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Colombia Medica (Cali, Colombia) May 2021A young male patient with a complete section of the ulnar and radial arteries preserved the perfusion of the hand through an anatomical variant, the median artery,...
CASE DESCRIPTION
A young male patient with a complete section of the ulnar and radial arteries preserved the perfusion of the hand through an anatomical variant, the median artery, identified by angiotomography.
CLINICAL FINDINGS
A wound in the distal third of the left forearm with present pulses and adequate hand coloration. An angiotomography of the upper left limb showed a median artery originating as a continuation of the anterior interosseous artery and ending in the palm of the hand with an incomplete superficial palmar arch.
TREATMENT AND OUTCOMES
Ligation of both radial and ulnar arteries was performed. It was not possible to follow up the patient.
CLINICAL RELEVANCE
Forming the superficial and deep palmar arches, the irrigation of hand comes from the ulnar and radial arteries, which can compromise the viability of the limb when injured. The median artery is present in 0.6-21.1% of the population, originates from the anterior interosseous artery (branch of the ulnar), accompanies the median nerve in its path and ends in the palm joining the superficial palmar arch. Diagnostic imaging is a key tool for assessing arterial circulation and characterizing upper limb vascular lesions. Knowledge of the anatomical variations of the arterial supply of the hand, including variability of the superficial palmar arch, is crucial for the safety and success of hand surgeries.
Topics: Adult; Arteries; Forearm Injuries; Hand; Humans; Male; Radial Artery; Ulnar Artery
PubMed: 34188329
DOI: 10.25100/cm.v52i2.4521 -
The Journal of Veterinary Medical... Mar 2023In this study, we investigated the aortic arch (AA) branching pattern in the Eurasian otter (Lutra lutra). We performed arterial silicone casting of the AA of 18...
In this study, we investigated the aortic arch (AA) branching pattern in the Eurasian otter (Lutra lutra). We performed arterial silicone casting of the AA of 18 Eurasian otters (8 males and 10 females). We analyzed the AA branching pattern at three levels: the AA, brachiocephalic trunk (BCT), and subclavian artery (SB), using different classification methods at each level. We introduced new criteria for classifying the SB branching pattern applicable for Eurasian otter and other carnivores based on the sequence of the four main branches: vertebral artery (VT), internal thoracic artery (IT), costocervical artery (CCT), and superficial cervical artery (SC). In all Eurasian otters, two major branches emerged directly from the AA, i.e., the BCT and left SB. The BCT branched off the left common carotid artery and terminated in the right common carotid artery and right SB in 17 of 18 Eurasian otters; the BCT formed a bicarotid artery in the remaining case. The SBs showed various branching patterns, with the main branching pattern involving branching to the VT and IT at the same position, followed by the CCT and SC. The SB branching pattern in the Eurasian otter differed from that in dogs in that the two first branching arteries were VT and IT, rather than VT and CCT. Here, we present the anatomical characteristics of the AA branching patterns in the Eurasian otter and new analysis methods applicable for comparative studies of other carnivores.
Topics: Male; Female; Animals; Dogs; Otters; Aorta, Thoracic; Subclavian Artery; Mammary Arteries; Carotid Artery, Common
PubMed: 36792211
DOI: 10.1292/jvms.22-0517 -
Annals of Surgery Nov 1982From 1965 through 1980, 51 men and 49 women (mean age: 55 years) underwent transthoracic or extrathoracic revascularization of the innominate, common carotid,...
From 1965 through 1980, 51 men and 49 women (mean age: 55 years) underwent transthoracic or extrathoracic revascularization of the innominate, common carotid, subclavian, or vertebral arteries. Preoperative symptoms were limited to the vertebrobasilar syndrome in 29 patients, to hemispheric neurologic or monocular visual events in 19, and to upper extremity ischemia in 13. Multiple symptoms were present in 27 other patients, and 12 patients were asymptomatic before operation. Median sternotomy was performed for correction of innominate, common carotid, or subclavian lesions in 34 patients, including six simultaneous brachiocephalic and cardiac procedures, with five operative deaths (14.7%). Extrathoracic reconstruction, such as carotosubclavian and axilloaxillary bypass or vertebral endarterectomy and reimplantation, was employed in 66 patients, with two operative strokes but no mortality (p less than .01). Late results were obtained from two to 189 months after operation (mean: 52 months). Considering their original symptoms, 82 patients have been classified as asymptomatic or improved, nine as unchanged, and nine others, including those who had operative complications, as worse. Twelve patients have eventually sustained either transient cerebral ischemia (six) or strokes (six), most of which were unrelated to eight documented late operative failures. In addition to 20 patients who required combined brachiocephalic and carotid bifurcation reconstruction, 27 additional carotid endarterectomies have at some time been necessary for patients having extensive cerebrovascular disease. Twenty patients have died during the follow-up interval, including eight with myocardial infarctions, but only one with a fatal stroke.
