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Sample records for subclavian artery arsa

  1. [ABERRANT RIGHT SUBCLAVIAN ARTERY (ARSA)--A NEW ULTRASOUND MARKER FOR CHROMOSOMAL FETAL ABNORMALITIES].

    Science.gov (United States)

    Atanasova, D; Markov, D; Pavlova, E

    2015-01-01

    The development of the fetal aorta ends with the formation of the aortic arch which normally branches into three blood vessels: 1) a. brachiocephalica (a. innominata), which divides into the right subclavian artery (RSA) and the right carotid artery; 2) the left carotid artery; and 3) the left subclavian artery. Occasionally, RSA originates as a separate fourth branch of the aortic arch, passing behind the trachea with an oblique course to the right shoulder. This rare variant is called an aberrant right subclavian artery (ARSA) and is observed in approximately 2% of normal individuals. On the other hand, the reported incidence of ARSA varies between 25 and 37% in cases with Down syndrome and other chromosomal abnormalities. To evaluate the success rate of ultrasound visualization of the fetal RSA between 18 and 23 weeks of gestation and to establish the importance of the prenatal diagnosis of ARSA in the risk assessment for fetal chromosomal abnormalities in the second trimester. Three experienced sonographers scanned 992 fetuses in MC "Markovs", Sofia between 01.09.2013-01.06.2014 with Voluson 730 Expert (GE Healthcare) ultrasound equipment. Visualization of RSA was successful in 92.7% of cases. Overall, 17 cases with ARSA were diagnosed in the study period. ARSA was an isolated sonographic finding in 13 of them. The remaining 4 cases had additional pathology. In the first case ARSA was associated with a short femurand humerus, short nasal bone and borderline nuchal thickness without any other soft markers or structural abnormalities. Trisomy 21 was diagnosed after amniocentesis and the pregnancy was terminated at patient's request. In the second case ARSA was associated with severe polymalformation syndrome. Trisomy 18 was diagnosed by DNA analysis post abortem. In the third case ARSA was associated with an unilateral cleft lip and cleft palate. Abnormalities of the fetal karyotype and Di George syndrome were excluded by amniocentesis. The fourth case was

  2. Aberrant Right Subclavian Artery: A Life‑threatening Anomaly that ...

    African Journals Online (AJOL)

    Lusoria artery or aberrant right subclavian artery (ARSA) is a rare anatomical variation of the origin of the right subclavian artery. Essentially, right subclavian artery originates from the brachiocephalic artery, but in 0.4-1.8% of the general population it may arise directly from the aortic arch distal to the left subclavian artery.

  3. Association of aberrant right subclavian artery with abnormal karyotype and microarray results.

    Science.gov (United States)

    Svirsky, Ran; Reches, Adi; Brabbing-Goldstein, Dana; Bar-Shira, Anat; Yaron, Yuval

    2017-08-01

    The objective of this study is to evaluate the incidence of chromosomal aberration (both microscopic and sub-microscopic) in fetuses with an aberrant right subclavian artery (ARSA) detected by ultrasonographic anomaly scan. The study included 62 pregnant women whose fetuses were diagnosed with ARSA who were referred for genetic counseling. Of these, 55 patients underwent amniocentesis and 7 declined invasive testing. All 55 amniocentesis samples were tested by standard G-banding and chromosomal microarray, except for 2 samples for which only karyotype and fluorescence in situ hybridization for 22q11.2 deletions were performed. Of the 55 women who underwent amniocentesis, 5 were detected with trisomy 21 (9.1%), all of whom had additional ultrasound findings. Among the 14 fetuses with ARSA and additional ultrasound findings, the incidence of trisomy 21 was 35.7%. In fetuses with isolated ARSA, no chromosomal aberrations were detected by standard cytogenetic analysis and only one (1.9%) deleterious copy number variants (CNV) was detected by chromosomal microarray. Aberrant right subclavian artery with additional ultrasound findings constitute a strong predictor for aneuploidy. However, when ARSA is found in isolation, it confers no increased risk for aneuploidy or pathogenic CNVs. © 2017 John Wiley & Sons, Ltd. © 2017 John Wiley & Sons, Ltd.

  4. Prenatal diagnosis of aberrant right subclavian artery in an unselected population

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    Song, Mi Jin; Han, Byoung Hee; Kim, Young Hwa; Yoon, So Young; Lee, Yoo Mi; Jeon, Hye Su; Park, Bo Kyung [Cheil General Hospital and Women' s Healthcare Center, Dankook University College of Medicine, Seoul (Korea, Republic of)

    2017-07-15

    The purpose of this study was to determine the frequency of aberrant right subclavian artery (ARSA) among unselected fetuses and to evaluate its association with chromosomal abnormalities and other congenital anomalies.In all, 7,547 fetuses (gestational age, 20 to 34 weeks) were examined using routine antenatal sonography at our institution between April 2014 and September 2015. The right subclavian artery was assessed using grayscale and color Doppler ultrasonography in the transverse 3-vessel and tracheal view, and confirmed in the coronal plane. ARSA was found in 28 fetuses (0.4%). Further, 27 of these 28 fetuses were euploid (96.4%). Trisomy 18 was the only chromosomal anomaly (3.6%) found in the study sample. ARSA was an isolated finding in 23 of the 28 cases (82.1%). In the remaining three cases (10.7%), ARSA was accompanied with extracardiac anomalies. Other cardiac defects were present in three cases (10.7%). Isolated ARSA does not seem to be associated with a significantly increased risk of aneuploidy. However, the possibility of fetal karyotyping, which is a more invasive procedure, should be discussed in the light of the overall risk of the fetus.

  5. Aberrant right subclavian artery in fetuses with Down syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Scala, C; Leone Roberti Maggiore, U; Candiani, M; Venturini, P L; Ferrero, S; Greco, T; Cavoretto, P

    2015-09-01

    The primary objective was to estimate the prevalence of aberrant right subclavian artery (ARSA) in fetuses with Down syndrome. Secondary objectives were to assess the prevalence of ARSA in euploid fetuses, the feasibility of ultrasound evaluation of the right subclavian artery (RSA) in the first and second trimesters of pregnancy, the performance of ARSA in screening for trisomy 21 and its association with other abnormalities. Web-based databases (PubMed, EMBASE and MEDLINE) were searched up to July 2014. The STROBE, PRISMA and QUIPS instruments were used to assess all included studies and for reporting of methodology, results and conclusions. Original studies that reported prenatal ultrasound evaluation of ARSA, assessment of its prevalence in Down-syndrome and euploid fetuses, feasibility of ultrasound evaluation of the RSA in the first and second trimesters of pregnancy and correlation of ARSA with other abnormalities were included, excluding duplications and case reports. Collected data were summarized to estimate prevalence and feasibility. A meta-analysis was performed pooling the study-specific positive and negative likelihood ratios (LR+ and LR-), detection rates and false-positive rates for trisomy 21. Prevalence of ARSA in Down-syndrome fetuses was 23.6% (95% CI, 19.4-27.9%), whereas in euploid fetuses it was 1.02% (95% CI, 0.86-1.10%). Ultrasound evaluation of the RSA course and origin in the first and second trimesters of pregnancy was feasible in 85% and 98% of cases (first and second trimester, respectively) and it was directly related to sonographic experience and fetal crown-rump length and inversely related to maternal body mass index. In more than 20% of fetuses with ARSA there was an association with other abnormalities but ARSA seemed to be an independent marker of trisomy 21. The meta-analysis showed that ARSA is a significant risk factor for Down syndrome (pooled LR+ = 26.93, 95% CI, 19.36-37.47, P for effect Down syndrome. Additional

  6. [Prosthesis interposition in the case of subclavian artery transposition].

    Science.gov (United States)

    György, G; Acosta Alvarez, P

    1993-01-01

    When we can't realize the reimplantation because of technical difficulties, special cases are presented during transposition from the subclavian artery to the primitive carotid artery. In these cases, between primitive carotid artery and the subclavian artery and also the vertebral artery, Gore-tex's tubes were implanted with favourable results.

  7. Upper Gastrointestinal Bleeding Secondary to an Aberrant Right Subclavian Artery-Esophageal Fistula: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Adam Millar

    2007-01-01

    Full Text Available An aberrant right subclavian artery (ARSA is a common aortic arch abnormality. A case of a 57-year-old man presenting with melena and hypotension secondary to an ARSA-esophageal fistula is reported. The current report is unique because it is the first reported case of ARSA-esophageal fistula associated with prior esophagectomy and gastric pull-up. A MedLine search was performed for ARSA-esophageal fistula cases, which were then compared with the present case. Because this patient had no vascular conduits, nasogastric or endotracheal tubes, the fistula likely occurred secondary to the previous surgery. This case is unusual because the patient survived the original hemorrhage associated with the ARSA-esophageal fistula.

  8. Retroesophageal right subclavian artery: A case report and review ...

    African Journals Online (AJOL)

    This is a report of a case of an adult male cadaver with a retroesophageal right subclavian artery. Objective: To highlight the significance of a retroesophageal right subclavian artery, especially its clinical and surgical implications. Method: Is a report of a case of an anomalous vessel found during routine student dissection of ...

  9. Validation of subclavian duplex velocity criteria to grade severity of subclavian artery stenosis.

    Science.gov (United States)

    Mousa, Albeir Y; Morkous, Ramez; Broce, Mike; Yacoub, Michael; Sticco, Andrew; Viradia, Ravi; Bates, Mark C; AbuRahma, Ali F

    2017-06-01

    Validation of subclavian duplex ultrasound velocity criteria (SDUS VC) to grade the severity of subclavian artery stenosis has not been established or systematically studied. Currently, there is a paucity of published literature and lack of practitioner consensus for how subclavian duplex velocity findings should be interpreted in patients with subclavian artery stenosis. The objective of the present study was to validate SDUS measurements using subclavian conventional or computed tomography angiogram (subclavian angiogram [SA])-derived measurements. Secondary objectives included measuring the correlation between SDUS peak systolic velocities and SA measurements, and to determine the optimal cutoff value for predicting significant stenosis (>70%). This is a retrospective review of all patients with suspected subclavian artery stenosis and a convenience sample of carotid artery patients who underwent SDUS and SA from May 1999 to July 2013. SA reference vessel and intralesion minimal lumen diameters were measured and compared with SDUS velocities obtained within 3 months of the imaging study. Percent stenosis was calculated using the North American Symptomatic Carotid Endarterectomy Trial method for detecting stenosis in a sufficiently large cohort. Receiver operating characteristic curves was generated for SDUS VC to predict >70% stenosis. Velocity cutoff points were determined with equal weighting of sensitivity and specificity. We examined 268 arteries for 177 patients. The majority of the arteries were for female patients (52.5%) with a mean age of 66.7 ± 11.1 years. Twenty-three arteries had retrograde vertebral artery flow and excluded from further analysis. For the remaining 245 arteries, the average peak systolic velocity was 212.6 ± 110.7 cm/s, with a range of 45-626 cm/s. Average stenosis was 25.8% ± 28.2%, with a range of 0% to 100%. Following receiver operating characteristic analysis, we found a cutoff value of >240 cm/s to be most predictive

  10. Percutaneous subclavian artery stent-graft placement following failed ultrasound guided subclavian venous access

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    Szkup Peter

    2006-05-01

    Full Text Available Abstract Background Ultrasound guidance for central and peripheral venous access has been proven to improve success rates and reduce complications of venous cannulation. Appropriately trained and experienced operators add significantly to diminished patient morbidity related to venous access procedures. We discuss a patient who required an arterial stent-graft to prevent arterial hemorrhage following inadvertent cannulation of the proximal, ventral, right subclavian artery related to unsuccessful ultrasound guided access of the subclavian vein. Case presentation During pre-operative preparation for aortic valve replacement and aorto-coronary bypass surgery an anesthetist attempted ultrasound guided venous access. The ultrasound guided attempt to access the right jugular vein failed and the ultrasound guided attempt at accessing the subclavian vein resulted in inappropriate placement of an 8.5 F sheath in the arterial system. Following angiographic imaging and specialist consultations, an arterial stent-graft was deployed in the right subclavian artery rather than perform an extensive anterior chest wall resection and dissection to extract the arterial sheath. The patient tolerated the procedure, without complication, despite occlusion of the right internal mammary artery and the right vertebral artery. There were no neurologic sequelae. There was no evidence of hemorrhage after subclavian artery sheath extraction and stent-graft implantation. Conclusion The attempted ultrasound guided puncture of the subclavian vein resulted in placement of an 8.5 F subclavian artery catheter. Entry of the catheter into the proximal subclavian artery beneath the medial clavicle, the medial first rib and the manubrium suggests that the operator, most likely, did not directly visualize the puncture needle enter the vessel with the ultrasound. The bones of the anterior chest impede the ultrasound beam and the vessels in this area would not be visible to ultrasound

  11. Surgical Treatment of Atherosclerotic Lesions of the Subclavian Artery

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    Cohn, Lawrence H.; Fogarty, Thomas J.; Daily, Pat O.; Silverman, James F.; Shumway, Norman E.

    1972-01-01

    Of eight patients with atherosclerotic lesions (seven occlusive, one aneurysmal) of the subclavian artery, five were operated upon because of the subclavian steal and three for severe ischemia of the hand and fingers. Removal or bypass of these lesions was uniformly successful in relieving symptoms. In most cases transcervical carotid-subclavian saphenous vein bypass graft is the treatment of choice, provided no carotid obstruction exists or, if there is obstruction, it can be dealt with at operation. ImagesFigure 1.Figure 2.Figure 3. PMID:4639853

  12. Upper gastrointestinal bleeding secondary to an aberrant right subclavian artery-esophageal fistula: A case report and review of the literature

    Science.gov (United States)

    Millar, Adam; Rostom, Alaa; Rasuli, Pasteur; Saloojee, Nav

    2007-01-01

    An aberrant right subclavian artery (ARSA) is a common aortic arch abnormality. A case of a 57-year-old man presenting with melena and hypotension secondary to an ARSA-esophageal fistula is reported. The current report is unique because it is the first reported case of ARSA-esophageal fistula associated with prior esophagectomy and gastric pull-up. A MedLine search was performed for ARSA-esophageal fistula cases, which were then compared with the present case. Because this patient had no vascular conduits, nasogastric or endotracheal tubes, the fistula likely occurred secondary to the previous surgery. This case is unusual because the patient survived the original hemorrhage associated with the ARSA-esophageal fistula. An ARSA-esophageal fistula is a rare, but potentially fatal cause of upper gastrointestinal bleeding. A high index of suspicion is needed to make the diagnosis. This condition should be considered in patients with risk factors combined with hemodynamically significant gastrointestinal bleeding. PMID:17571174

  13. Delayed Presentation of Catheter-Related Subclavian Artery Pseudoaneurysm

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    Hwa Rim Kang

    2015-08-01

    Full Text Available Central venous catheterization is a common diagnostic and therapeutic procedure in modern clinical practice. Pseudoaneurysms of the subclavian artery are rare and usually occur immediately after the causative event, whether the cause was trauma or a medical procedure. Here we report the rare case of a 71-year-old woman with delayed presentation of catheter-related subclavian pseudoaneurysm. The patient was treated for aspiration pneumonia with respiratory failure in another hospital. The patient's chest wall swelling began two weeks after the initial catheterization in the other hospital, probably because of slow leakage of blood from the injured subclavian artery caused by incomplete compression of the puncture site and uremic coagulopathy. She was successfully treated with ultrasound-guided thrombin and angiography-guided histoacryl injection without stent insertion or surgery. Her condition improved, and she was discharged to her home.

  14. Anomalous Origin of the Subclavian Artery Associated with ...

    African Journals Online (AJOL)

    Anomalous origin of the right subclavian artery is a well- known anomaly; in most instances it is not responsible for symptoms and is an incidental finding at angiography, surgery or autopsy.'" If symptoms of tracheal compres- sion occur, surgical relief of the abnormal vascular ring is necessary. It is the purpose of this report ...

  15. Left subclavian artery revascularization as part of thoracic stent grafting

    NARCIS (Netherlands)

    Saouti, N.; Hindori, V.; Morshuis, W.J.; Heijmen, R.H.

    2015-01-01

    OBJECTIVES: Intentional covering of the left subclavian artery (LSA) as part of thoracic endovascular aortic repair (TEVAR) can cause (posterior) strokes or left arm malperfusion. LSA revascularization can be done as prophylaxis against, or as treatment of, these complications. We report our

  16. Intrathoracic lipoma masquerading as subclavian artery trauma.

    LENUS (Irish Health Repository)

    Munro, P T

    2012-02-03

    A 58 year old man was admitted to the accident and emergency department following an industrial accident in which he sustained a three part fracture dislocation of his right humerus. Chest radiography revealed a large mass in the right upper hemithorax and, when the patient became hypotensive, an emergency thoracotomy was performed. The mass was found to be a massive intrathoracic lipoma. This case shows how preexisting intrathoracic lesions may be mistaken for subclavian or great vessel trauma following violent shoulder girdle injury. The differential diagnosis of traumatic and non-traumatic intrathoracic mass lesions in chest radiography should be considered carefully.

  17. Rarely Cause Of Disphagia: Aberrant Insertion of the Right Subclavian Artery

    OpenAIRE

    Büyükkaya A et al.

    2009-01-01

    The lusorian artery (Aberrant Insertion of the Right Subclavian Artery) is a rare anomaly of the right subclavian artery. Normally this anomaly causes no symptoms during life span. Dysphagia can be caused %10 percent of the adult patience with this anomaly which was first described by Bayford as “lusorian disphagia”. The purpose of this case report is present the aberrant insertion of the right subclavian artery with symptomatic disphagia and its radiological findings because of its rarity in...

  18. The aberrant retroesophageal right subclavian artery.

    Science.gov (United States)

    Seres-Sturm, M; Maros, T N; Seres-Sturm, L

    1985-01-01

    Two cases with arteria lusoria were found at 278 routine dissections. These arteria arise as the last branches of the aortic arch and have a retroesophageal position. At the crossing point, the esophagus narrows due to the groove caused by the artery. The appearance of this malposition is the consequence of the perturbation in the organo-genesis of the right dorsal aorta and fourth branchial artery. The aberration can lead to disphagia lusoria.

  19. A case of sudden death due to spontaneous right subclavian artery dissection.

    Science.gov (United States)

    Majdoub, Wael; Mosbahi, Amal; Beji, Meriem; Sriha, Badreddine; Turki, Elyes

    2017-12-01

    Acute subclavian artery dissection (SAD) is a rare entity which is usually associated with several vascular abnormalities and traumatic events. Spontaneous SAD remains exceptional and often affects the left artery. We report the autopsy case of a 29-year-old female who died suddenly following a spontaneous dissection of the right subclavian artery.

  20. Subclavian Artery Pseudoaneurysm in an Unusual Case of Digital Gangrene.

    Science.gov (United States)

    Majhi, Bhuban; Pal, Nandita

    2017-01-01

    A young male patient presented at a tertiary care hospital with cold and bluish left upper limb accompanied with digital gangrene arousing suspicion of peripheral vascular disease. History did not reveal any high-risk behavior. Clinical examination and subsequent investigations lead to the diagnosis of acute infective endocarditis of native aortic valve along with peripheral embolism caused by methicillin-resistant Staphylococcus aureus. Fogarty's balloon embolectomy was done following which patient developed pseudoaneurysm of the left subclavian artery. These iatrogenic sequelae were managed with the resection of the pseudoaneurysm and prolonged antibiotic therapy as per the culture and sensitivity report.

  1. Radiographic mislead: apparent arterial placement of subclavian central venous catheter due to mediastinal shift

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    Shaji Mathew

    2014-01-01

    Full Text Available Optimal placement of central venous catheters (CVC is essential for accurate monitoring of central venous pressure (CVP in major surgeries and ensuring long-term use of the catheter for managing the critically ill patient. Accidental subclavian artery catheterization is one of the most serious complications of the procedure. Radiography is commonly used to ensure optimal placement of CVC tip and rule out subclavian artery catheterization in the absence of Doppler ultrasound and a pressure transducer. We present a case of a haemodynamically unstable and hypoxaemic patient with mediastinal shift, in which the anaesthesiologist was in a dilemma about the arterial placement of the right subclavian CVC. The CVC crossing the midline due to mediastinal shift gave the false impression of it being placed in subclavian artery rather than the vein. Subsequently, it was proved to be correctly placed in the subclavian vein.

