Male; Humans; Aged, 80 and over; Trachea; Subclavian Artery; Carotid Artery, Common; Neck; Cadaver
PubMed: 37106242
DOI: 10.1007/s00276-023-03156-1 -
World Journal of Radiology Jun 2023The course and variations of thyroid arteries must be understood by surgeons to prevent bleeding during operative procedures of the thyroid gland. There is limited...
BACKGROUND
The course and variations of thyroid arteries must be understood by surgeons to prevent bleeding during operative procedures of the thyroid gland. There is limited scientific literature regarding the radiological anatomy of thyroid arteries in this geographical area, the Garhwal region of Sub-Himalayan belt, which is considered to be the endemic belt of goiter. Computed tomography angiography provides a three-dimensional orientation of the vascular and surgical anatomy of the entire cervical region.
AIM
To estimate the proportion of variation in origin of thyroid arteries using Computed Tomography Angiography.
METHODS
Using Computed Tomography Angiography, the presence and origin of the superior thyroid artery, inferior thyroid artery, and thyroid ima artery were observed and assessed.
RESULTS
Out of total 210 subjects, superior thyroid artery was seen to be emerging from external carotid artery in 77.1% cases. The artery was found to be originating at the level of bifurcation of common carotid artery in 14.3% cases, whereas in 8.6% cases, it emerged as a direct branch of the common carotid artery. Similarly, the inferior thyroid artery was observed to be emerging from thyrocervical trunk, subclavian artery and vertebral artery in 95.7% cases, 3.3% and 1% cases, respectively. Thyroid ima artery was also reported in a subject, arising from the brachiocephalic trunk.
CONCLUSION
To avoid vascular injuries, excessive and uncontrollable bleeding, intra-operative difficulties, and post-operative issues, it is imperative for surgeons to be aware of the course and variations of thyroid arteries.
PubMed: 37424736
DOI: 10.4329/wjr.v15.i6.182 -
The American Journal of Case Reports Apr 2024BACKGROUND Aortic dissection is rare after coronary artery bypass grafting (CABG). It is a potentially fatal complication of cardiac surgery. Reoperation may pose...
BACKGROUND Aortic dissection is rare after coronary artery bypass grafting (CABG). It is a potentially fatal complication of cardiac surgery. Reoperation may pose problems with thoracotomy, adhesiolysis, and myocardial protection. No standard treatment guidelines exist for chronic aortic dissection after CABG. We present a case of chronic type A aortic dissection after cardiac surgery, which was successfully treated. CASE REPORT A 65-year-old female patient presented with a medical background of hypertension, type 2 diabetes mellitus, and hyperlipidemia.No connective tissue disorders were diagnosed. The aortic valve was tricuspid. Three years ago, she had undergone coronary artery bypass grafting involving four branches at a different medical facility. She was complaining of chest pain weeks after bypass surgery, which gradually increased. Aortic dissection was observed in the latest contrast-enhanced CT scan. Beginning from just above the sinotubular junction and reaching below the brachiocephalic trunk. Two grafts from the saphenous vein were patent, and one was lying just below the sternum. Cardiopulmonary support was initiated by cannulating the right femoral artery and vein. An opening in the ascending aorta exposed an intimal tear near the proximal anastomosis of the two great saphenous vein grafts. Antegrad Del-Nido cardioplegia was given through native ostia and functional bypass grafts. Proximal and then distal anastomosis of graft prosthesis was performed. A new venous graft was anastomosed to the apical part of the left anterior descending artery (LAD). This saphenous vein and the buttons of the two previous vein grafts were anastomosed to the prosthesis. The patient was successfully liberated from the heart-lung machine and exhibited favorable cardiac function in the postoperative period. CONCLUSIONS We can conclude that initial peripheral cannulation with a half dose of heparin provides a relatively bloodless and secure re-entry sternotomy. Del-Nido cardioplegia is easy to implement, safe, and gives surgeons enough time without interruptions to perform complex procedures fluently.  .