Topics: Adult; Aged; Angiography; Arm; Arteries; Brachiocephalic Trunk; Carotid Arteries; Endarterectomy; Female; Follow-Up Studies; Head; Humans; Male; Middle Aged; Postoperative Complications; Subclavian Artery; Vertebral Artery
PubMed: 6751246
DOI: 10.1097/00000658-198211000-00006 -
Romanian Journal of Morphology and... 2012The segmental branches of the renal artery vary in number and origin. The 1998, Terminologia Anatomica homologates two branches of the renal artery (anterior, posterior)... (Review)
Review
The segmental branches of the renal artery vary in number and origin. The 1998, Terminologia Anatomica homologates two branches of the renal artery (anterior, posterior) and five segmental arteries: four from the anterior branch and one from the posterior one. The purpose of this study is to evaluate the renal artery branching pattern, the number and origin of the segmental arteries, as well as to review data from similar studies. The study material consisted of 60 formalin-fixed adult kidneys. Dissections and microdissections were performed on the renal arteries and their branches. The branching of the renal artery was prehilar in 81.67% of cases, hilar in 10% and intra-sinusal in 8.33%. The number branches varied as follows: two branches in 42 cases (70%), three branches in 14 cases (23.33%) and four branches in four cases (6.67%). We subsequently analyzed the origin of the segmental arteries and found that in 53% of the cases the segmental arteries arose independently from the renal artery's branches, while in 47% of the cases they derived from common trunks of type I (85%) or II (15%). Type I trunks are those that originate directly from the main renal artery. They divide either into 2-3 segmental branches, or into just 1-2 branches and a smaller trunk (type II). The type II trunks further divide into 2-3 other segmental branches. These common trunks must be taken into account to avoid confusion with the segmental arteries. Knowledge of these variations is useful not only morphologically, but also clinically.
Topics: Humans; Kidney; Renal Artery
PubMed: 22732797
DOI: No ID Found -
Journal of Vascular Surgery Mar 2022Atherectomy has become commonplace as an adjunct to interventional treatments for peripheral arterial disease, but the procedures have been complicated by risks...
OBJECTIVE
Atherectomy has become commonplace as an adjunct to interventional treatments for peripheral arterial disease, but the procedures have been complicated by risks including distal embolization and arterial perforation. This study aimed to examine the safety and effectiveness of a novel atherectomy system to treat femoropopliteal and below-knee peripheral arterial disease.
METHODS
The Revolution Peripheral Atherectomy System (Rex Medical LP, Conshohocken, Pa) was studied in 121 patients with 148 femoropopliteal and below-knee lesions, enrolled at 17 United States institutions. Technical success was defined when the post-atherectomy angiographic stenosis was ≤50%, as assessed by an independent core laboratory. Major adverse events were adjudicated by an independent Clinical Events Committee.
RESULTS
Among 148 site-identified target lesions in 121 patients, 21.4% were in the superficial femoral artery, 13.7% involved the popliteal artery, and 67.9% were in tibial arteries; 3.1% involved more than one segment. Technical success was 90.2%, with stenoses decreasing from 73% ± 19% at baseline to 42% ± 14% after atherectomy. Adjunctive treatment after atherectomy included angioplasty with uncoated balloons in 91%, drug-coated balloons in 11%, bare stent deployment in 8%, and drug-eluting stent placement in 3%. Procedural success (<30% residual stenosis) was achieved in 93.7% of target lesions. Complications during the procedure included one target vessel perforation and two distal embolizations; each of which were adjudicated by the Clinical Events Committee as unrelated to the device and were not visualized angiographically by the core laboratory. Freedom from major adverse events was 97.3% through 30 days. The Kaplan-Meier estimates of primary, assisted primary, and secondary patency were 81.6%, 87.7%, and 91.6% at 6 months, respectively.
CONCLUSIONS
The use of the Revolution Peripheral Atherectomy System was associated with few procedural complications and a high rate of success at the index procedure and through 6 months.