  2. Concomitant aorto-right subclavian artery bypass with off-pump coronary artery bypass grafting: a case report.

    Science.gov (United States)

    Tazume, Hirokazu; Okamoto, Ken; Fukui, Toshihiro

    2017-10-11

    Atherosclerotic stenosis of the brachiocephalic artery sometimes occurs in patients with coronary artery disease, and can cause stroke during the perioperative period of coronary artery bypass grafting. We describe the case of a 77-year old male with severe stenosis of the brachiocephalic artery and severe coronary artery disease. He successfully underwent aorto-right subclavian artery bypass that was performed concomitantly with off-pump coronary artery bypass. Concomitant aorto-subclavian artery bypass with off-pump coronary artery bypass grafting is a therapeutic option that minimizes the risk of perioperative stroke in patients with brachiocephalic artery stenosis and coronary artery disease.

  3. Aorta-LITA Bypass Grafting with Saphenous Vein in a Patient Undergoing Coronary Artery Surgery with Subclavian Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Kerim Çağlı

    2011-12-01

    Full Text Available The internal thoracic artery (ITA is the primary graft for coronary artery bypass grafting and can not be used if there is subclavian artery stenosis (SAS. Aorto-axillary, carotid-subclavian bypass and also angioplasty with stenting or other interventional treatments are acceptable procedures for SAS treatment. Aorta-ITA bypass with saphenous vein can be alternative and simple technique for SAS to save Winslow pathway for patients with peripheral artery disease.

  4. Prenatal diagnosis of aortopulmonary window associated with aberrant subclavian artery.

    Science.gov (United States)

    Louis-Jacques, Adetola F; Običan, Sarah G; Nguyen, Thieu; Odibo, Anthony

    2017-09-01

    Aortopulmonary window is a rare cardiac developmental anomaly characterised by a communication between the ascending aorta and the pulmonary artery. Aortopulmonary window may be isolated or associated with cardiac defects such as ventricular septal defect, atrial septal defect, interrupted aortic arch, and tetralogy of Fallot. We report a case of aortopulmonary window associated with aberrant subclavian artery based on fetal two-dimensional echocardiogram. The mother was referred for fetal echocardiography because of multiple fetal anomalies. Prenatal echocardiography at 30 weeks of gestation revealed a defect between the main and right pulmonary arteries and the ascending aorta (type III). The patient was born at 38 weeks of gestation via caesarean delivery, and was admitted to the neonatal intensive care unit because of respiratory failure and multiple congenital anomalies. Postnatal echocardiogram and cardiac MRI confirmed the prenatal findings. In addition, this patient had severe Dandy-Walker malformation and renal anomalies with poor prognosis. The family decided to withdraw respiratory care support on day of life 4, and the neonate passed away shortly after.

  5. Penetrating neck injury: Collaterals for another life after ligation of common carotid artery and subclavian artery

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    Annu Babu

    2017-02-01

    Full Text Available Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially life-threatening hemorrhage but also need profound surgical expertise in management. Development of collateral circulation in neck is well known; however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of penetrating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient presented with no neurological or motor deficits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.

  6. Evaluating vertebral artery dominancy before T4 lung cancer surgery requiring subclavian artery reconstruction.

    Science.gov (United States)

    Sekine, Yasuo; Saitoh, Yukio; Yoshino, Mitsuru; Koh, Eitetsu; Hata, Atsushi; Inage, Terunaga; Suzuki, Hidemi; Yoshino, Ichiro

    2017-08-02

    To evaluate vertebral artery (VA) dominancy and the risk of brain infarction in T4 lung cancer patients with tumor invasion into the subclavian artery. We reconstructed the subclavian artery in 10 patients with T4 non-small cell lung cancer. The histological stages were IIIA in eight patients and IIIB in two patients. We evaluated the VA dominancy by performing a four-vessel study preoperatively and investigated the relationship between the methods of VA treatment and postoperative brain complications, retrospectively. Seven patients had a superior sulcus tumor (SST) and three had direct invasion into the mediastinum. Based on the tumor location, a transmanublial approach was used in five patients and a posterolateral hook incision was used in the other five. All subclavian artery (SA) reconstructions were done using an artificial woven graft. Preoperative angiography of the VA revealed poor development of the contralateral side in two patients. One of these patients suffered a severe brain infarction on postoperative day 2, which proved fatal. In the other patient, the VA was connected to the left SA graft by a side-to-end anastomosis and there was no postoperative brain complication. Preoperative SA and VA angiography is mandatory for identifying the need for VA reconstruction in lung cancer patients with major arterial invasion.

  7. Left subclavian artery revascularization as part of thoracic stent grafting.

    Science.gov (United States)

    Saouti, Nabil; Hindori, Vikash; Morshuis, William J; Heijmen, Robin H

    2015-01-01

    Intentional covering of the left subclavian artery (LSA) as part of thoracic endovascular aortic repair (TEVAR) can cause (posterior) strokes or left arm malperfusion. LSA revascularization can be done as prophylaxis against, or as treatment of, these complications. We report our experience with the surgical technique, indications and the results of LSA revascularization. Between 2000 and 2013, 51 patients of 444 patients who were treated by TEVAR, had LSA revascularization. All elective patients had a preoperative work-up with magnetic resonance angiography to evaluate the circle of Willis. In all, surgical access was through a left supraclavicular incision only. The majority (90%) had prophylactic LSA revascularization because of incomplete circle of Willis and or dominant left vertebral artery (LVA) (n=29), patent left internal mammary artery (n=1), prevention spinal cord ischaemia (SCI) (n=2), prevention left arm ischaemia due to small LVA (n=2) and LVA origin in arch (n=1). Fourteen percent had secondary revascularization, either immediate because of malperfusion of the left arm (n=2) or late after TEVAR because of persisting left arm claudication (n=5). In 12 patients, the following early complications were observed: re-exploration for bleeding, n=1; left recurrent nerve paralysis, n=2; left phrenic nerve paralysis, n=1; left sympathetic chain neuropraxia, resulting in Horner's syndrome, n=3; Chyle duct lesions, resulting in persistent Chyle leakage, n=3. Neither strokes nor SCI was observed. One patient experienced occlusion of the bypass at 6 months. The present study shows that the procedure of LSA revascularization as part of TEVAR is safe with low morbidity consisting of mainly (transient) nerve palsy. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  8. "Classical Blalock-Taussig shunt" gone wrong: Confusing the right common carotid with right subclavian artery

    Directory of Open Access Journals (Sweden)

    A Mohammed Idhrees

    2015-01-01

    Full Text Available A 14-year-old girl underwent classical Blalock-Taussig shunt at 5 months of age. Computed tomography evaluation showed "Adachi type H" pattern of aortic arch vessels with the right common carotid artery being anastomosed to the right pulmonary artery mistaking it for the right subclavian artery.

  9. Subclavian artery stenosis caused by non-specific arteritis (Takayasu disease): treatment with Palmaz stent

    Energy Technology Data Exchange (ETDEWEB)

    Maskovic, J.; Jankovic, S.; Lusic, I.; Cambj-Sapunar, L.; Mimica, Z.; Bacic, A

    1999-09-01

    A 32-year old woman was admitted to the hospital with a sudden onset of right-sided hemiplegia and aphasia. Immediate angiographic examination revealed a severe form of type I Takayasu arteritis with occlusion of all supra-aortic vessels, with the exception of the left subclavian artery which was, however, almost completely occluded 1 cm proximal to the origin of the left vertebral artery. Since the latter provided the entire blood supply to the brain tissues, an immediate attempt was undertaken to dilate the left subclavian artery; when this was unrewarding, stenting of the lesion was successfully accomplished with excellent primary and 6-month follow-up results.

  10. Right Aortic Arch and Kommerell's Diverticulum Repaired without Reconstruction of Aberrant Left Subclavian Artery.

    Science.gov (United States)

    Osawa, Hiroshi; Shinohara, Daisuke; Orii, Kouan; Hosaka, Shigeru; Fukuda, Shoji; Akashi, Okihiko; Furukawa, Hiroshi

    2013-01-01

    Right aortic arch with Kommerell's diverticulum is a very rare situation. Surgical treatment is recommended for symptomatic patients or asymptomatic patients with a large diverticulum. However planning the strategy of operation is difficult without a 3D imaging. We report a case of a 57-year-old man with right aortic arch, Kommerell's diverticulum, and aberrant left subclavian artery. After a 3D-CT imaging, the patient underwent descending aortic replacement without reconstruction of aberrant left subclavian artery. After operation, there was no signs or symptoms of ischemia of the left arm. If the reconstruction of the aberrant subclavian artery was too difficult, closing its orifice is an acceptable decision. It has been found advantageous because of a decrease blood loss and a shorter cardiopulmonary bypass duration. If an ischemia of the arm is noticed, additional reconstruction will have to be considered. 3D-CT imaging was very useful to have a proper orientation and plan for the operative strategy.

  11. Subclavian artery occlusion and pseudoaneurysm caused by lung apex mucormycosis: successful treatment with transcatheter embolization.

    Science.gov (United States)

    Economopoulos, Nikolaos; Kelekis, Dimitris; Papadopoulos, Antonios; Kontopoulou, Christina; Brountzos, Elias N

    2007-01-01

    Subclavian artery pseudoaneurysm and occlusion in young patients are usually post-traumatic. We report the case of a 33-year-old diabetic woman with subclavian artery occlusion and pseudoaneurysm formation caused by pulmonary mucormycosis infection. The patient presented with diabetic ketoacidosis, Horner's syndrome, and absent left arm pulses. A cystic lesion of the left lung apex was found by imaging, was surgically resected, and was histologically diagnosed as mucormycosis infection. Magnetic resonance angiography depicted a left subclavian artery pseudoaneurysm and occlusion adjacent to the mucormycosis lesion. To protect against thromboembolic complications and rupture, the pseudoaneurysm was embolized with coils. The patient is clinically well 1 year after the intervention with no perfusion of the pseudoaneurysm.

  12. Arterial reconstruction of the brachiocephalic trunk and the subclavian arteries. 10 years' experience with a follow-up study

    DEFF Research Database (Denmark)

    Schroeder, T; Hansen, Hans Jørgen Buchardt

    1980-01-01

    -three reconstructive procedures were performed together with two arterial ligations (four patients were operated on bilaterally and one patient was operated on twice on the same side). There were 30 transthoracic procedures, essentially endarterectomies, and 35 supraclavicular procedures, mostly carotid......-subclavian bypasses and transpositions of the subclavian artery to the common carotid artery. One patient died (1.5 per cent). Serious complications occurred in additional four cases. In the follow-up study data on all the patients were available. During the follow-up period, ranging from four to 124 months (mean 43...

  13. Aberrant right subclavian artery and calcified aneurysm of kommerell's diverticulum: an alternative approach

    Science.gov (United States)

    Alvarez, Jose Rubio J; Quiroga, Sierra JL; Nazar, Adrio B; Comendador, Martinez JM; Carro, Garcia J

    2008-01-01

    We report a 72 year-old man with dysphagia and dizziness. Aortography and Computed tomographic scans revealed the aberrant right subclavian artery arising from a calcified aneurysm of the Kommerell's diverticulum and bilateral carotid artery disease with atherosclerotic narrowing. Surgical relief was accomplished by excluding the aneurysm from circulation through the aortic arch and a 10 mm graft was interposed between the aberrant artery and the ascending aorta. PMID:18613969

  14. Aberrant right vertebral artery originating from the aortic arch distal to the left subclavian artery: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Soo Heui; Baek, Hye Jin [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

    2014-03-15

    We present a rare case of an aberrant right vertebral artery originated from the distal aortic arch. This issue has been incidentally detected on a preoperative CT angiography after a stabbing injury of the cervical spinal cord. Normally, the right vertebral artery originates from the right subclavian artery. Therefore, in this case report we will review the incidence and the embryological mechanism of this aberrant course of the right vertebral artery and we will discuss as well the clinical importance of this variation.

  15. [Coronary subclavian steal syndrome: two cases after coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Penninga, L.; Damgaard, S.

    2008-01-01

    , was diagnosed with CSSS and treated by transposition of the proximal IMA from the subclavian artery to the aorta. Patient B was diagnosed with CSSS by control angiography. Myocardial scintigraphy showed reversible silent ischemia. He was offered treatment, but refused as he was symptom-free Udgivelsesdato: 2008/3/31...

  16. [The accidental cannulation of subclavian artery in a patient undergoing CABG].

    Science.gov (United States)

    Dabrowski, Wojciech R; Biernacka, Jadwiga T; Kotlińska, Edyta; Nestorowicz, Andrzej

    2005-01-01

    Obtaining central venous access is a standard procedure necessary for safe anesthesia in patients undergoing surgery with extracorporeal circulation. It is well known that jugular way is safer and causes less complication than subclavian. The authors present a case of accidental left subclavian artery cannulation during left internal jugular vein catheterisation. Due to the complex character of myocardial revascularization procedure with extracorporeal circulation and specific catheter localization surgical removal was necessary. This case underline well documented high risk of internal jugular vein cannulation even in operating room condition.

  17. Right-sided aortic arch with anomalous origin of the left subclavian artery: Case report

    Directory of Open Access Journals (Sweden)

    Vučurević Goran

    2011-01-01

    Full Text Available Introduction. A right-sided aortic arch is a rare congenital defect of the aorta with incidence of 0.05% to 0.1% reported in published series. Usually it is associated with congenital heart anomalies and esophageal and tracheal compression symptoms. We present a case of a right-sided aortic arch of anomalous left subclavian artery origin, accidentally revealed during multislice CT (MSCT supraaortic branches angiography. Case Outline. A 53-year-old female patient was examined at the Outpatients’ Unit of the Vascular Surgery University Clinic for vertigo, occasional dizziness and difficulty with swallowing. Physical examination revealed a murmur of the left supraclavicular space, with 15 mmHg lower rate of arterial tension on the left arm. Ultrasound of carotid arteries revealed 60% stenosis of the left subclavian artery and bilateral internal carotid artery elongation. MSCT angiography revealed a right-sided aortic arch with aberrant separation of the left subclavian artery that was narrowed 50%, while internal carotid arteries were marginally elongated. There was no need for surgical treatment or percutaneous interventions, so that conservative treatment was indicated. Conclusion. A right-sided aortic arch is a very rare anomaly of the location and branching of the aorta. Multislice CT angiography is of great importance in the diagnostics of this rare disease.

  18. Subclavian artery aneurysm in a patient with vascular Ehlers-Danlos syndrome.

    Science.gov (United States)

    Yasuda, Shota; Imoto, Kiyotaka; Uchida, Keiji; Uranaka, Yasuko; Kurosawa, Kenji; Masuda, Munetaka

    2016-02-01

    We describe our experience of surgical treatment in a 28-year-old woman with vascular Ehlers-Danlos syndrome. A right subclavian artery aneurysm was detected. The right vertebral artery arose from the aneurysm. Digital subtraction angiography showed interruption of the left vertebral artery. The aneurysm was excised and the right vertebral artery was anastomosed end-to-side to the right common carotid artery under deep hypothermia and circulatory arrest. The patient remained very well 4 years after surgery, with no late vascular complication. © The Author(s) 2014.

  19. Endovascular treatment of the subclavian artery aneurysm in high-risk patient - a single-center experience

    Directory of Open Access Journals (Sweden)

    Marjanović Ivan

    2016-01-01

    Full Text Available We present our first experience with endovascular treatment of 6 subclavian artery aneurysms (SAA occurring in five male and one female patient. All patients, in our studies, according to ASA classification were high risk for open repair of SAA. The etiology of the all aneurysms was atherosclerosis degeneration of the artery. Two aneurysms were of intrathoracic location, then the other were extrathoracic. Symptoms related to subclavian artery aneurysms were present in two patients, compression and chest pain in one, and hemorrhage shock in second, while the remaining patients were asymptomatic. We preferred the Viabhan endoprosthesis for endovascular repair in 5 cases. In one patient with ruptured of subclavian artery aneurysm who was high-risk for open repair we made combined endovascular procedure. First at all, we covered the origin of left subclavian artery with thoracic stent graft and after that we put two coils in proximal part of subclavian artery. There was no operative mortality, and the early patency rate was 100%. The follow-up period was from 3 months to 3 years. During this period, one patient died of heart failure and one patient required endovascular reoperation due to endoleak type I. Endovascular treatment is recommended for all patients with subclavian artery aneurysm whenever this is possible due to anatomical reasons especially in high-risk patient with intrathoracic localization of aneurysm, to prevent potential complications.

  20. Bilateral Subclavian Steal Syndrome

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    Reza Amini

    2011-01-01

    Full Text Available Bilateral subclavian steal syndrome is a rare condition. It is usually due to reversal of vertebral blood flow in the setting of bilateral proximal subclavian or left subclavian plus innominate artery severe stenosis or occlusion. This finding may cause cerebral ischemia related to upper extremities exercise. We report a case of bilateral subclavian steal secondary to total occlusion of the innominate and left subclavian arteries in a patient who presented with cardiomyopathy and flow reversal in the right carotid and bilateral vertebral arteries.

  1. Right Aortic Arch and Kommerell’s Diverticulum Repaired without Reconstruction of Aberrant Left Subclavian Artery

    Directory of Open Access Journals (Sweden)

    Hiroshi Osawa

    2013-01-01

    Full Text Available Right aortic arch with Kommerell’s diverticulum is a very rare situation. Surgical treatment is recommended for symptomatic patients or asymptomatic patients with a large diverticulum. However planning the strategy of operation is difficult without a 3D imaging. We report a case of a 57-year-old man with right aortic arch, Kommerell’s diverticulum, and aberrant left subclavian artery. After a 3D-CT imaging, the patient underwent descending aortic replacement without reconstruction of aberrant left subclavian artery. After operation, there was no signs or symptoms of ischemia of the left arm. If the reconstruction of the aberrant subclavian artery was too difficult, closing its orifice is an acceptable decision. It has been found advantageous because of a decrease blood loss and a shorter cardiopulmonary bypass duration. If an ischemia of the arm is noticed, additional reconstruction will have to be considered. 3D-CT imaging was very useful to have a proper orientation and plan for the operative strategy.

  2. Ease of Using a Dedicated Percutaneous Closure Device after Inadvertent Cannulation of the Subclavian Artery: Case Report

    Directory of Open Access Journals (Sweden)

    Arnaud Devriendt

    2009-01-01

    Full Text Available Inadvertent puncture of the subclavian artery is a relatively frequent and potentially disastrous complication of attempted central venous access. Due to its noncompressible location, accidental subclavian arterial cannulation may result in hemorrhage as the sheath is removed. We report a new case of successful percutaneous closure of the subclavian artery which had been inadvertently cannulated, using a closure device based on a collagen plug (Angio-Seal, St. Jude Medical. This was performed in a patient who had received maximal antiplatelet and anticoagulation therapies because of prior coronary stenting in the context of cardiogenic shock. There was no prior angiographic assessment, as arterial puncture was presumed to have been distal to the right common artery and vertebral arteries. No complications were observed in this high-risk patient, suggesting that this technique could be used once the procedure has been evaluated prospectively.