Topics: Female; Humans; Aged; Diabetes Mellitus, Type 2; Coronary Artery Bypass; Aortic Dissection; Aorta; Cardiac Surgical Procedures; Reoperation
PubMed: 38600678
DOI: 10.12659/AJCR.942673 -
Brazilian Journal of Cardiovascular... Aug 2023Infant, 11-month-old, male, diagnosis of Tetralogy of Fallot with retrotracheoesophageal course of the brachiocephalic vein. Usual findings of Tetralogy of Fallot on...
CLINICAL DATA
Infant, 11-month-old, male, diagnosis of Tetralogy of Fallot with retrotracheoesophageal course of the brachiocephalic vein. Usual findings of Tetralogy of Fallot on physical examination. Technical description: Chest radiography showed slightly reduced pulmonary vascular markings and no cardiomegaly. Normal preoperative electrocardiogram with postoperative right bundle branch block. Usual findings of Tetralogy of Fallot on echocardiogram. Postoperative computed tomography angiography confirmed left brachiocephalic vein with anomalous retrotracheoesophageal course, configuring a U-shaped garland vein, in addition to postoperative findings of total correction of Tetralogy of Fallot.
OPERATION
Complete surgical repair was performed with pulmonary valve commissurotomy and placement of bovine pericardial patch to solve right ventricular outflow tract obstruction, pulmonary trunk enlargement, and ventricular septal defect closure.
COMMENTS
Systemic venous drainage may show variations in patients with Tetralogy of Fallot. These abnormalities are usually of little clinical relevance, as they are asymptomatic. We presented a rare case of retrotracheoesophageal course of an anomalous left brachiocephalic vein with intraoperative diagnosis, confirmed by imaging during postoperative follow-up, without compromising clinical management or surgical approach.
Topics: Infant; Humans; Male; Animals; Cattle; Tetralogy of Fallot; Brachiocephalic Veins; Heart Septal Defects, Ventricular; Echocardiography; Cardiac Surgical Procedures
PubMed: 37540801
DOI: 10.21470/1678-9741-2023-0047 -
VASA. Zeitschrift Fur Gefasskrankheiten Nov 2023Upper-extremity peripheral arterial disease (PAD) may present with a broad spectrum of signs and symptoms. If an endovascular treatment is planned, percutaneous...
Upper-extremity peripheral arterial disease (PAD) may present with a broad spectrum of signs and symptoms. If an endovascular treatment is planned, percutaneous angioplasty and stent placement may lead to a better patency compared to percutaneous angioplasty alone. We assessed the characteristics and clinical course of patients with upper-extremity PAD who received angioplasty and a balloon-expandable stent. We analyzed data from consecutive patients treated with angioplasty and placement of a balloon-expandable BeSmooth Peripheral Stent System (Bentley, Germany) at the Angiology Department (University Hospital Zurich) between 2018 and 2022. The primary outcome was re-intervention at the target lesion within 6 months from index angioplasty and during available follow-up. The study was approved by the local ethical commission. A total of 27 patients were treated. The median age was 70 (Q1-Q3: 60-74) years and 59% were men. The subclavian artery (74%) represented the most frequently treated target lesion, followed by the innominate artery (26%). The mean improvement in blood pressure in the treated arm was 21 (95%CI 7 to 35) mmHg at 24 hours and 29 (95%CI 15 to 43) mmHg at 6 months. At 6 months, 2 (8%) patients required a target lesion re-intervention. During the remaining follow-up period up to 24 months, one of these two patients required additional intervention and a total of 3 (11%) patients died due to sepsis, cancer, and unknown causes, respectively. Percutaneous catheter-based treatment with a balloon-expandable stent for symptomatic upper extremity PAD appeared to be effective and safe.
Topics: Male; Humans; Aged; Female; Angioplasty, Balloon; Brachiocephalic Trunk; Vascular Patency; Stents; Peripheral Arterial Disease; Treatment Outcome
PubMed: 37786357
DOI: 10.1024/0301-1526/a001092