Topics: Aged; Aged, 80 and over; Angiography; Atherectomy; Equipment Design; Female; Femoral Artery; Humans; Male; Middle Aged; Peripheral Arterial Disease; Popliteal Artery; Prospective Studies; Tibial Arteries; Time Factors; Treatment Outcome; United States; Vascular Patency
PubMed: 34624496
DOI: 10.1016/j.jvs.2021.08.107 -
Journal of Applied Physiology... Sep 2014Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality in modern societies, and advancing age is the major risk factor for CVD. Arterial... (Review)
Review
Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality in modern societies, and advancing age is the major risk factor for CVD. Arterial dysfunction, characterized by large elastic artery stiffening and endothelial dysfunction, is the key event leading to age-associated CVD. Our work shows that regular aerobic exercise inhibits large elastic artery stiffening with aging (optimizes arterial compliance) and preserves endothelial function. Importantly, among previously sedentary late middle-aged and older adults, aerobic exercise improves arterial stiffness and enhances endothelial function in most groups and, therefore, also can be considered a treatment for age-associated arterial dysfunction. The mechanisms by which regular aerobic exercise destiffens large elastic arteries are incompletely understood, but existing evidence suggests that reductions in oxidative stress associated with decreases in both adventitial collagen (fibrosis) and advanced glycation end-products (structural protein cross-linking molecules), play a key role. Aerobic exercise preserves endothelial function with aging by maintaining nitric oxide bioavailability via suppression of excessive superoxide-associated oxidative stress, and by inhibiting the development of chronic low-grade vascular inflammation. Recent work from our laboratory supports the novel hypothesis that aerobic exercise may exert these beneficial effects by directly inducing protection to aging arteries against multiple adverse factors to which they are chronically exposed. Regular aerobic exercise should be viewed as a "first line" strategy for prevention and treatment of arterial aging and a vital component of a contemporary public health approach for reducing the projected increase in population CVD burden.
Topics: Aging; Animals; Arteries; Exercise; Humans; Mice; Physical Conditioning, Animal; Vascular Stiffness
PubMed: 24855137
DOI: 10.1152/japplphysiol.00362.2014 -
Journal of Anatomy Feb 2017The anatomical basis for auricular flaps used in multiple aesthetic and reconstructive procedures is currently based on a random distribution of the underlying arterial...
The anatomical basis for auricular flaps used in multiple aesthetic and reconstructive procedures is currently based on a random distribution of the underlying arterial network. However, recent findings reveal a systematic pattern as opposed to the present concepts. Therefore, we designed this study to assess the arterial vascular pattern of the auricle in order to provide reliable data about the vascular map required for surgical interventions. Sixteen human auricles from eight body donors (five females/three males, 84.33 ± 9.0 years) were investigated using the unique 'Spalteholz' method. After arterial injection of silicone, a complete transparency of the tissue was achieved and the auricular arteries and branches were visible. Qualitative and quantitative evaluation of the arterial vascular pattern was performed. The superior and the inferior anterior auricular artery provided the vascular supply to the helical rim, forming an arcade, i.e. helical rim arcade. On the superior third of the helical rim another arcade was confirmed between the superior anterior auricular artery and the posterior auricular artery (PAA), i.e. the helical arcade. The perforators of the PAA were identified lying in a vertical line 1 cm posterior to the tragus, supplying the concha, inferior crus, triangular fossa, antihelix and the earlobe. The results of this study confirmed the constant presence of the helical rim arcade (Zilinsky-Cotofana), consistent perforating branches of the PAA, and the helical arcade (Erdman), and will help and guide physicians performing auricular surgeries toward fast and simple procedures with optimal patient satisfaction.
Topics: Aged; Aged, 80 and over; Arteries; Ear Auricle; Female; Humans; Male; Regional Blood Flow
PubMed: 27726131
DOI: 10.1111/joa.12550 -
Annals of Surgery Jul 1994Anatomic variations in the hepatic arteries were studied in donor livers that were used for orthotopic transplantation. (Review)
Review
OBJECTIVE
Anatomic variations in the hepatic arteries were studied in donor livers that were used for orthotopic transplantation.
SUMMARY BACKGROUND DATA
Variations have occurred in 25% to 75% of cases. Donor livers represent an appropriate model for study because extrahepatic arterial anatomy must be defined precisely to ensure complete arterialization of the graft at time of transplantation.
METHODS
Records of 1000 patients who underwent liver harvesting for orthotopic transplantation between 1984 and 1993 were reviewed.
RESULTS
Arterial patterns in order of frequency included the normal Type 1 anatomy (n = 757), with the common hepatic artery arising from the celiac axis to form the gastroduodenal and proper hepatic arteries and the proper hepatic dividing distally into right and left branches; Type 3 (n = 106), with a replaced or accessory right hepatic artery originating from the superior mesenteric artery; Type 2 (n = 97), with a replaced or accessory left hepatic artery arising from the left gastric artery; Type 4 (n = 23), with both right and left hepatic arteries arising from the superior mesenteric and left gastric arteries, respectively; Type 5 (n = 15), with the entire common hepatic artery arising as a branch of the superior mesenteric; and Type 6 (n = 2), with the common hepatic artery originating directly from the aorta.