  3. Contemporary management of subclavian and axillary artery injuries-A Western Trauma Association multicenter review.

    Science.gov (United States)

    Waller, Christine J; Cogbill, Thomas H; Kallies, Kara J; Ramirez, Luis D; Cardenas, Justin M; Todd, S Rob; Chapman, Kayla J; Beckman, Marshall A; Sperry, Jason L; Anto, Vincent P; Eriksson, Evert A; Leon, Stuart M; Anand, Rahul J; Pearlstein, Maura; Capano-Wehrle, Lisa; Cothren Burlew, Clay; Fox, Charles J; Cullinane, Daniel C; Roberts, Jennifer C; Harrison, Paul B; Berg, Gina M; Haan, James M; Lightwine, Kelly

    2017-12-01

    Subclavian and axillary artery injuries are uncommon. In addition to many open vascular repairs, endovascular techniques are used for definitive repair or vascular control of these anatomically challenging injuries. The aim of this study was to determine the relative roles of endovascular and open techniques in the management of subclavian and axillary artery injuries comparing hospital outcomes, and long-term limb viability. A multicenter, retrospective review of patients with subclavian or axillary artery injuries from January 1, 2004, to December 31, 2014, was completed at 11 participating Western Trauma Association institutions. Statistical analysis included χ, t-tests, and Cochran-Armitage trend tests. A p value less than 0.05 was significant. Two hundred twenty-three patients were included; mean age was 36 years, 84% were men. An increase in computed tomography angiography and decrease in conventional angiography was observed over time (p = 0.018). There were 120 subclavian and 119 axillary artery injuries. Procedure type was associated with injury grade (p < 0.001). Open operations were performed in 135 (61%) patients, including 93% of greater than 50% circumference lacerations and 83% of vessel transections. Endovascular repairs were performed in 38 (17%) patients; most frequently for pseudoaneurysms. Fourteen (6%) patients underwent a hybrid procedure. Use of endovascular versus open procedures did not increase over the duration of the study (p = 0.248). In-hospital mortality rate was 10%. Graft or stent thrombosis occurred in 7% and graft or stent infection occurred in 3% of patients. Mean follow-up was 1.6 ± 2.4 years (n = 150). Limb salvage was achieved in 216 (97%) patients. The management of subclavian and axillary artery injuries still requires a wide variety of open exposures and procedures, especially for the control of active hemorrhage from more than 50% vessel lacerations and transections. Endovascular repairs were used most often for

  4. Endovascular Treatment of an Iatrogenic Right Internal Jugular Vein- Right Subclavian Artery Fistula and Pseudoaneurysm During the Attempt of a Hemodialysis Catheter Insertion: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Eui Min; Kim, Hyun Lee; Kim, Dong Hyun [Chosun University, Gwangju (Korea, Republic of)

    2009-02-15

    Complications during the placement of a central venous catheter, via the right internal jugular vein puncture include local hematoma, hemothorax, pneumothorax, central vein thrombosis, and hemopericardium. Iatrogenic right internal jugular vein-right subclavian artery fistula with the formation of right subclavian artery pseudoaneurysms is an extremely rare complication in patients undergoing a central vein puncture. We report the case of a patient who developed a local hematoma at the vein puncture site and dyspnea due to a right internal jugular vein-subclavian artery fistula and a right subclavian artery pseudoaneurysm at the mediastinum after puncture of right internal jugular vein. The patient was successfully treated by embolization using microcoils.

  5. Ultrasonic duplex scanning in atherosclerotic disease of the innominate, subclavian and vertebral arteries. A comparative study with angiography

    NARCIS (Netherlands)

    Eikelboom, B.C.; Ackerstaff, R.G.A.; Hoeneveld, H.; Slowikowski, J.M.; Moll, F.L.; Ludwig, J.W.

    1984-01-01

    Ultrasonic duplex scanning of the vertebral artery has a sensitivity of 0.80 and a specificity of 0.83 for the detection of an obstructive lesion of 50% or more at the site of the ostium. For the subclavian arteries these values are respectively 0.73 and 0.91. For both vessels the test has a very

  6. Anomalous origin of the right pulmonary artery from the abdominal aorta with aberrant right subclavian artery and left patent ductus arteriosus.

    Science.gov (United States)

    Fu, Songling; Xie, Chunhong; Gong, Fangqi; Zhu, Weihua

    2011-06-01

    Anomalous origin of the pulmonary artery (AOPA) from the aorta is a rare congenital heart malformation. This report describes a case of AOPA from the abdominal aorta in association with an aberrant right subclavian artery and a patent ductus arteriosus, which never has been reported previously in the literature.

  7. Association of left subclavian artery coverage without revascularization and spinal cord ischemia in patients undergoing thoracic endovascular aortic repair: A Vascular Quality Initiative® analysis.

    Science.gov (United States)

    Teixeira, Pedro Gr; Woo, Karen; Beck, Adam W; Scali, Salvatore T; Weaver, Fred A

    2017-12-01

    Objectives Investigate the impact of left subclavian artery coverage without revascularization on spinal cord ischemia development in patients undergoing thoracic endovascular aortic repair. Methods The Vascular Quality Initiative thoracic endovascular aortic repair module (April 2011-July 2014) was analyzed. Patients undergoing left subclavian artery coverage were divided into two groups according to revascularization status. The association between left subclavian artery revascularization with the primary outcome of spinal cord ischemia and the secondary outcome of stroke was assessed with multivariable analysis adjusting for between-group baseline differences. Results The left subclavian artery was covered in 508 (24.6%) of the 2063 thoracic endovascular aortic repairs performed. Among patients with left subclavian artery coverage, 58.9% underwent revascularization. Spinal cord ischemia incidence was 12.1% in the group without revascularization compared to 8.5% in the group undergoing left subclavian artery revascularization (odds ratio (95%CI): 1.48(0.82-2.68), P = 0.189). Multivariable analysis adjustment identified an independent association between left subclavian artery coverage without revascularization and the incidence of spinal cord ischemia (adjusted odds ratio (95%CI): 2.29(1.03-5.14), P = 0.043). Although the incidence of stroke was also higher for the group with a covered and nonrevascularized left subclavian artery (12.1% versus 8.5%), this difference was not statistically significant after multivariable analysis (adjusted odds ratio (95%CI): 1.55(0.74-3.26), P = 0.244). Conclusion For patients undergoing left subclavian artery coverage during thoracic endovascular aortic repair, the addition of a revascularization procedure was associated with a significantly lower incidence of spinal cord ischemia.

  8. [Right-side aortic arch with aberrant left subclavian artery and Kommerell's diverticulum. A cause of vascular ring].

    Science.gov (United States)

    Tamayo-Espinosa, Tania; Erdmenger-Orellana, Julio; Becerra-Becerra, Rosario; Balderrabano-Saucedo, Norma; Segura-Standford, Begoña

    The right-side aortic arch may be associated with aberrant left subclavian artery, in some cases this artery originates from an aneurismal dilation of the aorta called Kommerell's diverticulum. A report is presented on 2 cases of vascular ring formed by a right-side aortic arch, anomalous left subclavian artery, Kommerell's diverticulum and left patent ductus arteriosus. A review the literature was also performed as regards the embryological development and the imaging methods used to help in the diagnosis of this rare vascular anomaly. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  9. Repair of Multiple Subclavian and Axillary Artery Aneurysms in a 58-Year-Old Man with Marfan Syndrome.

    Science.gov (United States)

    Dolapoglu, Ahmet; de la Cruz, Kim I; Preventza, Ourania; Coselli, Joseph S

    2016-10-01

    Dilation of the ascending aorta and aortic dissections are often seen in Marfan syndrome; however, true aneurysms of the subclavian and axillary arteries rarely seem to develop in patients who have this disease. We present the case of a 58-year-old man with Marfan syndrome who had undergone a Bentall procedure and thoracoabdominal aortic repair for an aortic dissection and who later developed multiple aneurysmal dilations of his right subclavian and axillary arteries. The aneurysms were successfully repaired by means of a surgical bypass technique in which a Dacron graft was placed between the carotid and brachial arteries. We also discuss our strategy for determining the optimal surgical approach in these patients.

  10. A Right-sided Aortic Arch with Kommerell's Diverticulum of the Aberrant Left Subclavian Artery Presenting with Syncope

    Directory of Open Access Journals (Sweden)

    Ming-Hsun Yang

    2009-05-01

    Full Text Available A right-sided aortic arch with an aneurysm of the aberrant subclavian artery is a rare disease. We report a case of Kommerell's diverticulum of an aberrant left subclavian artery in a patient with a right-sided aortic arch. Fewer than 50 cases have been reported in the literature. A number of operative strategies are described. Right thoracotomy provides good exposure and avoids the morbidity associated with bilateral thoracotomy or sternotomy and thoracotomy. In our patient with symptoms of dysphagia, syncope, and left subclavian steal syndrome, a left thoracotomy was used. The repair was accomplished by division of a left ligamentum arteriosum, obliteration of the Kommerell's aneurysm, and an aorto-subclavian bypass. Postoperative complications included left vocal cord palsy and Horner's syndrome. Hoarseness and left ptosis recovered spontaneously 3 months after surgery, and the patient remained symptom-free at the 1-year follow-up. We believe a left thoracotomy for direct repair of Kommerell's diverticulum is a simple and safe method without the increased morbidity found in other procedures.

  11. J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system

    Energy Technology Data Exchange (ETDEWEB)

    Hama, Yukihiro; Kusano, Shoichi [Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-0042, Saitama (Japan); Makita, Kohzoh [Department of Radiology, Social Insurance Chuo General Hospital, Tokyo (Japan)

    2004-05-01

    The aim of this study was to verify the feasibility of using a J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system (RPCS). Twenty-five patients with various hepatic malignancies underwent percutaneous implantation of an RPCS through the left subclavian artery for regional chemotherapy. To successfully puncture the left subclavian artery, a J-tipped guidewire was used as a target with fluoroscopic guidance. Technical success and complication rates, and numbers of puncture failures, were retrospectively analyzed. Implantation of the RPCS was successful in all patients. Eight (32%) patients had minor complications and no patient had major complications. The number of puncture failures per patient was 0 to 1 (mean=0.32). The J-tipped guidewire is a safe and appropriate target for puncture of the subclavian artery in the placement of an RPCS. (orig.)

  12. Polymyalgia rheumatica and systemic giant cell arteritis. Bioptic findings of the subclavian arteries in a case of aortic arch syndrome.

    Science.gov (United States)

    Di Giacomo, V; Fraioli, A; Carmenini, G; Schietroma, M; Meloni, F; Grossi, F

    1984-08-01

    A 64 year old woman complained of aches and stiffness of the neck and the shoulders with fever and E.S.R. increase. A nonsteroid anti-inflammatory treatment was unsuccessful. A clinical examination revealed absence of both radial pulses and presence of murmurs at level of the carotids. The angiographic findings confirmed an aortic arch syndrome with severe stenosis of the subclavian and axillary arteries. The diagnostic approach, in spite of a negativity of the temporal artery biopsy, was for systemic giant cell arteries with general manifestations of polymyalgia rheumatica. The biopsies of both subclavian arteries, performed during a surgery revascularization, showed a typical giant cell arteries in acute stage. The histopathological pattern of extratemporal giant cell arteries obtained by means of a surgical biopsy is really uncommon, being the previous reports performed on necroscopic findings only. In addition this case confirms that polymyalgia rheumatica implies a systemic arteries even if the clinical and histopathological signs of temporal arteritis are lacking. Therefore the temporal artery should be only considered as a particular and inconstant localization of this vasculitis.

  13. Technical strategy in a patient with symptomatic thoracic aneurysm near the origin of the left subclavian artery and left internal thoracic artery coronary graft.

    Science.gov (United States)

    Babic, Srdjan D; Radak, Djordje J; Sotirovic, Vuk A; Unic-Stojanovic, Dragana R; Babic, Dusan S; Popov, Petar Z; Sagic, Dragan Z

    2012-11-01

    Thoracic endovascular aortic repair (TEVAR) is a safe and reliable technique utilized in the treatment for aortic aneurysms. However, in up to 40% of patients, devices are typically placed over the left subclavian artery (LSA) origin. In this report, we present a case of a successful TEVAR procedure following the transposition of the LSA with protective carotico-axillary/carotid bypass in a patient with a patent left internal thoracic artery (LITA)-left anterior descending (LAD) coronary artery bypass graft and right internal carotid artery (ICA) occlusion. © 2012 Wiley Periodicals, Inc.

  14. Carotid-subclavian bypass for subclavian steal syndrome following coarctation repair in infancy

    Directory of Open Access Journals (Sweden)

    Scott Chowning

    2012-01-01

    Full Text Available A 19 year old man presented with dizziness that was exacerbated while using left arm. On investigation, subclavian steal syndrome (SSS was diagnosed. He underwent left carotid to subclavian bypass with relief of symptoms. Subclavian steal syndrome, although rare, should be considered in the differential diagnosis in patients with the history of subclavian artery manipulation in the past in proper settings.

  15. [Aberrant right subclavian artery (arteria lusoria) and the risk for trisomy 21. Retrospective study of 11,479 fetopathological examinations].

    Science.gov (United States)

    Carles, D; Pelluard, F; André, G; Nocart, N; Sauvestre, F

    2014-11-01

    The aberrant right subclavian artery is a malformation of the aortic arch present at less than 2 % of the individuals in the general population. This incidence is higher in trisomy 21, making it possible use the aberrant right subclavian artery as a prenatal marker of trisomy 21. This work, which relates to a series of 11,479 consecutive fetal autopsies aims to measure the force of association between the aberrant right subclavian artery and trisomy 21, to confront our results with the sonographic series previously published and to contribute to assess the place that can have this sign in the echographic screening and the fetopathologic diagnosis of trisomy 21. The isolated presence of an aberrant right subclavian artery does not represent an argument sufficient for the indication of a karyotype. But the detection of this anomaly must make pay a special attention in search of other associated signs. On the results of this study, the aberrant right subclavian artery has to be considered as a part of the spectrum not only of trisomy 21, but also of many other congenital syndromes. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  16. Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair.

    Science.gov (United States)

    Patterson, Benjamin O; Holt, Peter J; Nienaber, Christoph; Fairman, Ronald M; Heijmen, Robin H; Thompson, Matt M

    2014-12-01

    Thoracic endovascular aortic repair (TEVAR) of various pathologies has been associated with peri-interventional neurologic complication rates of up to 15%. The objective of this study was to determine the influence of the management of the left subclavian artery (LSA) on neurologic complications and to define subgroups that might benefit from LSA revascularization. The Medtronic Thoracic Endovascular Registry (MOTHER; Medtronic, Santa Rosa, Calif), consists of data from five sponsored trials and one institutional series incorporating 1010 patients undergoing TEVAR from 2002 to 2010. Perioperative stroke and spinal cord injury (SCI) rates were described according to the management of the LSA and presenting pathology. Multivariate analysis was performed to determine factors associated with perioperative neurologic complications. Of 1002 patients included in the analysis, stroke occurred in 48 (4.8%), and SCI developed in 42 (4.2%) ≤ 30 days of surgery. The stroke rate was 2.2% in patients with no coverage of the LSA vs 9.1% with coverage alone and 5.1% in patients who underwent LSA revascularization before coverage (P < .001). This relationship was strongest in the aneurysm group. Coverage of the LSA without revascularization was independently associated with stroke (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.7-7.1), specifically in the posterior territory (OR, 11.7; 95% CI, 2.5-54.6), as was previous cerebrovascular accident (OR, 7.1; 95% CI, 2.2-23.1; P = .001), whereas a covered LSA was not associated with an increased risk of SCI. Coverage of the LSA without revascularization is an important modifiable risk factor for stroke in patients undergoing TEVAR for a thoracic aortic aneurysm. Prior revascularization appears to protect against posterior circulation territory stroke. Copyright © 2014 Society for Vascular Surgery. All rights reserved.

  17. Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation?

    DEFF Research Database (Denmark)

    Weigang, Ernst; Parker, Jack A T C; Czerny, Martin

    2011-01-01

    subclavian artery (LSA) limiting the proximal landing zone site without proximal vessel coverage. In patients in whom the distance between the LSA and aortic lesion is too short, extension of the landing zone can be obtained by covering the LSA's origin with the endovascular stent graft (ESG). This manoeuvre...... and analysed three basic treatment concepts for LSA revascularisation in TEVAR patients (prophylactic, conditional prophylactic and no prophylactic LSA revascularisation). The available evidence supports prophylactic revascularisation of the LSA before ESG LSA coverage when preoperative imaging reveals...

  18. Aberrant right subclavian artery presenting as tracheoesophagial fistula in a 50-year-old lady: Case report of a rare presentation of a common arch anomaly

    Directory of Open Access Journals (Sweden)

    Sayyed Ehtesham Hussain Naqvi

    2017-01-01

    Full Text Available A 50-year-old, woman with a 2-year history of progressive dysphagia and 2-month history of chronic cough was referred to our center in a state of generalized sepsis. Provisional diagnosis of carcinoma esophagus with tracheoesophagial fistula was made. Evaluation of the patient revealed an aberrant right subclavian artery with retroesophageal course with compression of the esophagus and trachea with fistulous communication in between. The patient was managed with medical stabilization and with feeding jejunostomy, but she succumbed to underlying severe sepsis. This presentation of aberrant subclavian artery at this advanced age rare and is therefore reported.

  19. A bypass case due to an acute inferior myocardial infarction caused by vascular occlusion of the left subclavian artery and left anterior descending artery

    Directory of Open Access Journals (Sweden)

    Altas Y

    2016-07-01

    Full Text Available Yakup Altas, Ali Veysel Ulugg Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey Abstract: ST segment elevation is the most common electrocardiographic finding in acute myocardial infarction. ST elevation in chest leads generally represents left anterior descending artery occlusion, while elevation in DII and III, and aVF represents right coronary and circumflex artery occlusion. A female patient aged 66 years was admitted to our emergency service with ST elevation in leads DIII and aVF. A diagnosis of acute inferior myocardial infarction was made. The patient’s history included coronary artery bypass graft involving the left internal mammary artery to the left anterior descending coronary artery and aorta to the right coronary artery. The patient was taken to the cardiac catheterization laboratory for primary percutaneous coronary intervention and a lesion in the left anterior descending artery was identified. Additionally, the left subclavian artery was totally occluded. Following intervention to the lesion, the patient was discharged on day 4 of admission. Keywords: electrocardiography, myocardial infarction, coronary circulation

  20. IN THE GROSS ANATOMY LABORATORY: A REVIEW OF THE EMBRYOLOGY AND MOLECULAR GENETICS OF THE ABERRANT RIGHT SUBCLAVIAN ARTERY. En el laboratorio de Anatomía macroscópica: Revisión de la embriología y genética molecular de la arteria subclavia derecha aberra

    Directory of Open Access Journals (Sweden)

    Todd M Chappell

    2016-03-01

    Full Text Available La disección del cadáver embalsamado de una mujer de 66-años por  los estudiantes de medicina de primer año de anatomía general, reveló la presencia de una arteria subclavia derecha aberrante (ASDA de trayecto retroesofágico. La prevalencia de una ASDA en la población normal es del 0.2-2.0%. Se ha reportado que la ASDA tiene una asociación con varias deformidades congénitas, tales como el síndrome de Down, Kommerell divertículo, y varias otras anomalías. No es común asociar síntomas clínicos con la ASDA, sin embargo, el síntoma más común es la disfagia lusoria. Hemos descubierto que la ASD se originó desde la porción más distal del arco aórtico en una posición retroesofágica. Medidas pertinentes de las arterias se grabaron y un análisis para obtener información clínica, genética, y embriológica acerca de la ASDA se realizó. Como en la mayoría de los casos, el curso de la ASDA fue entre el esófago y la columna vertebral. Se ha demostrado que una región en el cromosoma humano 22 (22q11 está involucrada en el desarrollo normal de los vasos del arco aórtico. Este artículo ilustra cómo el descubrimiento de una variante a través de la disección da pie a estudiantes de medicina a aprender y repasar la literatura, sobre la embriología y la genética molecular, sobre anomalías del arco aórtico y sus correlaciones clínicas. Dissection of a 66-year-old female embalmed cadaver by medical students in a first-year gross anatomy course revealed the presence of an aberrant (retroesophageal right subclavian artery (ARSA. The prevalence of an ARSA is between 0.2-2.0% in the normal population. ARSA has been reported to have an association with various congenital deformities, such as Down syndrome, Kommerell diverticulum, and various other anomalies. Clinical symptoms are usually not associated with ARSAs but when present, the most common symptom is dysphagia lusoria. We discovered that the RSA originated from the most

  1. Blunt traumatic aortic injury of right aortic arch in a patient with an aberrant left subclavian artery.

    Science.gov (United States)

    Yeo, Daryl Li-Tian; Haider, Sajjad; Zhen, Claire Alexandra Chew

    2015-03-01

    Right-sided aortic arch (RAA) is a rare congenital developmental variant present in about 0.1 percent of the population. This anatomical anomaly is commonly associated with congenital heart disease and complications from compression of mediastinal structures. However, it is unknown if patients are at a higher risk of blunt thoracic aortic injury (BTAI). We report a case of a 20-year-old man admitted to the hospital after being hit by an automobile. Computed tomographic scan revealed an RAA with an aberrant left subclavian artery originating from a Kommerell's diverticulum. A pseudo-aneurysm was also seen along the aortic arch. A diagnosis of blunt traumatic aortic injury was made. The patient was successfully treated with a 26mm Vascutek hybrid stentgraft using the frozen elephant trunk technique. A literature review of the pathophysiology of BTAI was performed to investigate if patients with right-sided aortic arch are at a higher risk of suffering from BTAI. Results from the review suggest that although theoretically there may be a higher risk of BTAI in RAA patients, the rarity of this condition has prevented large studies to be conducted. Previously reported cases of BTAI in RAA have highlighted the possibility that the aortic isthmus may be anatomically weak and therefore prone to injury. We have explored this possibility by reviewing current literature of the embryological origins of the aortic arch and descending aorta.

  2. A minimally invasive technique for closing an iatrogenic subclavian artery cannulation using the Angio-Seal closure device: two case reports

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    Szkup Peter L

    2012-03-01

    Full Text Available Abstract Introduction In the two cases described here, the subclavian artery was inadvertently cannulated during unsuccessful access to the internal jugular vein. The puncture was successfully closed using a closure device based on a collagen plug (Angio-Seal, St Jude Medical, St Paul, MN, USA. This technique is relatively simple and inexpensive. It can provide clinicians, such as intensive care physicians and anesthesiologists, with a safe and straightforward alternative to major surgery and can be a life-saving procedure. Case presentation In the first case, an anesthetist attempted ultrasound-guided access to the right internal jugular vein during the preoperative preparation of a 66-year-old Caucasian man. A 7-French (Fr triple-lumen catheter was inadvertently placed into his arterial system. In the second case, an emergency physician inadvertently placed a 7-Fr catheter into the subclavian artery of a 77-year-old Caucasian woman whilst attempting access to her right internal jugular vein. Both arterial punctures were successfully closed by means of a percutaneous closure device (Angio-Seal. No complications were observed. Conclusions Inadvertent subclavian arterial puncture can be successfully managed with no adverse clinical sequelae by using a percutaneous vascular closure device. This minimally invasive technique may be an option for patients with non-compressible arterial punctures. This report demonstrates two practical points that may help clinicians in decision-making during daily practice. First, it provides a practical solution to a well-known vascular complication. Second, it emphasizes a role for proper vascular ultrasound training for the non-radiologist.

  3. The potential risk of left subclavian artery injury from excessively long thoracic pedicle screws placed in the proximal thoracic regions of Lenke type 2 adolescent idiopathic scoliosis patients and normal teenagers: an anatomical study.

    Science.gov (United States)

    Jiang, Jun; Qian, Bang-Ping; Qiu, Yong; Wang, Bin; Yu, Yang; Zhu, Ze-Zhang

    2016-10-01

    The altered anatomic positions of important structures adjacent to the vertebrae in adolescent idiopathic scoliosis (AIS) patients have been comprehensively investigated by previous radiographic studies. However, no study has evaluated the altered position of left subclavian artery (SA) in these patients. The purpose of this study is to evaluate the altered position of left subclavian artery in AIS patients with a double thoracic curve pattern. Nineteen Lenke type 2 AIS patients and thirteen normal teenagers were included in this study. Axial computed tomography images at T2 and T3 levels were obtained in all these subjects to evaluate the subclavian artery-vertebral angle (SAVA, defined as 0° when the artery was located directly lateral to the left and 180° when directly lateral to the right) and subclavian artery-vertebral distance (SAVD, the shortest distance between the artery and vertebral body). The percentage of left subclavian arteries at potential risk of injury from excessively long pedicle screws was calculated. The SAVA was significantly larger in AIS patients than that in normal teenagers at both T2 and T3 levels (P teenagers at both T2 and T3 levels (P teenagers. The left SA is located much closer to the vertebrae in the proximal thoracic curve of Lenke type 2 AIS patients when compared with normal teenagers. The spine surgeons should be aware of such altered position of left SA and choose appropriate pedicle length to avoid anterior cortical penetration in Lenke type 2 AIS patients.

  4. Investigation of hemodynamics in an in vitro system simulating left ventricular support through the right subclavian artery using 4-dimensional flow magnetic resonance imaging.

    Science.gov (United States)

    Jung, Bernd; Müller, Christoph; Buchenberg, Waltraud; Ith, Michael; Reineke, David; Beyersdorf, Friedhelm; Benk, Christoph

    2015-07-01

    Left ventricular assist devices are an important treatment option for patients with heart failure alter the hemodynamics in the heart and great vessels. Because in vivo magnetic resonance studies of patients with ventricular assist devices are not possible, in vitro models represent an important tool to investigate flow alterations caused by these systems. By using an in vitro magnetic resonance-compatible model that mimics physiologic conditions as close as possible, this work investigated the flow characteristics using 4-dimensional flow-sensitive magnetic resonance imaging of a left ventricular assist device with outflow via the right subclavian artery as commonly used in cardiothoracic surgery in the recent past. An in vitro model was developed consisting of an aorta with its supra-aortic branches connected to a left ventricular assist device simulating the pulsatile flow of the native failing heart. A second left ventricular assist device supplied the aorta with continuous flow via the right subclavian artery. Four-dimensional flow-sensitive magnetic resonance imaging was performed for different flow rates of the left ventricular assist device simulating the native heart and the left ventricular assist device providing the continuous flow. Flow characteristics were qualitatively and quantitatively evaluated in the entire vessel system. Flow characteristics inside the aorta and its upper branching vessels revealed that the right subclavian artery and the right carotid artery were solely supported by the continuous-flow left ventricular assist device for all flow rates. The flow rates in the brain-supplying arteries are only marginally affected by different operating conditions. The qualitative analysis revealed only minor effects on the flow characteristics, such as weakly pronounced vortex flow caused by the retrograde flow via the brachiocephalic artery. The results indicate that, despite the massive alterations in natural hemodynamics due to the

  5. Topological changes of the human autonomic cardiac nervous system in individuals with a retroesophageal right subclavian artery: two case reports and a brief review.

    Science.gov (United States)

    Kawashima, Tomokazu; Sasaki, Hiroshi

    2005-11-01

    The topological changes of the human autonomic cardiac nervous system in two cadavers with a retroesophageal right subclavian artery (Rersa) were compared with the normal autonomic cardiac nervous system. The following new results were obtained in addition to the conventional deficient finding of the right recurrent laryngeal nerve. (1) Right superior cardiac nerves arising from the superior cervical ganglion were consistently observed in both cadavers, in addition to the right thoracic cardiac nerves along the Rersa. (2) A segmental accompanying tendency of the right cardiac nerves was recognized: the cardiac nerves arising from the sympathetic trunk cranial to the middle cervical ganglia ran along with the right common carotid artery, whereas the cardiac nerves arising from the sympathetic trunk caudal to the vertebral ganglion ran along the Rersa. (3) The right thoracic cardiac nerves, which have never been observed to accompany the normal right subclavian artery, ran along the proximal part of the Rersa. According to previous reports of individuals with the Rersa, a thick right thoracic cardiac nerve is commonly observed instead of a right superior cardiac nerve. However, all the cardiac nerves were recognized in both the individuals described in the present report. Therefore, we strongly disagree with the previous idea that the origin of the right cardiac nerves from the sympathetic trunk and ganglia is shifted caudally in individuals with the Rersa. The topological changes of the autonomic cardiac nervous system in two cases of Rersa also reflected spatial changes of great arteries.

  6. PHACE association with intracranial, oropharyngeal hemangiomas, and an atypical patent ductus arteriosus arising from the tortuous left subclavian artery in a premature infant

    Directory of Open Access Journals (Sweden)

    Do-Hyun Kim

    2012-01-01

    Full Text Available PHACE association is a rare neurocutaneous condition in which facial hemangiomas associate with a spectrum of posterior fossa malformations, arterial cerebrovascular anomalies, cardiovascular anomalies, and eye anomalies. We reported a case of PHACE association in a premature infant showing facial, intracranial, and oropharyngeal hemangiomas with evidence of the Dandy-Walker variant and complicated cardiovascular anomalies, including a right-sided aortic arch and an atypical patent ductus arteriosus arising from a tortuous left subclavian artery. To our knowledge, intracranial hemangiomas are rare in PHACE association, and a concomitant oropharyngeal hemangioma has not been previously reported in the PHACE association literature. In infants presenting with large, plaque-like facial hemangiomas, it is important to conduct active cardiovascular and neurological evaluations. Special attention should be given to the laryngoscopic examination to search for additional hemangiomas in the airway.

  7. Subclavian steal syndrome without subclavian stenosis

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    Matt Cwinn, MD

    2017-09-01

    Full Text Available Subclavian steal syndrome (SSS has been well described in the setting of subclavian stenosis. We describe an unusual case of SSS caused by a high-flow arteriovenous dialysis fistula in the absence of subclavian stenosis, provide a review of the literature, and propose that arteriovenous fistula-induced SSS is an underdiagnosed cause of syncope in this population of patients.

  8. Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Ahmed, Ahmed T., E-mail: Ahmed.Ahmed1@mayo.edu; Mohammed, Khaled, E-mail: Mohammed.Khaled@mayo.edu [Mayo Clinic, Evidence-Based Practice Research Program (United States); Chehab, Monzer, E-mail: moe.chehab@beumont.edu [Oakland University William Beaumont School of Medicine, Department of Diagnostic Radiology and Molecular Imaging (United States); Brinjikji, Waleed, E-mail: Brinjikji.Waleed@mayo.edu [Mayo Clinic, Department of Radiology (United States); Hassan Murad, M., E-mail: Murad.Mohammad@mayo.edu [Mayo Clinic, Evidence-Based Practice Research Program (United States); Cloft, Harry, E-mail: Cloft.Harry@mayo.edu; Bjarnason, Haraldur, E-mail: Bjarnason.Haraldur@mayo.edu [Mayo Clinic, Department of Radiology (United States)

    2016-05-15

    Background and PurposeSubclavian artery occlusive disease (SAOD) is often associated with cerebrovascular symptoms such as subclavian steal syndrome and stroke. We conducted a systematic review and meta-analysis to compare percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of SAOD.Materials and MethodsWe searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through October 16, 2014. From each study, we abstracted baseline patient characteristics, study design variables, and outcome data including rates of technical success, primary patency (≤2 and >2 years follow-up), symptom resolution, and complications. Meta-analysis was performed using a random-effects model.ResultsA total of 35 non-comparative studies with 1726 patients were included. Technical success rate was significantly higher in the stent group than the PTA group (92.8 vs 86.8 %, p = 0.007). Long-term primary patency rates (76.9 vs 79.6 %, p = 0.729) and symptom resolution rates (82.2 vs 73.0 %, p = 0.327) were not statistically different. There was no statistically significant difference in the rates of stroke or death.ConclusionStent placement for treatment of SAOD may be associated with higher rates of technical success but similar rates of symptom resolution and long-term outcomes. The confidence in the available estimates is low. Further comparative studies are needed to guide patients and clinicians in shared decision making.

  9. Trombose de artéria carótida comum: tratamento cirúrgico com anastomose subclávio-carotidea Occlusion of the common carotid artery treated with a subclavian-internal carotid artery bypass

    Directory of Open Access Journals (Sweden)

    Marcos Antônio Dellaretti Filho

    2003-06-01

    Full Text Available Descrevemos o caso de mulher de 62 anos, com história de vários ataques isquêmicos transitórios. Os exames complementares revelaram oclusão da artéria carótida comum e revascularização da artéria carótida interna (ACI através de anastomose com a artéria tiroidiana inferior, bem como aneurisma na ACI supraclinoidea. A paciente foi tratada com "bypass" entre a artéria subclávia e a artéria carótida interna cervical, ocorrendo regressão completa dos sintomas de isquemia cerebral no pós-operatório.We describe the case of a 62 years old woman with several transient isquemic attacks. The neuroradiological study demonstrated occlusion of the common carotid artery with revascularization of the internal carotid artery by anastomosis with the inferior thyroid artery and an aneurysm of internal carotid artery at the emergency of the anterior choroidal artery. The patient was treated with a bypass between the subclavian artery and the internal carotid artery with complete regression of the symptoms.

  10. Multi-detector row computed tomographic evaluation of a rare type of complete vascular ring: Double aortic arch with atretic left arch distal to the origin of left subclavian artery

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    Hung, Ying Ying; Fu, Ching Yun; Wei, Hao Ji; Tsai, I Chen; Chen, Clayton Chi Chang [Taichung Veterans General Hospital, Taichung (China)

    2013-10-15

    Double aortic arch with an atretic left arch distal to the origin of left subclavian artery was diagnosed with multi-detector row computed tomography (MDCT) in two children with dysphagia. This rare type of complete vascular ring is clinically important because it may be confused with right aortic arch in mirror imaging. Anatomic details of this rare type of complete vascular ring demonstrated on MDCT facilitated appropriate surgical treatment.

  11. Persistent right aortic arch with an aberrant left subclavian artery, Kommerell’s diverticulum and bicarotid trunk in a 3-year-old cat

    Directory of Open Access Journals (Sweden)

    Dylan Shannon

    2015-10-01

    Full Text Available Case summary A 3-year-old male, neutered, domestic shorthair cat with a history of chronic regurgitation since being obtained as a kitten was presented for weight loss and regurgitation of all ingested food. The cat was in poor body condition and had a firm swelling in the ventral neck at the time of presentation. Thoracic radiographs showed severe dilation of the entire cervical and cranial intrathoracic esophagus to the level of the heart base. Computed tomographic angiography (CTA showed a persistent right aortic arch with an aberrant left subclavian artery and severe dilation of the cervical and intrathoracic esophagus cranial to the heart base. CTA also showed a bicarotid trunk and Kommerell’s diverticulum to be present, which are rare vascular structures in the cat. Esophagoscopy showed esophageal dilation and multiple compact trichobezoars obstructing the esophagus. Removal of the obstructing trichobezoars resulted in resolution of clinical signs, and the cat was able to drink water and eat a canned food slurry without regurgitation. Surgical correction was not pursued. Relevance and novel information Vascular ring anomaly (VRA should be considered in all cats with a history of regurgitation, regardless of their age at the time of presentation. CTA is a valuable diagnostic imaging procedure that allows differentiation of a VRA from other causes of esophageal obstruction and provides information about the VRA that can be used to determine amenability to surgical correction.

  12. Supraclavicular versus Infraclavicular Subclavian Vein Catheterization in Infants

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    Wen-Hsien Lu

    2006-04-01

    Conclusion: In our study, we found that there was no statistically significant difference among the 4 SVC locations in effectiveness of operation or in risk of complication. There was a tendency to damage the subclavian arteries through the supraclavicular route.

  13. Quantification of Aortic Valve Regurgitation by Pulsed Doppler Examination of the Left Subclavian Artery Velocity Contour: A Validation Study with Cardiovascular Magnetic Resonance Imaging.

    Science.gov (United States)

    Spampinato, Ricardo A; Jahnke, Cosima; Paetsch, Ingo; Hilbert, Sebastian; Busch, Franziska; Schloma, Valerie; Dmitrieva, Yaroslava; Bonamigo Thome, Fernanda; Löbe, Susanne; Strotdrees, Elfriede; Hindricks, Gerhard; Mohr, Friedrich-Wilhelm; Borger, Michael A

    2018-01-01

    Reflux of the aortic regurgitation (AR) causes an increased diastolic reverse flow in the aorta and its branching vessels. We aimed to evaluate the feasibility and accuracy of Doppler measurements in the left subclavian artery (LSA) for quantification of AR in a cardiovascular magnetic resonance imaging (CMR) validation study. Systolic and diastolic flow profiles of the LSA (subclavicular approach) were evaluated prospectively by use of pulsed wave Doppler in 59 patients (55.5 ± 15 years; 44 men), 47 with a wide spectrum of AR and 12 as control group. Using CMR phase-contrast sequences (performed 1 cm above the aortic valve), the AR was divided into three groups: mild, regurgitant fraction (RF)  40% (n = 20). The LSA Doppler-derived RF was calculated as the ratio between diastolic and systolic velocity-time integrals (VTI). Quality LSA Doppler signal could be obtained in all cases. Patients with CMR severe AR had higher values of LSA Doppler-derived RF (51% ± 9% vs 36% ± 11% vs 16% ± 8%; P Doppler showed a good correlation with CMR, with a sensitivity of 95%, specificity of 89%, and diagnostic accuracy for severe AR of 91.5%. Finally, Bland-Altman plots showed agreement in the group with moderate to severe AR (mean bias = -2.2% ± 8%, 95% CI, -17.7 to 13.3; P = .145) but differed in mild AR. Measurements of the RF for quantification of AR using LSA Doppler are comparable to those of CMR, highlighting the potential role of LSA Doppler as an adjunctive technique to assess the severity of AR. Copyright © 2017 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  14. Pseudo subclavian steal syndrome: Case report.

    Science.gov (United States)

    Konda, Sneha; Dayawansa, Samantha; Singel, Soren; Huang, Jason H

    2015-01-01

    Vertebrobasilar insufficiency (VBI) is a condition that results from restricted blood flow to the posterior portions of the brain, which are primarily served by the vertebral and basilar arteries. It is the most common cause of vertigo in the elderly and is usually accompanied by impaired vision and sensation. Congenital abnormalities, atherosclerosis, stroke and/or trauma may all lead to decreased vertebrobasilar circulation. A syndrome called Subclavian Steal Syndrome (SSS), which manifests with similar neurological symptoms but with a different pathophysiology, may also cause VBI. A middle-aged female presented with gradual onset fainting and vertigo attacks. Cardiac, auditory and autonomic etiologies were investigated and excluded. Clinical findings and presentation were highly suggestive of subclavian steal. However, subsequent CT angiography showed normal subclavian arteries. Instead, findings included a persistent right trigeminal artery (PTA), stenosis of the right proximal internal carotid artery, atresis of the left vertebral artery and distal segment of right vertebral artery, congenitally compromised changes in vertebral circulation (bilateral absence of the posterior communicating arteries (PCOMs)) and an absent anterograde vertebrobasilar circulation. Symptoms resolved after carotid endarterectomy. Due to the absence of a normally developed posterior circulation, the PTA was the main source of blood supply for the patient. Development of recent artheromatous changes in the right internal carotid artery, however, resulted in decreased blood through PTA, further compromising posterior circulation. This resulted in vertebrobasilar insufficiency, and manifested in symptomology similar to SSS. This clinical encounter illustrates the relative contribution of anatomical and vasoocclusive factors in closely mimicking symptoms of subclavian steal syndrome. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Left subclavian artery revascularization in zone 2 thoracic endovascular aortic repair is associated with lower stroke risk across all aortic diseases.