CONCLUSIONS
These data are useful for the planning and conduct of surgical and radiological procedures of the upper abdomen, including laparoscopic operations of the biliary tract.
Topics: Hepatic Artery; Humans; Liver Transplantation
PubMed: 8024358
DOI: 10.1097/00000658-199407000-00008 -
The American Journal of Case Reports Jul 2018BACKGROUND Vascular anomalies of the carotid vessels can be attributed to false embryogenesis. A rare variant called a nonbifurcating carotid artery (NBCA) exists, where... (Review)
Review
BACKGROUND Vascular anomalies of the carotid vessels can be attributed to false embryogenesis. A rare variant called a nonbifurcating carotid artery (NBCA) exists, where typical carotid bifurcation is not recognizable with its typical branches of the external carotid artery (ECA) and internal carotid artery (ICA). This paper describes a case of this anomaly and reviews the embryogenesis of the carotid arteries for explanation. CASE REPORT A 66-year-old man received a routine health examination at our hospital. Initial carotid ultrasound indicated an absence of bifurcation in the right cervical carotid artery, and magnetic resonance imaging of the brain indicated an absence of the proximal cervical segment of the right ICA, with a remnant arterial stump at the expected bifurcation level. No evidence of the carotid bulb was identified. The common carotid artery seemed to continue cranially in the trunk of the ECA, where it exhibited extracranial branches. After distributing these branches, the carotid artery coursed medially at the C2 level, where it ascended into the carotid canal to become the petrosal segment of the ICA. This carotid anomaly was labelled an NBCA. No aberrant intracranial arteries were derived from the NBCA in this case. CONCLUSIONS In this case, the arterial stump was considered a remnant from agenesis of the right ICA. We assumed that the NBCA most likely developed because of false regression of the third embryogenic aortic arch with persistence of the second aortic arch.
Topics: Aged; Brain; Carotid Arteries; Carotid Artery, External; Carotid Artery, Internal; Humans; Magnetic Resonance Imaging; Male
PubMed: 30057401
DOI: 10.12659/AJCR.910019 -
Acta Biomaterialia Jun 2018The collagen-rich adventitia is the outermost arterial layer and plays an important biomechanical and physiological role in normal vessel function. While there has been...
UNLABELLED
The collagen-rich adventitia is the outermost arterial layer and plays an important biomechanical and physiological role in normal vessel function. While there has been a lot of effort to understand the role of the medial layer on arterial biomechanics, the adventitia has received less attention. In this study, we hypothesized that different ultrastructural and nanomechanical properties would be exhibited in the adventitia of the internal mammary artery (IMA) in patients with a low degree of arterial stiffening as compared to those with a high degree of arterial stiffening. Human IMA biopsies were obtained from a cohort of patients with arterial stiffening assessed via carotid-femoral PWV. Patients were grouped as low PWV (8.5 ± 0.7 ms, n = 8) and high PWV (13.4 ± 3.0 ms, n = 9). Peakforce QNM atomic force microscopy (AFM) was used to determine the nanomechanical and morphological properties of the IMA. The nano-scale elastic modulus was found to correlate with PWV. We show for the first time that nano-scale alterations in adventitial collagen fibrils in the IMA are evident in patients with high PWV, even though the IMA is not involved in the carotid-femoral pathway. Our approach provides new insight into systemic structure-property changes in the vasculature, and also provides a method of characterizing small biopsy samples to predict the development of arterial stiffening.
STATEMENT OF SIGNIFICANCE
Arterial stiffening occurs as part of the natural aging process and is strongly linked to cardiovascular risk. Although arterial stiffening is routinely measured in vivo, little is known about how localised changes in artery structure and biomechanics contributes to in vivo arterial stiffening. This study focusses on the role of the outermost layer of arteries, the adventitia, in arterial stiffening. The study provides data on nano-scale changes in collagen fibril structure and mechanical properties in the adventitia and shows how it relates to in vivo stiffness measurements in the vascular system. This is the first study to link in vivo arterial stiffening with nanomechanical changes in artery biopsy samples. Hence, this approach could be used to develop new diagnostic methods for vascular disease.
Topics: Adventitia; Aged; Biomechanical Phenomena; Biopsy; Carotid Arteries; Cohort Studies; Collagen; Elastic Modulus; Female; Femoral Artery; Humans; Male; Mammary Arteries; Microscopy, Atomic Force; Middle Aged; Models, Cardiovascular; Nanomedicine; Principal Component Analysis; Proteomics; Pulse Wave Analysis; Risk; Vascular Diseases; Vascular Stiffness
PubMed: 29684625
DOI: 10.1016/j.actbio.2018.04.036