    Science.gov (United States)

    Bradshaw, Rhiannon J; Ahanchi, S Sadie; Powell, Obie; Larion, Sebastian; Brandt, Colin; Soult, Michael C; Panneton, Jean M

    2017-05-01

    The best management strategy for the left subclavian artery (LSA) in pathologic processes of the aorta requiring zone 2 thoracic endovascular aortic repair (TEVAR) remains controversial. We compared LSA coverage with or without revascularization as well as the different means of LSA revascularization. A retrospective chart review was conducted of patients with any aortic diseases who underwent zone 2 TEVAR deployment from 2007 to 2014. Primary end points included 30-day stroke and 30-day spinal cord injury (SCI). Secondary end points were 30-day procedure-related reintervention, freedom from aorta-related reintervention, aorta-related mortality, and all-cause mortality. We identified 96 patients with zone 2 TEVAR who met our inclusion criteria. The mean age of the patients was 62 years, with 61.5% male. Diseases included acute aortic dissections (n = 25), chronic aortic dissection with aneurysmal degeneration (n = 22), primary aortic aneurysms (n = 21), penetrating aortic ulcers/intramural hematomas (n = 17), and traumatic aortic injuries (n = 11). Strategies for the LSA included coverage with revascularization (n = 54) or without revascularization (n = 42). Methods of LSA revascularization included laser fenestration with stenting (n = 33) and surgical revascularization: transposition (n = 10) or bypass (n = 11). Of the 54 patients with LSA revascularization, 44 (81.5%) underwent LSA intervention at the time of TEVAR and 10 (18.5%) at a mean time of 33 days before TEVAR (range, 4-63 days). For the entire cohort, the overall incidence of 30-day stroke was 7.3%; of 30-day SCI, 2.1%; and of procedure-related reintervention, 5.2%. At a mean follow-up of 24 months (range, 1-79 months), aorta-related reintervention was 15.6%, aorta-related mortality was 12.5%, and all-cause mortality was 29.2%. The 30-day stroke rate was highest for LSA coverage without revascularization (6/42 [14.3%]) compared with any form of LSA revascularization (1/54 [1.9%]; P

  16. Isolated Subclavian Vein Injury: A Rare and High Mortality Case

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    Sahin Iscan

    2013-01-01

    Full Text Available Isolated subclavian vein injuries are rarely seen without concomitant arterial injury, bone fracture, damage to brachial plexus, and thoracal traumas. Our case was brought to the emergency service 6 hours after he had been shot at the shoulder with a firearm. After detection of extravasation from the left axillary and subclavian vein on arteriographic and venographic examinations, he was operated on. An autogenous saphenous vein graft was interposed between subclavian and axillary veins. Cardiac arrest developed twice because of hypovolemia, which was resolved with medical therapy. Subclavian vein injuries have a more mortal course when compared with the injuries to the subclavian arteries. Its most important reason is excessive blood loss and air embolism because of delayed arrival to hospital. As is the case in all vascular injuries, angiography is the most important diagnostic examination. If the general health state of the patient permits, arteriography and venography should be performed in patients potentially exposed to vascular injuries. In patients with extreme blood loss and deteriorated health state, direct surgical exploration of the injury site, containment of the bleeding, and venous repair are life-saving approaches.

  17. Stridor and Horner's syndrome, weeks after attempted right subclavian vein cannulation

    NARCIS (Netherlands)

    van der Werf, TS; Drijver, Y; Stegeman, CA; Boonstra, PW; Ligtenberg, JJM; Tulleken, JE; Zijlstra, JG

    A 23-year-old woman presented with renal failure resulting from polycystic kidney disease (PKD) aggravated by tubulointerstitial nephritis. Emergency haemodialysis was planned, and cannulation of the right subclavian vein was attempted, but failed. During this procedure, inadvertent arterial

  18. Origem ectópica da artéria subclávia direita e do tronco bicarotídeo no cão Ectopic origin of the right subclavian artery and the bicarotid trunk in the dog

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    Paulete de Oliveira Vargas Culau

    2004-10-01

    Full Text Available O suprimento sangüíneo para a cabeça, pescoço, tórax e membros torácicos dos cães provém da artéria aorta através de dois grandes vasos que surgem do arco aórtico, o tronco braquiocefálico e a artéria subclávia esquerda. O presente trabalho descreve a variação de origem da artéria subclávia direita e do tronco bicarotídeo, que foram observados em 8 cães durante 20 anos de dissecções em aulas de anatomia. Nos oito casos examinados, três artérias surgiram do arco aórtico. O primeiro ramo a emergir foi o tronco bicarotídeo, logo após nasceu a artéria subclávia esquerda e imediatamente a seguir, a artéria subclávia direita. O tronco bicarotídeo surgiu do arco aórtico, lateroventralmente à esquerda da traquéia, dirigindo-se cranialmente e bifurcando-se em nível da primeira costela em artérias carótidas comuns direita e esquerda. Na seqüência, emerge a artéria subclávia esquerda e imediatamente após, surgindo diretamente do arco aórtico, encontra-se a artéria subclávia direita, que se dirige para a margem cranial da primeira costela, estendendo-se dorsocranialmente para cruzar a linha mediana ao nível da primeira costela, dorsalmente ao esôfago e à traquéia. As artérias subclávia direita e esquerda apresentaram todos os seus ramos sem alterações. Embora o esôfago tenha se apresentado externamente marcado por um sulco, em razão do percurso alterado da artéria subclávia direita, a relativa ausência de dilatação cranial a este e o bom estado nutricional dos animais, nos levaram a supor que o progresso dos alimentos no esôfago não foi afetado significativamente.The blood supply to the head, neck, thorax and thoracic limb come from the aorta artery through its two broad branches, the brachiocephalic trunk and the left subclavian artery, which arise from the arch of the aorta. The present report described the abnormal origins of the right subclavian and common carotid arteries observed in eigth

  19. Functional Promiscuity of Homologues of the Bacterial ArsA ATPases

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    Rostislav Castillo

    2010-01-01

    Full Text Available The ArsA ATPase of E. coli plays an essential role in arsenic detoxification. Published evidence implicates ArsA in the energization of As(III efflux via the formation of an oxyanion-translocating complex with ArsB. In addition, eukaryotic ArsA homologues have several recognized functions unrelated to arsenic resistance. By aligning ArsA homologues, constructing phylogenetic trees, examining ArsA encoding operons, and estimating the probable coevolution of these homologues with putative transporters and auxiliary proteins unrelated to ArsB, we provide evidence for new functions for ArsA homologues. They may play roles in carbon starvation, gas vesicle biogenesis, and arsenic resistance. The results lead to the proposal that ArsA homologues energize four distinct and nonhomologous transporters, ArsB, ArsP, CstA, and Acr3.

  20. Blood flow-vessel interaction in a subclavian aneurysm

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    Alexandru M. MOREGA

    2011-12-01

    Full Text Available This paper presents a mathematical mode and numerical simulation results of the blood flow-structural interaction, which occurs in a saccular aneurysm emerging out of the left subclavian artery, using computational domains made of by medical images reconstruction. A correlation between the total force per area acting upon the artery walls by the pulsatile blood flow and the rupture probability are also investigated.

  1. A modified approach to supraclavicular subclavian vein catheter placement: the pocket approach.

    Science.gov (United States)

    Gorchynski, Julie; Everett, Worth W; Pentheroudakis, Eleni

    2004-07-01

    Central venous access is often necessary for the administration of fluids, blood products, and medications. Several approaches to supraclavicular subclavian venous access have been described. This study examines the effectiveness of central venous catheter placement utilizing an alternative set of anatomic landmarks for supraclavicular subclavian vein access. This was a two phase study. The first portion involved subclavian vein cannulation using a supraclavicular approach in 28 cadavers. The specific set of anatomic landmarks for the supraclavicular approach, termed the "pocket approach," is described. Cadavers were subsequently dissected to verify appropriate line placement. The second portion was a chart review of Emergency Department (ED) patients who underwent attempted subclavian vein catheter placement utilizing the pocket approach. Charts were extracted following education of the ED faculty and resident staff to determine: 1) Success of subclavian line placement, 2) The incidence of pneumothorax, and 3) The use of supraclavicular subclavian access in the trauma setting, during cardiopulmonary resuscitation (CPR), and in patients who had cervical collars. In 28 cadavers, the success rate of the pocket approach was 100% (34/34; 95% CI 90% to 100%). Chart review of the 68 patients revealed a success rate of 90% (61/68; CI 80% to 96%). No pneumothoraces were recorded (0/68; CI 0% to 5%). The pocket approach was used successfully in 11 patients with cervical collars, (100%, CI 72% to 100%) and in 15 of 16 patients undergoing CPR (94%, CI 70% to 100%). In four fresh cadavers, the average distance from the posterior subclavian vein to the subclavian artery was 0.40cm, and the dome of the pleura was 1.75cm posterior to the vein. Our data suggest that the supraclavicular pocket approach to subclavian vein cannulation is a useful and safe method of adult central venous catheterization, with complication and success rates comparable to more common approaches. The

  2. Jugular versus subclavian totally implantable access ports: Catheter position, complications and intrainterventional pain perception

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    Plumhans, Cedric, E-mail: plumhans@rad.rwth-aachen.de [Department of Diagnostic Radiology, University Hospital, RWTH-Aachen University, Pauwelsstrasse 30, D-52074 Aachen (Germany); Mahnken, Andreas H. [Department of Diagnostic Radiology, University Hospital, RWTH-Aachen University, Pauwelsstrasse 30, D-52074 Aachen (Germany); Applied Medical Engineering, Helmholtz Institute, RWTH-Aachen University (Germany); Ocklenburg, Christina [Institute of Medical Statistics, University Hospital, RWTH-Aachen University (Germany); Keil, Sebastian; Behrendt, Florian F.; Guenther, Rolf W.; Schoth, Felix [Department of Diagnostic Radiology, University Hospital, RWTH-Aachen University, Pauwelsstrasse 30, D-52074 Aachen (Germany)

    2011-09-15

    Purpose: To determine the safest and most tolerable method for totally implantable access ports (TIAPs) particularly in regard to patient's pain perception and catheter-related complications. Materials and methods: From January 2007 to October 2008 a subcutaneous TIAP (Bardport, Bard Access System, UT, USA) was implanted in 138 oncological patients (60 male, 78 female; 18-85 years old; mean age of 56 {+-} 6 years) by experienced interventional radiologists. 94 TIAP were implanted through the subclavian vein (subclavian group) and 44 TIAP were implanted through the internal jugular vein (jugular group). Intrainterventional pain perception (visual analogue scale from 1 to 10), postinterventional catheter tip migration and radiation dose were documented for each method and implantation side and differences were compared with Wilcoxon t-test. For ordinal variables, comparison of two groups was performed with the Fisher's exact test. Results: No severe periinterventional complication occurred. Inadvertent arterial punctures without serious consequences were reported in one case for the jugular group versus four cases in the subclavian group. Significantly (p < 0.05) lower pain perception, radiation dose and tip migration rate were observed in the jugular group. Catheter occlusions occurred in 4% (n = 4) of the subclavian group versus 2% (n = 1) of the jugular group. The corresponding values for vein thrombosis and catheter dislocation were 3% (n = 3) and 1% (n = 1) in the subclavian group, while none of those complications occurred in the jugular group. Conclusion: Both techniques, the TIAP implantation via fluoroscopy-guided subclavian vein puncture and via ultrasound-guided jugular vein puncture, are feasible and safe. Regarding intrainterventional pain perception, radiation dose, postinterventional catheter tip position and port function the jugular vein puncture under ultrasound guidance seems to be advantageous.

  3. Placement of central venous access via subclavian vein under fluoroscopic guidance with intravenous contrast injection

    Energy Technology Data Exchange (ETDEWEB)

    Choo, Sung Wook; Choo, In Wook; Do, Young Soo; Kim, Seung Hoon; Yoh, Kyu Tong; Ro, Duk Woo; Kim, Bo Kyung [Samsung Medical Center, Seoul (Korea, Republic of)

    1997-01-01

    To evaluate the safety and efficacy of Hickman catheter placement via the subclavian vein under fluoroscopic guidance with intravenous contrast injection. During an eleven-month period, 187 Hickman catheters were percutaneously placed in 167 consecutive patients in an interventional radiology suite. Subclavian venous puncture was made with injection of contrast medium into the peripheral venous line. After subclavian venous access had been obtained, a subcutaneous tunnel was created using a peel-away sheath or a tunneler. The Hickman catheters were inserted through a peel-away sheath, the distal tip of which was as the junction of the right atrium and the superior vena cava. One hundred and eighty-six Hickman catheters were successfully placed ; the one failure was due to anatomical tortuosity of the vein (0.53%). Complications included one case of subclavian vein occlusion (0.53%) ; three of line occlusion by thrombus (1.6%) ; one of oozing at the suture site (0.53%) ; six of infection or inflammation (3.2%) ; eight of natural removal (4.2%) ; one case of air embolism (0.53%) and two of malposition (0.1%). Major complications such as pneumothorax or arterial puncture leading to mediastinal hemorrhage did not, however, occur. The authors concluded that radiologic Hickman catheter placement offers advantages over traditional approaches in terms of safety, convenience, and time and cost savings.

  4. Comparison of the visualisation of the subclavian and axillary veins: An ultrasound study in healthy volunteers.

    Science.gov (United States)

    Roger, Claire; Sadek, Meriem; Bastide, Sophie; Jeannes, Pascal; Muller, Laurent; Bobbia, Xavier; Lefrant, Jean-Yves

    2017-02-01

    To compare the area of the lumen of the axillary and subclavian veins using ultrasound (US) in 50 healthy volunteers. Using an ultrasound device, depth, area, short axis vein length and long axis vein, vein-artery and vein-pleura distances were measured for axillary and subclavian approaches. The mean cross-sectional area of the axillary vein was greater than the mean cross-sectional area of the subclavian vein (327±89 mm(2) versus 124±46 mm(2), Pvisualised in 3 and 45 volunteers, respectively (Pvisualisation of the axillary vein under US is greater than that for the subclavian vein, mainly due to a better alignment with the long axis of the axillary vein leading to a greater cross-sectional area of the axillary vein. NCT01647815. Copyright © 2016 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  5. Technical developments: use of targeting guide wire in left subclavian puncture during percutaneous implantation of port-catheter systems using the catheter tip fixation method

    Energy Technology Data Exchange (ETDEWEB)

    Yamagami, Takuji; Kato, Takeharu; Nakamura, Toshiyuki; Iida, Shigeharu; Tanaka, Osamu; Nishimura, Tsunehiko [Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii, Kawaramachi-Hirokoji, Kamigyo, Kyoto 602-8566 (Japan)

    2003-04-01

    Our objective was to evaluate the feasibility and safety of a new method in approaching the access route percutaneously for the implantable port-catheter system for repeated hepatic arterial infusion chemotherapy. Fifteen patients underwent port-catheter system placement via the left subclavian artery with the catheter tip fixed within the gastroduodenal artery with embolic materials and a catheter side hole opening to the common hepatic artery. Before port-catheter placement, the right gastric artery was embolized via the femoral catheter access. Then a 0.035-in. guide wire was inserted from the right femoral artery to the left subclavian artery. The guide wire was left in place during puncture by the needle as an access route for catheter placement. At the time of puncture, the tip of the puncture needle was aimed at the guide wire placed in the subclavian artery beforehand. In all 15 patients the procedure was successfully completed in a reasonable time (mean time 95.0 min, range 50-240 min). Complications occurred in two patients: a transient numbness of the arm in 1 patient and a mild hematoma detected in the subcutaneous pocket in another patient. This experience indicates the possibility of using a targeting guide wire in puncture of the subclavian artery as an access route for catheter placement. (orig.)

  6. Compact X-ray irradiator on the base of pulsed accelerator ARSA in medicine and biology

    Energy Technology Data Exchange (ETDEWEB)

    Ehl' yash, S.L.; Kalinovskaya, N.I. [Russian Federal Nuclear Center - All-Russian Scientific Research Institute of Experimental Physics (Russian Federation)

    1998-07-01

    ARSA is a compact pulsed accelerator on the base of a ten-cascade Marx generator with voltage of 1 MV, developed in the Russian Federal Nuclear Center - All-Russian Scientific Research Institute of Experimental Physics (RFNC-VNIEEF). It is successfully used in physical research. An accelerating tube (a sealed diode vacuum cold-cathode tube) is the source of electron and X-ray radiation. The maximum dose per impulse with duration 10ns is 3 x 10{sup 4} Gy and 3 Gy, correspondingly. The mass of the high-voltage assembly is about 50 kg. A compact X-ray irradiator on the base of the ARSA accelerator can be used for irradiation of donor blood and for research of biological effects of super-powerful radiation, as well as for solving other problems of radiobiology and medicine. The irradiator is equipped with biological protection, monitor-dosimeter and control panel. The irradiator is ecologically safe, mobile and easy to operate. (author)

  7. Left subclavian-carotid bypass in a 38-year old female with brain ischemic symptoms secondary to Takayasu’s arteritis: A case report

    Directory of Open Access Journals (Sweden)

    Carlos A. Hinojosa, MD MSc.

    2016-01-01

    Discussion/Conclusion: This case illustrates the clinical presentation of TA affecting both carotid arteries; open revascularization via carotid subclavian bypass grafting was successfully performed with minimal morbidity, complete resolution of symptoms and improvement of the patient’s quality of life. Revascularization procedures when indicated should be performed while the disease is inactive and close surveillance is mandatory.

  8. Endovascular repair of inadvertent arterial injury induced by central venous catheterization using a vascular closure device: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, So Hee; Jang, Woo Jin; Oh, Ju Heyon; Song, Yun Gyu [Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Korea, Republic of)

    2017-04-15

    Central venous catheterization can cause various complications. Inadvertent subclavian artery catheterization was performed during insertion of a central venous catheter in a 73-year-old man suffering from panperitonitis due to small-bowel perforation. Endovascular treatment was conducted to treat the injured subclavian artery with a FemoSeal vascular closure device.

  9. Rock climbing-related subclavian vein thrombosis.

    Science.gov (United States)

    Lutter, Christoph; Monasterio, Erik; Schöffl, Volker

    2015-10-01

    Paget-Schroetter syndrome, also known as upper extremity deep venous thrombosis (UEDVT), is a rare condition, characterised by a (sub-) total occlusion of the axillary-subclavian venous system due to thrombosis. UEDVT is the most common vascular condition among athletes so far; although the general incidence is low, this problem will become more frequent as a result of increased participation in climbing sports. The purpose of this report is to illustrate two cases in rock climbers where UEDVT developed during rock climbing or bouldering. Fortunately, both patients were diagnosed relatively early after the symptoms began, despite the ambiguity of UEDVT symptoms. This relatively unfamiliar condition may become more highly recognised as a potentially serious differential diagnosis of unspecific pain of the shoulder. Rock climbers are disposed to develop UEDVT due to frequent stress on the upper extremities during training or competition. 2015 BMJ Publishing Group Ltd.

  10. PICTORIAL ESSAY Is anomalous origin of the left vertebral artery ...

    African Journals Online (AJOL)

    The incidence of anomalous origin of the left vertebral artery from the aortic arch ranges between 1% and 5.8%.1,2 This anomaly has important implications for thoracic surgery and interventional procedures. The left vertebral artery may originate from: • the left common carotid artery. • the root of the left subclavian artery ...

  11. Anatomical Study of Subclavian Artery and Its Branches

    Directory of Open Access Journals (Sweden)

    zahed Safikhani

    2006-02-01

    Conclusion: For preserving the integrity of important structures in the base of the neck, especially thyroid gland in surgery, this vascular variations are presented to physicians to keep in mind that such variations exists during diagnostic investigation and surgical procedures of the neck. An awareness of these variations is important, because this area in used for diagnostic and surgical procedures.

  12. Retroesophageal right subclavian artery: a case report and review of ...

    African Journals Online (AJOL)

    The anatomic and morphologic variations of the aortic arch and its branches are significant for diag- nostic and surgical procedures in the thorax and neck. This present study describes a case of RRESA in our specimen and discusses the anatomy and embryology. Corresponding author: Anthony Ocaya. Lecturer and Head,.

  13. Influence of Mechanical Ventilation on the Incidence of Pneumothorax During Infraclavicular Subclavian Vein Catheterization: A Prospective Randomized Noninferiority Trial.

    Science.gov (United States)

    Kim, Eugene; Kim, Hyun Joo; Hong, Deok Man; Park, Hee-Pyoung; Bahk, Jae-Hyon

    2016-09-01

    It remains unclear whether we have to interrupt mechanical ventilation during infraclavicular subclavian venous catheterization. In practice, the clinicians' choice about lung deflation depends on their own discretion. The purpose of this study was to assess the influence of mechanical ventilation on the incidence of pneumothorax during infraclavicular subclavian venous catheterization. A total of 332 patients, who needed subclavian venous catheterization, were randomly assigned to 1 of the 2 groups: catheterizations were performed with the patients' lungs under mechanical ventilation (ventilation group, n = 165) or without mechanical ventilation (deflation group, n = 167). The incidences of pneumothorax and other complications such as arterial puncture, hemothorax, or catheter misplacements and the success rate of catheterization were compared. The incidences of pneumothorax were 0% (0/165) in the ventilation group and 0.6% (1/167) in the deflation group. The incidence of pneumothorax in the deflation group was 0.6% higher than that in the ventilation group and the 2-sided 90% confidence interval for the difference was (-1.29% to 3.44%). Because the lower bound for the 2-sided 90% confidence interval, -1.29%, was higher than the predefined noninferiority margin of -3%, the inferiority of the ventilation group over the deflation group was rejected at the .05 level of significance. Other complication rates and success rates of catheterization were comparable between 2 groups. The oxygen saturation dropped below 95% in 9 patients in the deflation group, while none in the ventilation group (P = .007). The success and complication rates were similar regardless of mechanical ventilation. During infraclavicular subclavian venous catheterization, interruption of mechanical ventilation does not seem to be necessary for the prevention of pneumothorax.

  14. Supraclavicular versus Infraclavicular Subclavian Vein Catheterization in Infants

    OpenAIRE

    Wen-Hsien Lu; Mei-Ling Yao; Kai-Sheng Hsieh; Pao-Chin Chiu; Ying-Yao Chen; Chu-Chuan Lin; Ta-Cheng Huang; Chu-Chin Chen

    2006-01-01

    Central venous catheterization is an important procedure for infant patients for a number of different purposes, including nutritional support, surgical operation, hemodynamic monitoring, and multiple lines for critical care medications. Subclavian vein catheterization (SVC) is one of the central vein catheterization techniques. SVC can be performed from 4 different locations: right supraclavicular (RSC), left supraclavicular (LSC), right infraclavicular (RIC), and left infraclavicular (LIC)....

  15. Successful Interventional Management for Pulmonary Arterial Injury Secondary to Pacemaker Implantation

    Directory of Open Access Journals (Sweden)

    Hiroyuki Tokue

    2016-01-01

    Full Text Available Subclavian vein puncture is a relatively fast and safe technique to access the right heart for placement of pacemaker leads. Hemothorax related to injury of the pulmonary artery (PA is a rare complication of subclavian vein access but can be life-threatening. We report a case of hemothorax occurring after subclavian vein puncture for pacemaker implantation. No cases of transcatheter arterial embolization for PA injury secondary to pacemaker implantation have been reported. Understanding of this rare complication after pacemaker implantation along with its specific clinical presentation may lead to early diagnosis and intervention.

  16. Subclavian vein aneurysm secondary to a benign vessel wall hamartoma

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Patrick [Nationwide Children' s Hospital, Section of Pediatric Interventional Radiology, Columbus, OH (United States); Spaeth, Maya [Nationwide Children' s Hospital, Section of Plastic and Reconstructive Surgery, Columbus, OH (United States); Prasad, Vinay [Nationwide Children' s Hospital, Section of Pediatric Pathology, Columbus, OH (United States); McConnell, Patrick [Nationwide Children' s Hospital, Section of Cardiothoracic Surgery, Columbus, OH (United States)

    2013-11-15

    Venous aneurysms are rare clinical entities, particularly in children, and their presentation and natural history often depend on the anatomical location and underlying etiology. We present a single case of a 12-year-old girl who presented with a palpable right supraclavicular mass. Imaging evaluation with CT, conventional venography, MRI and sonography revealed a large fusiform subclavian vein aneurysm with an unusual, mass-like fibrofatty component incorporated into the vessel wall. The girl ultimately required complete resection of the right subclavian vein with placement of a synthetic interposition graft. This case provides a radiology/pathology correlation of an entity that has not previously been described as well as an example of the utility of multiple imaging modalities to aid diagnosis and preoperative planning. (orig.)

  17. Countercurrent aortography via radial artery

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Hyung Kuk; Lee, Young Chun; Lee, Seung Chul; Jeon, Seok Chol; Joo, Kyung Bin; Lee, Seung Ro; Kim, Soon Yong [College of Medicine, Hanyang University, Seoul (Korea, Republic of)

    1987-06-15

    Countercurrent aortography via radial artery was performed for detection of aortic arch anomalies in 4 infants with congenital heart disease. Author's cases of aortic arch anomalies were 3 cases of PDA, 1 case of coarctation of aorta, and 1 case of occlusion of anastomosis site on subclavian artery B-T shunt. And aberrant origin of the right SCA, interrupted aortic arch, hypoplastic aorta, anomalous origin of the right pulmonary artery from the ascending aorta can be demonstrated by this method. Countercurrent aortography affords an safe and simple method for detection of aortic arch anomalies without retrograde arterial catheterization, especially in small infants or premature babies.

  18. The arterial supply of the thymus in dogs

    Directory of Open Access Journals (Sweden)

    Frederico Ozanan Carneiro e Silva

    1994-06-01

    Full Text Available There were observed the origin, the number and the ordering of the thymic vessels in 30 dogs fetuses, by dissection after injection with Neoprene latex 450 solution and fixation with formalin solution at 10%. The results permited to conclude that: the thymic arteries come, directly and indirectly, from the internal thoracic arteries, brachiocephalic trunk, pericardicophrenics arteries, costocervicals trunks and subclavian arteries, wich combined by theirself given from five to fourteen contributions that showed a own vascularization model for each organ.

  19. Thrombosis caused by polyurethane double-lumen subclavian superior vena cava catheter and hemodialysis

    DEFF Research Database (Denmark)

    Wanscher, Maria Rørbæk; Frifelt, J J; Smith-Sivertsen, C

    1988-01-01

    During an 18-month period, 82 consecutive patients (37 women and 45 men), with a mean age of 50 yr (range 15 to 74), underwent hemodialysis with 91 polyurethane double-lumen subclavian superior vena cava catheters inserted via the right subclavian vein. Upon catheter removal, venograms were...

  20. The Epidemiology of Subclavian Stenosis and its Association with Markers of Subclinical Atherosclerosis: the Multi-Ethnic Study of Atherosclerosis (MESA)

    Science.gov (United States)

    Aboyans, Victor; Kamineni, Aruna; Allison, Matthew A.; McDermott, Mary McGrae; Crouse, John R.; Ni, Hanyu; Szklo, Moyses; Criqui, Michael H.

    2010-01-01

    Background Recent studies indicate that subclavian stenosis (SS), diagnosed by a large systolic blood pressure difference (SBPD) between the right and left brachial arteries, is associated with cardiovascular disease (CVD) risk factors and outcomes. We sought to describe the epidemiology of SS and determine its association with markers of subclinical CVD in the baseline cohort of the Multi-Ethnic Study of Atherosclerosis. Methods We defined SS by an absolute SBPD ≥15 mmHg. Peripheral artery disease (PAD) was defined by an ankle-brachial index ≤0.90. The coronary artery calcium score (CAC) and the common-carotid artery intima-media thickness (CCA-IMT) were measured by computed tomography and B-mode ultrasound, respectively. Odds ratios for the associations of SS with risk factors and subclinical disease were estimated using logistic regression. Results Of 6,743 subjects studied, 307 participants (4.6%) had SS, with a higher prevalence in women (5.1%) than men (3.9%), and in African-Americans (7.4%) and non-Hispanic whites (5.1%) than Hispanic (1.9%) or Chinese (1.0%) participants (p100 vs. score=0; OR=1.43; 1.03-2.01). Conclusions The subclavian stenosis is positively associated with other markers of subclinical atherosclerosis. PMID:20138280

  1. A patient presenting a 22q13 deletion associated with an apparently balanced translocation t(16;22: an illustrative case in the investigation of patients with low ARSA activity

    Directory of Open Access Journals (Sweden)

    Osvaldo Artigalás

    2012-01-01

    Full Text Available A 10-year-old speechless, mentally deficient male, with low arylsulfatase A (ARSA activity, and presumably, methachromatic leukodystrophy, underwent genetic evaluation. As the clinical picture was not compatible with this diagnosisan ARSA gene and chromosome analysis were performed, showing the presence of a pseudodeficiency ARSA allele and a de novo apparently balanced t(16;22(p11.2;q13 translocation. A deletion on the long arm of chromosome 22 encompassing the ARSA gene, as shown by FISH and array-CGH, indicated a 22q13 deletion syndrome. This case illustrates the importance of detailed cytogenetic investigation in patients presenting low arylsulfatase A activity and atypical/unspecific clinical features.

  2. A patient presenting a 22q13 deletion associated with an apparently balanced translocation t(16;22): An illustrative case in the investigation of patients with low ARSA activity

    Science.gov (United States)

    Artigalás, Osvaldo; Paskulin, Giorgio; Riegel, Mariluce; Burin, Maira; Saraiva-Pereira, Maria Luiza; Maluf, Sharbel; Kiss, Andrea; Schwartz, Ida Vanessa D.

    2012-01-01

    A 10-year-old speechless, mentally deficient male, with low arylsulfatase A (ARSA) activity, and presumably, methachromatic leukodystrophy, underwent genetic evaluation. As the clinical picture was not compatible with this diagnosisan ARSA gene and chromosome analysis were performed, showing the presence of a pseudodeficiency ARSA allele and a de novo apparently balanced t(16;22)(p11.2;q13) translocation. A deletion on the long arm of chromosome 22 encompassing the ARSA gene, as shown by FISH and array-CGH, indicated a 22q13 deletion syndrome. This case illustrates the importance of detailed cytogenetic investigation in patients presenting low arylsulfatase A activity and atypical/unspecific clinical features. PMID:22888290

  3. Management Strategy for Patients With Chronic Subclavian Vein Thrombosis.

    Science.gov (United States)

    Keir, Graham; Marshall, M Blair

    2017-02-01

    We performed a systematic review to determine best practice for the management of patients with chronic or subacute subclavian vein thrombosis. This condition is best managed with surgical excision of the first rib followed by long-term anticoagulation. Interventional techniques aimed at restoring patency are ineffective beyond 2 weeks postthrombosis. Additional therapeutic options should be made based on the severity of symptoms as well as vein status. Patients with milder symptoms are given decompression surgery followed by anticoagulation whereas patients with more severe symptoms are considered for either a jugular vein transposition or saphenous patch based on the vein characteristics. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Arterial supply of the thoracic lobes of the thymus in dogs of the Great Dane race.

    Directory of Open Access Journals (Sweden)

    Rosana Marques Silva

    2007-09-01

    Full Text Available The origins, numbers and type of arterial branches responsible for the blood supply of thoracic lobes of the thymus were studied in 28 stillborn dogs of the Great Dane, of which 18 were males and 10 were females. The arterial systems of these animals were filled with aqueous solution of Neoprene Latex “450”, 50%. After, the specimens were fixed in 10% formaldehyde aqueous solution. The lobes of the thymus were supplied by direct or indirect arterial branches coming from the right and left internal thoracic arteries, pericardiacophrenicas arteries, right and left costocervicais trunks, and left subclavian artery. The left subclavian artery and brachiocephalic trunk emitted direct branches towards the left thoracic lobe of the thymus.

  5. Hypertension following Therapeutic Arterial Embolization: A Rare Complication

    Directory of Open Access Journals (Sweden)

    Ghansham Biyani

    2014-05-01

    Full Text Available Accelerated hypertension following therapeutic arterial embolization is a rare phenomenon. A patient of left upper limb chronic lymphedema was posted for shoulder disarticulation under general anaesthesia. Coil embolization of the left subclavian artery was done prior to surgery. Following the intervention, patient’s blood pressure increased by more than 30% of the base line value and was managed with antihypertensives for the next 3 hours to get the blood pressure optimised prior to taking the patient for surgery.

  6. Bedside prediction of right subclavian venous catheter insertion length

    Directory of Open Access Journals (Sweden)

    Yoon Ji Choi

    2014-12-01

    Full Text Available Background and objective: The present study aimed to evaluate whether right subclavian vein (SCV catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I-IC, via the top of the SCV arch, or via the clavicle (denoted as I-T-IC and I-C-IC, respectively. Method: In total, 70 SCV catheterizations were studied. The I-IC, I-T-IC, and I-C-IC distances in each case were measured after ultrasound-guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X-ray. Results: L differed from the I-T-IC, I-C-IC, and I-IC distances by 0.14±0.53, 2.19±1.17, and -0.45 ±0.68 cm, respectively. The mean I-T-IC distance was the most similar to the mean L (intraclass correlation coefficient = 0.89. The mean I-IC was significantly shorter than L, while the mean I-C-IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm = -0.037 + 0.036 × Height (cm + 0.903 × I-T-IC (cm (adjusted r2 =0.64. Conclusion: The I-T-IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation.

  7. Subclavian Vein Stenosis/Occlusion Following Transvenous Cardiac Pacemaker and Defibrillator Implantation: Incidence, Pathophysiology and Current Management

    Directory of Open Access Journals (Sweden)

    Brian O'Leary

    2015-08-01

    Full Text Available Subclavian vein stenosis is a common, but usually asymptomatic, complication following cardiac device placement. In addition to reviewing the literature on incidence, pathogenesis and management options for this important clinical problem, we describe two cases of symptomatic subclavian vein occlusion following pacemaker/defibrillator placement and successful treatment with venoplasty and stenting.

  8. Bilateral Subclavian Vein Occlusion in a SAPHO Syndrome Patient Who Needed an Implantable Cardioverter Defibrillator.

    Science.gov (United States)

    Ishizuka, Masato; Yamamoto, Yuko; Yamada, Shintaro; Maemura, Sonoko; Nakata, Ryo; Motozawa, Yoshihiro; Yamamoto, Keisuke; Takizawa, Masataka; Uozumi, Hiroki; Ikenouchi, Hiroshi

    2016-05-25

    A 79-year-old Asian man was hospitalized because of progressive exertional dyspnea with decreasing left ventricular ejection fraction and frequent non-sustained ventricular tachycardia. Pre-procedure venography for implantable cardioverter defibrillator (ICD) implantation showed occlusion of the bilateral subclavian veins. In consideration of subcutaneous humps in the sterno-clavicular area and palmoplantar pustulosis, we diagnosed him as having synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome and speculated that it induced peri-osteal chronic inflammation in the sterno-clavicular area, resulting in occlusion of the adjacent bilateral subclavian veins. An automatic external defibrillator (AED) was installed in the patient's house and total subcutaneous ICD was considered. Venous thrombosis in SAPHO syndrome is not frequent but has been reported. To the best of our knowledge, this is the first case of bilateral subclavian vein occlusion in a SAPHO syndrome patient who needs ICD implantation.

  9. [Percutaneous catheterization of the subclavian vein and/or the Pirogoff angle].

    Science.gov (United States)

    Millet, J P; Wintrebert, P

    1977-07-19

    The approach to the sub-clavian venous axis being carried out blindly, the difficulties encountered oblige one: - to avoid the danger (pleural dome in particular); - to guide the catheter along the sub-clavian axis (and not in the jugular vein) and therefore to know the anatomical landmarks and a precise method. A variant of the CARLE technique, that which is proposed is based on no other anatomical argument than the direction of the sub-clavian axis and of its junction. The puncture site is higher and more external, a guiding finger shows the pathway in such a way as to try and leave the dangers behind the pathway of the needle. The obligatory long tunnelization of the catheter, becomes an advantage (fights against the danger of infection) to be added to the already known advantages of this pathway.

  10. Ultrasound-Guided Subclavian Vein Cannulation in Neonate via Supraclavicular Approach

    Directory of Open Access Journals (Sweden)

    Onur Balaban

    2017-01-01

    Full Text Available Central venous cannulation of infants may be challenging. Ultrasonography is recommended and has been found superior to classic landmark technique in pediatric central venous cannulation. The cannulation of the subclavian vein using supraclavicular approach under real-time ultrasound guidance is a novel technique. It may have advantages over ultrasound-guided jugular vein cannulation in specific patients. We report a case of 3200-gram 20-day-old anencephalic neonate who had a diffuse generalized edema. The neonate was cannulated successfully via subclavian vein using supraclavicular approach under ultrasound guidance.

  11. Permanent Cortical Blindness After Bronchial Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Doorn, Colette S. van, E-mail: cvandoorn@gmail.com; De Boo, Diederick W., E-mail: d.w.deboo@amc.uva.nl [Academic Medical Centre, Department of Radiology (Netherlands); Weersink, Els J. M., E-mail: e.j.m.weersink@amc.uva.nl [Academic Medical Centre, Department of Pulmonology (Netherlands); Delden, Otto M. van, E-mail: o.m.vandelden@amc.uva.nl; Reekers, Jim A., E-mail: j.a.reekers@amc.uva.nl; Lienden, Krijn P. van, E-mail: k.p.vanlienden@amc.uva.nl [Academic Medical Centre, Department of Radiology (Netherlands)

    2013-12-15

    A 35-year-old female with a known medical history of cystic fibrosis was admitted to our institution for massive hemoptysis. CTA depicted a hypertrophied bronchial artery to the right upper lobe and showed signs of recent bleeding at that location. Bronchial artery embolization (BAE) was performed with gelfoam slurry, because pronounced shunting to the pulmonary artery was present. Immediately after BAE, the patient developed bilateral cortical blindness. Control angiography showed an initially not opacified anastomosis between the embolized bronchial artery and the right subclavian artery, near to the origin of the right vertebral artery. Cessation of outflow in the bronchial circulation reversed the flow through the anastomosis and allowed for spill of embolization material into the posterior circulation. Unfortunately the cortical blindness presented was permanent.

  12. Incidentally diagnosed Takayasu arteritis on thyroid ultrasonography showing prominent collateral vessels of thyroidal arteries and common carotid artery occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Se Jin; Kim, Eun Kyung [Dept. of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-10-15

    We report a case of middle-aged woman incidentally diagnosed with Takayasu arteritis during the ultrasonography of a thyroid gland nodule. Prominent collaterals of the thyroidal arteries and a thin common carotid artery with mural thickening and deficient intraluminal flow signals were initially depicted on the ultrasonography with color Doppler. Subsequent magnetic resonance angiography and computed tomography aortography confirmed the diagnosis with the imaging features of a bilateral long segment common carotid artery occlusion and segmental stenosis of the left subclavian artery in addition to the suggestive physical findings.

  13. An anatomic landmark to simplify subclavian vein cannulation: the "deltoid tuberosity"

    NARCIS (Netherlands)

    von Goedecke, Achim; Keller, Christian; Moriggl, Bernhard; Wenzel, Volker; Bale, Reto; Deibl, Martina; Moser, Patrizia; Lirk, Philipp

    2005-01-01

    The subclavian vein is frequently used to obtain central venous access. Several landmarks exist to determine the puncture site and angle, but they may require patient manipulation and anatomic measurements. We studied the feasibility of using the deltoid tuberosity, located on the lateral aspect of

  14. Hemodialysis shunts-related subclavian vein stenosis : treatment with self-expandable metallic stent

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Gyee; Lee, Young Chul; Shin, Sang Soo; Kim, Yun Hyeon; Kim, Jae Kyu; Kang, Heoung Keun; Jeong, Sang Young; Choi, Su Jin Na [Chonnam Univ. College of Medicine, Kwangju (Korea, Republic of)

    1999-04-01

    To evaluate the usefulness of placement of self-expandable stents in hemodialytic shunt-related subclavian vein stenosis. Self-expandable metallic stent was placed in nine patients with hemodialytic shunt-related subclavian vein stenosis. In seven cases, angioplasty was attempted before stent placement; in five, stents were placed immediately after failed angioplasty; and in two, due to restenosis after angioplasty. Procedures involved a 10mm diameter, 7-10cm length Wallstent in eight cases, and a 10mm diameter, 8cm length Hanaro stent in one. In all cases, clinical follow-up, which included physical examination and the measurement of venous resistance pressure during hemodialysis, was performed. The follow-up period was between 5 months and 1 year 7 months. Repeated intervention was performed if restenosis was detected. The stenotic sites were in eight cases the site of a previous subclavian venous line, and in one, the site of anatomic narrowing at the thoracic inlet of the subclavian vein. The technical success rate was 100%;a resulting complication was stent migration into the right atrium in one case in which a Hanaro stent had been used; this was removed by snaring. During follow-up of the eight patients in whon stent placement was successful, restenosis developed in three cases. This occurred during the 7th, 8th, and 15th month, respectively. Two such cases were treated by balloon dilatation. In hemodialytic shunt-related subclavian vein stenosis, treatment involving the use of a self-expandable metallic stent is useful, especially for treating a lesion which has not responded to angioplasty with a high patency rate.

  15. Comparison of retavase and urokinase for management of spontaneous subclavian vein thrombosis.

    Science.gov (United States)

    Gelabert, Hugh A; Jimenez, Juan Carlos; Rigberg, David A

    2007-03-01

    Thrombolysis is an essential first step in the surgical management of acute spontaneous axillo-subclavian vein thrombosis (Paget-Schroetter syndrome). During the past decade, Urokinase became the standard thrombolytic agent until temporarily withdrawn from the market. In its absence, recombinant tissue plasminogen activator (r-TPA) was introduced and attained widespread use. A direct comparison of the efficacy of these two agents in this setting has not been published. The goal of this study is to compare thrombolytic agents in the management of acute Paget-Schroetter syndrome. This study is based on a retrospective review of 30 consecutive patients (15 Urokinase, 15 r-TPA) who underwent thrombolysis and surgery for Paget-Schroetter syndrome. Our hypothesis is that thromblysis with Urokinase and r-TPA is equally safe and effective in management of acute axillo-subclavian vein thrombosis. Primary outcome measures include success of lysis, hemorrhagic complications, subclavian vein patency at completion of treatment, resolution of presenting symptoms, and restitution of normal arm function. There were no significant differences in the primary outcome measures: success of lysis, hemorrhagic complication, perioperative bleeding, and subclavian vein patency. Time to completion of lysis was slightly shorter with r-TPA (but this did not achieve statistical significance). One patient in each group suffered incomplete lysis of thrombus. One patient in the r-TPA group required transfusion due to surgical bleeding. No patient received transfusion due to thrombolysis-related bleeding. All patients experienced resolution of symptoms and return of arm function. Our findings support the hypothesis that Urokinase and r-TPA are similarly safe and successful for management of spontaneous axillo-subclavian vein thrombosis. Given these results, secondary factors such as cost, availability, and familiarity with the different agents will likely determine the agent of choice.

  16. An alternative central venous route for cardiac surgery: supraclavicular subclavian vein catheterization.

    Science.gov (United States)

    Kocum, Aysu; Sener, Mesut; Calıskan, Esra; Bozdogan, Nesrin; Atalay, Hakan; Aribogan, Anis

    2011-12-01

    To evaluate the clinical success rate, safety, and usefulness for intraoperative central venous pressure monitoring, and the intravenous access of the supraclavicular subclavian vein approach when compared with the infraclavicular subclavian vein approach and the internal jugular vein approach for central venous catheterization during open-chest cardiac surgery. A prospective, randomized, single-center study. A university hospital. One hundred ninety-five patients scheduled for open-chest cardiac surgery. The study population consisted of patients for whom central vein catheterization was intended during cardiac surgery. Patients were randomized to 3 groups according to the route of central vein catheterization: the supraclavicular group: the supraclavicular approach for the subclavian vein (n = 65); the infraclavicular group: the infraclavicular approach for the subclavian vein (n = 65); and the jugular group: the internal jugular vein approach (n = 65). After the induction of anesthesia, central venous catheterization was performed according to the assigned approach. The success rates for the assigned approach were 98%, 98%, and 92% for the supraclavicular, infraclavicular, and jugular groups, respectively (p > 0.05). The success rates in the first 3 attempts in patients who were catheterized successfully according to the assigned approach were 96%, 100%, and 96% for the supraclavicular, infraclavicular, and jugular groups, respectively (p > 0.05). There was no difference among groups in catheter insertion time (p > 0.05). After sternal retraction, central venous pressure trace loss and difficulty in fluid infusion were significantly more frequent in the infraclavicular group (21%) when compared with the supraclavicular (3%) and jugular groups (0%) (p = 0.01). There was no difference among groups in terms of catheter malposition, complications during catheterization, and rate of catheter-related infection. The supraclavicular approach for subclavian vein

  17. Chopstick Injury: Successful Stent-Graft Therapy for Traumatic Left Subclavian Artery Aneurysm

    National Research Council Canada - National Science Library

    Ueda, Tatsuo; Tajima, Hiroyuki; Murata, Satoru; Takagi, Ryo; Yokota, Hiroyuki; Kumita, Shin-ichiro

    2017-01-01

    Traumatic chopstick injury is very rare, especially in the vascular system. We present an unusual case of a 19-year-old man who presented at the emergency department after being stabbed with a chopstick by his elder brother...

  18. Endovascular management of axillo-subclavian arterial injury: A review of published experience.

    Science.gov (United States)

    2012-01-01

    15 days,7 sub cutaneous heparin for 24 h,20,30 and sub cutaneous heparin for several weeks13,31 were all utilized. Antiplatelet agents, in the form of...clopidogrel 75 mg daily, ticlodipine 120 mg daily or aspirin 100 mg per day were also advocated by various authors, either in isolation or combined

  19. Coil embolization of internal mammary artery injured during central vein catheter and cardiac pacemaker lead insertion

    Energy Technology Data Exchange (ETDEWEB)

    Chemelli, A.P. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria)], E-mail: Andreas.Chemelli@i-med.ac.at; Chemelli-Steingruber, I.E. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria); Bonaros, N. [Department of Cardiovascular Surgery, Innsbruck Medical University (Austria); Luckner, G. [Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University (Austria); Millonig, G. [Department of Gastroenterology and Hepatology, Innsbruck Medical University (Austria); Seppi, K. [Department of Neurology, Innsbruck Medical University (Austria); Lottersberger, C.; Jaschke, W. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria)

    2009-08-15

    Purpose: This study describes several cases of endovascular coil embolization of the proximal internal mammary artery injured by blind approach to the subclavian vein for central venous catheter or pacemaker lead insertion. Materials and methods: We conducted a retrospective analysis of five patients with iatrogenic arterial lesions of the internal mammary artery (IMA). The lesions occurred in three patients from a puncture of the subclavian vein during insertion of a central venous catheter and in two patients from a puncture of the subclavian vein for insertion of a pacemaker lead. Four patients had acute symptoms of bleeding with mediastinal hematoma and hematothorax and one patient was investigated in a chronic stage. A pseudoaneurysm was detected in all five patients. All four acute and hemodynamic unstable patients required hemodynamic support. Results: In all patients, embolization was performed using a coaxial catheter technique, and a long segment of the IMA adjacent distally and proximally to the source of bleeding was occluded with pushable microcoils. In one patient, additional mechanically detachable microcoils were used at the very proximal part of the IMA. Microcoil embolization of the IMA was successful in all patients, and the source of bleeding was eliminated in all patients. Conclusion: Transarterial coil embolization is a feasible and efficient method in treating acute bleeding and pseudoaneurysm of the IMA and should be considered if mediastinal hematoma or hemathorax occurs after blind puncture of the subclavian vein.

  20. Spontaneous Subclavian Vein Thrombosis in a Healthy Adolescent Cheerleader: A Case of Paget-Schroetter Syndrome.

    Science.gov (United States)

    Chu, Andrew S; Harkness, Julia; Witmer, Char M

    2017-10-01

    We present the case of a healthy 13-year-old female adolescent who developed acute progressive swelling and pain in her right upper extremity that was secondary to an acute deep venous thrombosis of her right subclavian vein. Dynamic imaging revealed subclavian vein compression at the junction of the first rib and proximal third of the clavicle consistent with Paget-Schroetter syndrome, also known as effort-related thrombosis. The compressive etiology of her thrombus was most likely related to her cheerleading activity, in which she served as the pyramid base. The patient received multimodal therapy including anticoagulation, mechanical and site-directed thrombolysis, and a first rib resection. This case illustrates that frontline providers should have a high index of suspicion for an upper extremity thrombosis in pediatric patients who present with unilateral arm swelling.

  1. Malpositioning of Central Venous Catheter from Right to Left Subclavian Vein: A Rare Complication.

    Science.gov (United States)

    Takhar, P Rajendra; Motilal, Bunkar; Savita, Arya

    2017-11-01

    Invasive monitoring with central venous catheter (CVC) is a valuable tool now a day in Intensive Care Units and in postoperative hemodynamically unstable patients. It is often employed for administering medications and parenteral nutrition. In most of the instances, these catheters are inserted using proper topographical landmarks and ultrasonography-guided methods. Central venous cannulation is associated now and then with unexpected complications despite the use of all precautions and help of imaging techniques. There is a wide variety of complications related to the central venous cannulation including malpositioning. Malpositioning of the catheter into contralateral subclavian is an extremely unusual event. Here, we report a rare case of malpositioning of CVC from the right to the left subclavian vein also we outline how the misplacement was identified and effectively managed.

  2. Internal Jugular and Subclavian Vein Thrombosis in a Case of Ovarian Cancer

    Directory of Open Access Journals (Sweden)

    Hiroto Moriwaki

    2017-01-01

    Full Text Available Central venous catheter insertion and cancer represent some of the important predisposing factors for deep venous thrombosis (DVT. DVT usually develops in the lower extremities, and venous thrombosis of the upper extremities is uncommon. Early diagnosis and treatment of deep venous thrombosis are of importance, because it is a precursor of complications such as pulmonary embolism and postthrombotic syndrome. A 47-year-old woman visited our department with painful swelling on the left side of her neck. Initial examination revealed swelling of the region extending from the left neck to the shoulder without any redness of the overlying skin. Laboratory tests showed a white blood cell count of 5,800/mm3 and an elevated serum C-reactive protein of 4.51 mg/dL. Computed tomography (CT of the neck revealed a vascular filling defect in the left internal jugular vein to left subclavian vein region, with the venous lumina completely occluded with dense soft tissue. On the basis of the findings, we made the diagnosis of thrombosis of the left internal jugular and left subclavian veins. The patient was begun on treatment with oral rivaroxaban, but the left shoulder pain worsened. She was then admitted to the hospital and treated by balloon thrombectomy and thrombolytic therapy, which led to improvement of the left subclavian venous occlusion. Histopathologic examination of the removed thrombus revealed adenocarcinoma cells, indicating hematogenous dissemination of malignant cells.

  3. Diagnostic Performance of Combined Contrast-Enhanced Magnetic Resonance Angiography and Phase-Contrast Magnetic Resonance Imaging in Suspected Subclavian Steal Syndrome.

    Science.gov (United States)

    Tsao, Teng-Fu; Cheng, Kai-Lun; Shen, Chao-Yu; Wu, Ming-Chi; Huang, Hsin-Hui; Su, Chun-Hung; Chen, Fong-Lin; Tyan, Yeu-Sheng; Lin, Yung-Chang

    2016-05-01

    The study sought to evaluate the efficacy of magnetic resonance imaging (MRI) in patients with suspected subclavian steal syndrome (SSS) using both contrast-enhanced (CE) MR angiography and phase-contrast (PC) MRI. Fifteen suspected SSSs from 13 patients were evaluated using CE-MR angiography and PC-MRI. Ten patients also received dynamic CE-MR angiography. All MRI examinations were technically successful. By combining CE-MR angiography with PC-MRI, 10 SSSs were diagnosed in 9 patients. The delay enhancement dynamic technique predicted SSS with a sensitivity, specificity, and accuracy of 57.1%, 100%, and 72.7%, respectively. Without the dynamic technique, affected delay-enhanced arteries were poorly visualized and could be mistaken for occluded vessels. Retrograde vertebral flow by PC-MRI was used to predict ipsilateral SSS with a sensitivity, specificity, and accuracy of 100%, 60%, and 86.7%, respectively. There were 2 false positives including 1 patient with a proximal total occlusion of the affected vertebral artery and another with brachiocephalic steal syndrome rather than SSS. This suggested that retrograde vertebral flow does not always indicate SSS. CE-MR angiography combined with PC-MRI is efficacious when evaluating SSS in clinical practice. Copyright © 2016 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  4. Percutaneous recanalization of refractory dialysis-related subclavian vein obstruction : a case with needle puncture

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Dong Erk; Kim, Dae Ho; Choi, Deuk Lin [College of Medicine, Soonchunhyang University, Seoul (Korea, Republic of)

    2000-03-01

    Chronic central venous occlusion presents a difficult management problem, particularly when the occlusion cannot be traversed with a guide wire, a step which is essential for endovascular treatment such as balloon angioplasty and stent placement. We describe a less invasive technique in which the venous occlusion is traversed with a Rosch-Uchida Transjugular Liver Access Set. This procedure may be useful in cases where the involved extremity must be preserved for hemodialysis and where subclavian vein occlusion is refractory to traditional revascularization methods. (author)

  5. Goldenhar Syndrome Associated with Extensive Arterial Malformations.

    Science.gov (United States)

    Modica, Renee Frances; Barbeau, L Daphna Yasova; Co-Vu, Jennifer; Beegle, Richard D; Williams, Charles A

    2015-01-01

    Goldenhar Syndrome is characterized by craniofacial, ocular and vertebral defects secondary to abnormal development of the 1st and 2nd branchial arches and vertebrae. Other findings include cardiac and vascular abnormalities. Though these associations are known, the specific anomalies are not well defined. We present a 7-month-old infant with intermittent respiratory distress that did not improve with respiratory interventions. Echocardiogram suggested a double aortic arch. Cardiac CT angiogram confirmed a right arch and aberrant, stenotic left subclavian artery, dilation of the main pulmonary artery, and agenesis of the left thyroid lobe. Repeat echocardiograms were concerning for severely dilated coronary arteries. Given dilation, a rheumatologic workup ensued, only identifying few weakly positive autoantibodies. Further imaging demonstrated narrowing of the aorta below the renal arteries and extending into the common iliac arteries and proximal femoral arteries. Given a physical exam devoid of rheumatologic findings, only weakly positive autoantibodies, normal inflammatory markers, and presence of the coronary artery dilation, the peripheral artery narrowings were not thought to be vasculitic. This case illustrates the need to identify definitive anomalies related to Goldenhar Syndrome. Although this infant's presentation is rare, recognition of specific vascular findings will help differentiate Goldenhar Syndrome from other disease processes.

  6. Goldenhar Syndrome Associated with Extensive Arterial Malformations

    Directory of Open Access Journals (Sweden)

    Renee Frances Modica

    2015-01-01

    Full Text Available Goldenhar Syndrome is characterized by craniofacial, ocular and vertebral defects secondary to abnormal development of the 1st and 2nd branchial arches and vertebrae. Other findings include cardiac and vascular abnormalities. Though these associations are known, the specific anomalies are not well defined. We present a 7-month-old infant with intermittent respiratory distress that did not improve with respiratory interventions. Echocardiogram suggested a double aortic arch. Cardiac CT angiogram confirmed a right arch and aberrant, stenotic left subclavian artery, dilation of the main pulmonary artery, and agenesis of the left thyroid lobe. Repeat echocardiograms were concerning for severely dilated coronary arteries. Given dilation, a rheumatologic workup ensued, only identifying few weakly positive autoantibodies. Further imaging demonstrated narrowing of the aorta below the renal arteries and extending into the common iliac arteries and proximal femoral arteries. Given a physical exam devoid of rheumatologic findings, only weakly positive autoantibodies, normal inflammatory markers, and presence of the coronary artery dilation, the peripheral artery narrowings were not thought to be vasculitic. This case illustrates the need to identify definitive anomalies related to Goldenhar Syndrome. Although this infant’s presentation is rare, recognition of specific vascular findings will help differentiate Goldenhar Syndrome from other disease processes.

  7. A mixed-reality part-task trainer for subclavian venous access.

    Science.gov (United States)

    Robinson, Albert R; Gravenstein, Nikolaus; Cooper, Lou Ann; Lizdas, David; Luria, Isaac; Lampotang, Samsun

    2014-02-01

    Mixed-reality (MR) procedural simulators combine virtual and physical components and visualization software that can be used for debriefing and offer an alternative to learn subclavian central venous access (SCVA). We present a SCVA MR simulator, a part-task trainer, which can assist in the training of medical personnel. Sixty-five participants were involved in the following: (1) a simulation trial 1; (2) a teaching intervention followed by trial 2 (with the simulator's visualization software); and (3) trial 3, a final simulation assessment. The main test parameters were time to complete SCVA and the SCVA score, a composite of efficiency and safety metrics generated by the simulator's scoring algorithm. Residents and faculty completed questionnaires presimulation and postsimulation that assessed their confidence in obtaining access and learner satisfaction questions, for example, realism of the simulator. The average SCVA score was improved by 24.5 (n=65). Repeated-measures analysis of variance showed significant reductions in average time (F=31.94, Peducational tool (M=4.9). An SCVA mixed simulator offers a realistic representation of subclavian central venous access and offers new debriefing capabilities.

  8. A Case of Incomplete Central Retinal Artery Occlusion Associated with Short Posterior Ciliary Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Shinji Makino

    2013-01-01

    Full Text Available To our knowledge, incomplete central retinal artery occlusion associated with short posterior ciliary artery occlusion is extremely rare. Herein, we describe a case of a 62-year-old man who was referred to our hospital with of transient blindness in his right eye. At initial examination, the patient’s best-corrected visual acuity was 18/20 in the right eye. Fundus examination showed multiple soft exudates around the optic disc and mild macular retinal edema in his right eye; however, a cherry red spot on the macula was not detected. Fluorescein angiography revealed delayed dye inflow into the nasal choroidal hemisphere that is supplied by the short posterior ciliary artery. The following day, the patient’s visual acuity improved to 20/20. Soft exudates around the optic disc increased during observation and gradually disappeared. His hemodynamic parameters revealed subclavian steal syndrome as examined by cervical ultrasonography and digital subtraction angiography. We speculate that his transient blindness was due to ophthalmic artery spasms. In this particular case, spasms of the ophthalmic artery and occlusion of the short posterior ciliary artery occurred simultaneously. As the short posterior ciliary artery branches from the ophthalmic artery, the anatomical location of the lesion might be near the branching of both arteries.

  9. Prosthetic Subclavian-Aortic Bypass as a Safe Surgical Technique for the Coarctation of the Aorta in Adults

    Directory of Open Access Journals (Sweden)

    Ali Refatllari

    2015-12-01

    CONCLUSION: Coarctation of the aorta in adults is treated with optimal early results at our surgical centre. Subclavian-aortic bypass grafting requires less aortic dissection, can be performed with a partially occluding clamp, and does not compromise the spinal cord vascularization.

  10. A systematic study of the brain base arteries in the rabbit (Oryctolagus cuniculus

    Directory of Open Access Journals (Sweden)

    Fernanda de Souza

    2013-06-01

    Full Text Available The brains of 30 New Zealand rabbits (Oryctolagus cuniculus were injected with red stained latex. The arteries of the ventral surface of the brain were systematized on the right (R and on the left (L side with the respective percentage of appearance: the aortic arch emitted the braquicephalic trunk and the left subclavian artery (83.3%; or the braquicephalic trunk, the left common carotid artery and the left subclavian artery (16.7%. The braquicephalic trunk emitted the right and the left common carotid arteries and the right subclavian artery (83.3%; or the right common carotid artery and the right subclavian artery (16.7%. The common carotid arteries were divided into external and internal carotid arteries (96.7% on the R, 100% on the L.. The internal carotid artery to the R was present (96.7% and absent (3.3%, and to the L, was present (100%. The rostral choroidal artery to the R was collateral branch of the rostral branch of the internal carotid artery (83.3%, collateral branch of caudal branch of the internal carotid artery (16.7%, and to the L was collateral branch of the rostral branch of the internal carotid artery (93.3%, collateral branch of the caudal branch of the internal carotid artery (6.7%. The middle cerebral artery to the R and to the L was single (80% and double (20%. The rostral cerebral artery to the R had middle caliber (90%, thin caliber (6.7% and too thin caliber (3.3%, and to the L had middle caliber (76.7%, thin caliber (16.7% and too thin caliber (6.7%. The internal ethmoidal artery was absent (73.3%, present and single (26.7%. The caudal cerebral artery to the R was single (66.7%, double (26.7% and triple (6.7%, and to the L was single (63.3% and double (36.7%. The terminal branches of the right and left vertebral arteries were present (100%, and formed the basilar artery (100%. The ventral spinal artery was present (100%. The caudal cerebellar artery, to the R was single (43.3%, single with labyrinthic artery

  11. Web-like malformation of the carotid artery and multicystic encephalomalacia.

    Science.gov (United States)

    Sendelbach, K M; Gujrati, M; Husain, A N

    1992-01-01

    Multicystic encephalomalacia and hydranencephaly lie within a spectrum of brain lesions linked to ischemic cerebral damage. Causes include vascular malformation, thrombosis, embolism, infection, and toxins. We describe an infant with multicystic encephalomalacia associated with a peculiar web-like malformation of the right common carotid and left subclavian arteries. We postulate that this luminal bridging is a congenital malformation resulting from defective canalization of the medium-sized blood vessels but could represent organized and recanalized thrombi, the etiology of which remains unknown.

  12. The effects of the Trendelenburg position and intrathoracic pressure on the subclavian cross-sectional area and distance from the subclavian vein to pleura in anesthetized patients.

    Science.gov (United States)

    Kwon, Mi-Young; Lee, Eun-Kyung; Kang, Hye-Ju; Kil, Ho-Young; Jang, Kee-Hoon; Koo, Min-Seok; Lee, Gunn-Hee; Lee, Myung-Ae; Kim, Tae-Yop

    2013-07-01

    The effects of maneuvers to increase intrathoracic pressure and of Trendelenburg position on the cross-sectional area (CSA) of the subclavian vein (SCV) and the relationship between the SCV and adjacent structures have not been investigated. In ultrasonography-guided SCV catheterization (N = 30), the CSA of the SCV and the distance between the SCV and pleura (DSCV-pleura) were determined during 10-second airway opening, and 10-second positive inspiratory hold with 20 cm H2O in the supine position (S-0, and S-20) and the 10° Trendelenburg position (T-0, and T-20). In addition to a statistical significance of P pleura differences of ≥15% were defined as clinically relevant changes. CSA (mean [95% confidence interval]) in S-20, T-0, and T-20 (1.02 [0.95-1.14] cm(2), 1.04 [0.95-1.15] cm(2), and 1.14 [1.04-1.24] cm(2), respectively) was significantly larger than a CSA in S-0 (0.93 [0.86-1.00] cm(2), all P pleura measurements (mean) in S-20 and T-20 (0.61 and 0.60 cm) were significantly shorter than those in S-0 (0.70 cm, all P pleura were not clinically meaningful (≥15%). The combined application of inspiratory hold and Trendelenburg position provided a greater and more relevant degree of CSA increase without compromising DSCV-pleura, which may facilitate SCV catheterization. Further investigations are needed to determine whether these results affect the success rate of catheterization and the risk of procedural injury.

  13. Dorsal Scapular Artery Variations and Relationship to the Brachial Plexus, and a Related Thoracic Outlet Syndrome Case.

    Science.gov (United States)

    Verenna, Anne-Marie A; Alexandru, Daniela; Karimi, Afshin; Brown, Justin M; Bove, Geoffrey M; Daly, Frank J; Pastore, Anthony M; Pearson, Helen E; Barbe, Mary F

    2016-01-01

    Rationale Knowledge of the relationship of the dorsal scapular artery (DSA) with the brachial plexus is limited. Objective We report a case of a variant DSA path, and revisit DSA origins and under-investigated relationship with the plexus in cadavers. Methods The DSA was examined in a male patient and 106 cadavers. Results In the case, we observed an unusual DSA compressing the lower plexus trunk, that resulted in intermittent radiating pain and paresthesia. In the cadavers, the DSA originated most commonly from the subclavian artery (71%), with 35% from the thyrocervical trunk. Nine sides of eight cadavers (seven females) had two DSA branches per side, with one branch from each origin. The most typical DSA path was a subclavian artery origin before passing between upper and middle brachial plexus trunks (40% of DSAs), versus between middle and lower trunks (23%), or inferior (4%) or superior to the plexus (1%). Following a thyrocervical trunk origin, the DSA passed most frequently superior to the plexus (23%), versus between middle and lower trunks (6%) or upper and middle trunks (4%). Bilateral symmetry in origin and path through the brachial plexus was observed in 13 of 35 females (37%) and 6 of 17 males (35%), with the most common bilateral finding of a subclavian artery origin and a path between upper and middle trunks (17%). Conclusion Variability in the relationship between DSA and trunks of the brachial plexus has surgical and clinical implications, such as diagnosis of thoracic outlet syndrome.

  14. Isolated Unilateral Absent Branch Pulmonary Artery with Peripheral Pulmonary Stenosis and Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Sunil Abhishek B

    2017-09-01

    Full Text Available Isolated Unilateral Absent Pulmonary Artery (UAPA is a rare congenital anomaly. It is usually associated with congenital heart defects. A 45 year old male patient presented with complaints of fever with cough and expectoration for 15 days and retrosternal chest discomfort for the previous 2 days. ECG showed diffuse ST segment depression with T wave inversion in the inferior and lateral leads. Coronary Angiogram done through the right femoral approach revealed diffusely diseased Left Anterior Descending (LAD artery that was totally cut off at the mid segment. The Left Circumflex (LCx artery was providing blood supply to the right middle and lower lung areas. There was another collateral arising from the Left Subclavian Artery supplying the right middle and lower lung areas. The left pulmonary artery was normal, but branches supplying the middle and lower lobes of the right lung were absent and the upper lobe branch had pulmonary stenosis. UAPA is a rare clinical entity; collaterals from coronaries are extremely rare in this condition and till now there has not been any case report of unilateral absent branch pulmonary artery with peripheral stenosis of other branches, on the affected side and associated coronary artery disease.

  15. Prosthetic Subclavian-Aortic Bypass as a Safe Surgical Technique for the Coarctation of the Aorta in Adults.

    Science.gov (United States)

    Refatllari, Ali; Likaj, Ermal; Dumani, Selman

    2016-03-15

    Coarctation represents 5-8% of congenital heart disease. Residual hypertension remains the main problem after late correction. Surgical treatment in the adult remains a challenge for the surgeon. Our prefered method used in this category is the Subclavian-aortic bypass. We have reviewed our registry for the period of 12 years (1998- 2010) and we found a group of 18 adult patients being operated for coarctation of the aorta. The mean age of this group of patients was 24.7 ± 8.43 years (range 16-42 years). 13 were males and 5 females. Sugical technique: Most of the patients (13 pts, 72%) which were obviously treated with subclavian-aortic bypass with a Dacron prostheses. Mean preoperative and postoperative pressure gradients measured by echocardiography were 77.7 ± 20.16 mmHg and 22.3 ± 9.14 mmHg respectively. No mortality was observed in this series of patients. Chylothorax was the only complication observed in one patient in the early postoperative period. Coarctation of the aorta in adults is treated with optimal early results at our surgical centre. Subclavian-aortic bypass grafting requires less aortic dissection, can be performed with a partially occluding clamp, and does not compromise the spinal cord vascularization.

  16. Percutaneous left axillary artery approach for Impella 2.5 liter circulatory support for patients with severe aortoiliac arterial disease undergoing high-risk percutaneous coronary intervention.

    Science.gov (United States)

    Lotun, Kapildeo; Shetty, Ranjith; Patel, Manishkumar; Arain, Salman A

    2012-04-01

    The use of the Impella 2.5 liter (L) device for hemodynamic support has been well described. The typical access site for the Impella 2.5 L device is the femoral artery. The use of the axillary and subclavian artery has been described via surgical cut down for the Impella 5 L device when femoral artery access is not possible. In patients with severe aortoiliac disease and difficult anatomy the femoral artery access for the Impella 2.5 L device is not feasible. We describe the successful percutaneous use of the Impella 2.5 L device for hemodynamic support via the left axillary artery in 2 patients undergoing high-risk PCI with concomitant severe aortoiliac disease. ©2012, Wiley Periodicals, Inc.

  17. Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation?

    DEFF Research Database (Denmark)

    Weigang, Ernst; Parker, Jack A T C; Czerny, Martin

    2011-01-01

    and analysed three basic treatment concepts for LSA revascularisation in TEVAR patients (prophylactic, conditional prophylactic and no prophylactic LSA revascularisation). The available evidence supports prophylactic revascularisation of the LSA before ESG LSA coverage when preoperative imaging reveals......, covering, endovascular, revascularisation and thoracic aorta. We have gathered the most complete scientific evidence available used to support the various concepts to deal with this issue. After a review of the current available literature, 23 relevant articles were found, where we have identified...

  18. The Effect of a Third Generation Hemostatic Dressing in a Subclavian Artery and Vein Transection Porcine Model

    Science.gov (United States)

    2014-04-01

    followed by three minutes of compression to the packed dressing. The mini-sponge dressing (MSD) is a novel product that utilizes compressed, chitosan ...on the battlefield and in civilian trauma. A novel product , the minisponge-based dressing (MSD), has been developed to treat junctional hemorrhage...The MSD is comprised of a syringe applicator filled with compressed chitosan coated sponges which are delivered into the wound at the site of the

  19. Blunt Traumatic Aortic Injury of Right Aortic Arch in a Patient with an Aberrant Left Subclavian Artery

    OpenAIRE

    Yeo, Daryl Li-Tian; Haider, Sajjad; Zhen, Claire Alexandra Chew

    2015-01-01

    Right-sided aortic arch (RAA) is a rare congenital developmental variant present in about 0.1 percent of the population. This anatomical anomaly is commonly associated with congenital heart disease and complications from compression of mediastinal structures. However, it is unknown if patients are at a higher risk of blunt thoracic aortic injury (BTAI). We report a case of a 20-year-old man admitted to the hospital after being hit by an automobile. Computed tomographic scan revealed an RAA wi...

  20. Empirical description of bronchial and nonbronchial arteries with MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Yu Hong, E-mail: yuhong.2002@hotmail.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Liu Shiyuan, E-mail: cjr.liushiyuan@vip.163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Li Huimin, E-mail: yuhongphd@163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Xiao Xiangsheng, E-mail: cjr.xxsh@vip.163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Dong Weihua, E-mail: dongweihua2000@163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China)

    2010-08-15

    Purpose: We aimed to retrospectively evaluate bronchial and nonbronchial systemic arteries using multi-detector row helical computed tomographic (MDCT) angiography in patients with pulmonary disorders. Materials and Methods: Thirty-nine patients (24 men, 15 women; mean age, 63.4 years; range, 20-82 years) with congenital and acquired pulmonary disorders of the bronchial and nonbronchial systemic arteries underwent multi-detector row helical computed tomographic angiography of the thorax using a 16-detector row scanner. Each of these patients had experienced an episode of hemoptysis. Computed tomographic angiogram data, which included maximum intensity projections, multiplanar reconstruction, and three-dimensional volume-rendered images, were used to retrospectively analyse the characteristics of the bronchial and nonbronchial systemic arteries. Results: We identified a total of 128 bronchial arteries (76 on the right side and 52 on the left) in 39 patients. We detected 42 nonbronchial systemic artery branches, including 19 internal mammary artery branches, 8 subclavian artery branches, 8 inferior phrenic artery branches, 5 intercostal artery branches, 1 thyrocervical trunk branch, and 1 celiac trunk branch. Thirty-five dilated and tortuous nonbronchial systemic arteries entered into the lung parenchyma and extended down to the lesions. Every case, except the one case of sequestration, was associated with pleural thickening where the vascular structures passed through the extrapleural fat. Conclusions: The variations in both the bronchial artery anatomy and the location and type of the nonbronchial arteries were great. Nonbronchial arteries may be a significant source of hemoptysis. MDCT angiography can be used to detect detailed anatomical information about the origins and courses of bronchial and nonbronchial systemic arteries and their pathophysiologic features.

  1. Coexistence of Single Coronary Artery Anomaly and Aortic Arch Anomaly

    Directory of Open Access Journals (Sweden)

    Yilmaz Omur Otlu

    2014-03-01

    Full Text Available A 74-year-old male patient was admitted to our hospital for evaluation of recent onset atypical chest pain. His medical history included hypertension, dislipidemia and smoking. Physical examination was unremarkable. The resting electrocardiogram was demonstrated biphasic T waves on lateral derivations. Transthoracic echocardiography showed normal left and right ventricular dimensions and functions. Coronary angiography was planned for the patient. First, right transradial approach tried; but guidewire could not be advanced to ascendig aorta. Coronary angiography was performed through the right femoral artery. Multiple attempts to cannulate the left coronary ostium were unsuccessful. The right coronary artery cannulated from its normal ostium in the right sinus of Valsalva. After a very short common main stem, the artery divided into a right coronary artery, and separate left anterior descending artery and circumflex artery (Figure A. The coronary arteries were normal without any significant stenosis and any extrinsic compression. An aortic root injection confirmed the absence of left coronary ostium. Also, a retroesophageal right subclavian artery originating from the left aortic arch (arteria lusoria was detected as the last branch of aortic arch on contrast enhanced computerized tomography (Figure B-C. The patient discharged with medical teraphy.

  2. Complications of Central Venous Totally Implantable Access Port: Internal Jugular Versus Subclavian Access

    Directory of Open Access Journals (Sweden)

    Pil Young Jung

    Full Text Available Background: Totally implantable access port (TIAP provides reliable, long term vascular access with minimal risk of infection and allows patients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. Methods: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92 and subclavian approach (Group 2, n = 79 between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. Results: Median follow-up for TIAP was 278 days (range, 1-1868. Twenty four complications were occurred (14.0%, including pneumothorax (n = 1, 0.6%, migration/malposition (n = 4, 2.3%, pinch-off syndrome (n = 4, 2.3%, malfunction (n = 2, 1.1%, infection (n = 8, 4.7%, and venous thrombosis (n = 5, 2.9%. The overall incidence was 8.7% and 20.3% in each group (p = 0.030. Mechanical complications except infectious and thrombotic complications were more often occurred in group 2 (p = 0.033. The mechanical complication free probability is significantly higher in group 1 (p = 0.040. Conclusions: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.

  3. Subclavian perivascular block for open reduction and internal fixation of left midshaft humeral fracture--a case report.

    Science.gov (United States)

    Rukewe, A; Ogunlade, S O; Idowu, O A; Aderinto, D A

    2010-03-01

    Traumatic injuries affecting bones of the hand and forearm often require peripheral nerve blocks for analgesia and surgical intervention. The successful use of subclavian perivascular block as a sole anaesthetic for orthopaedic surgery has not been reported in our environment. We report the use of this technique for open reduction and internal fixation of a left midshaft humeral fracture. The trunk of the brachial plexus was localized by a Polystim II nerve stimulator. Complete sensorimotor block was achieved within 15 minutes and surgery lasted 55 minutes without complications. This technique obviated the use of general anaesthesia with its risks. The surgeon and the patient were satisfied with the quality of the anaesthesia.

  4. Raynaud's phenomenon in arterial obstructive disease of the hand demonstrated by locally provoked cooling

    DEFF Research Database (Denmark)

    Nielsen, Steen Levin; Nobin, B A; Hirai, M

    1978-01-01

    Finger systolic blood pressure (FSP) was measured by cuff technique before and after local cooling in three groups of patients (Raynaud's disease (7), subclavian stenoses, (5), thrombo-angiitis obliterans (15)), and in 15 normals. The response to finger cooling registered as a decrease in FSP...... indicates an increase of digital arterial tone. In all three groups, digital arterial tone increased more than in normals during finger cooling. Patients with Raynaud's disease showed a pathological increase in arterial tone at 23.5 degrees C with closure of the digital arteries at a mean temperature of 18.......5 degrees C. The temperature eliciting these phenomena in patients with thrombo-angiitis obliterans was about 7 degrees C lower (16.5 and 11.0 degrees C, respectively). Accordingly, cold sensitivity and Raynaud's phenomena in the two groups may have a different pathophysiological mechanism, namely...

  5. A homozygote for the c.459+1G>A mutation in the ARSA gene presents with cerebellar ataxia as the only first clinical sign of metachromatic leukodystrophy.

    Science.gov (United States)

    Lugowska, Agnieszka; Mierzewska, Hanna; Bekiesińska-Figatowska, Monika; Szczepanik, Elżbieta; Goszczańska-Ciuchta, Alicja; Bednarska-Makaruk, Małgorzata

    2014-03-15

    Metachromatic leukodystrophy (MLD) is a rare lysosomal disorder caused by deficient activity of arylsulfatase A or the lack of saposin B, which results in the accumulation of sulfatide in the oligodendrocytes and in the Schwann cells. Three main clinical types of MLD can be distinguished according to the age of onset and the dynamics of clinical outcome: late infantile, juvenile, and adult. We report on a case of late infantile MLD presenting with cerebellar ataxia as the only first clinical sign preceding even changes in white matter visible in MR imaging. The diagnosis was made on the basis of successive MRI, characteristic of demyelination, which developed in the course of the disease, and on the results of the following biochemical and molecular analyses. Very low residual activity of arylsulfatase A was demonstrated in blood leukocytes and the patient was a homozygote for a common mutation c.459+1G>A in the ARSA gene. Since cerebellar ataxia is a relatively common but unspecific neurological symptom in toddlers, it is recommended that MLD be considered as part of the differential diagnosis even if the initial neuroimaging studies are normal and ataxia is the only clinical symptom of the disease. Copyright © 2013 Elsevier B.V. All rights reserved.

  6. The first rib hypoplasia and the aberrant pulmonary artery branch detected by three-dimensional computed tomography in a surgical case with apical lung cancer, a case report.

    Science.gov (United States)

    Sugiura, Yasoo; Fujimoto, Hiroyuki; Naruke, Masao; Hashizume, Toshinori; Kaseda, Shizuka; Nemoto, Etsuo

    2017-01-11

    The complete resection is one of the most crucial requirements to achieve favorable outcomes in oncologic surgery. The apex of the lung is surrounded complicatedly by the clavicle, the first rib, the subclavian artery and vein, and the brachial plexus. Therefore, the image information especially about the infiltration of adjacent anatomic structures, facilitates the surgery in the apical lung cancer. A 70-year-old man presented at our hospital with a computed tomography (CT) scan showing a tumor at the left lung apex that infiltrated the chest wall. Two anatomical anomalies were found, which were the first rib hypoplasia and the aberrant pulmonary artery branch. The three-dimensional (3D) CT enhanced with using bolus tracking method, simultaneously revealed that the subclavian vessels existed between the clavicle and the second rib, and the left lingual pulmonary artery and the ventrobasal pulmonary artery diverged from the left main pulmonary artery as the first branch. We diagnosed the tumor as a primary lung squamous cell carcinoma that infiltrated the second rib, because sputum cytology suggested squamous cell carcinoma. Left lung upper lobectomy with lymph node dissection and chest wall resection (the second and third ribs) were performed with caution for the anatomical anomalies. The pathological diagnosis was pleomorphic carcinoma (5.0 × 3.0 × 1.9 cm) that invaded the second costal bone, and the pathological stage was confirmed to be pT3N0M0. Pathologically curative resection was accomplished. The patient was discharged from the hospital on 10 days after surgery. The 3D-CT precisely detected the anomalous structure consisted with the clavicle, the second rib, the subclavian artery and vein, the aberrant pulmonary artery branch. In the present case with the apical lung cancer, the evaluation of the anatomical structure via 3D-CT facilitated to achieve a pathological complete resection.

  7. Diagnostic value of computerized tomography venography in detecting stenosis and occlusion of subclavian vein and superior vena in chronic renal failure patients.

    Science.gov (United States)

    Bakhshoude, Banafsheh; Ravari, Hassan; Kazemzadeh, Gholam Hosein; Rad, Masoud Pezeshki

    2016-08-01

    Currently, venography is the standard diagnostic method to examine veins before implementing access, which is invasive in nature. Computerized tomography venography (CTV) can simultaneously indicate deep and superficial venous systems in the upper extremity and their relation to the surrounding anatomical structures; however, its diagnostic value in the detection of central venous disease has yet to be defined. The aim of this study was to determine the diagnostic value of CT venography compared to venography in the diagnosis of stenosis and the occlusion of subclavian veins and the superior vena in renal failure patients. This cross-sectional study was conducted from January to September 2015 on patients with chronic renal failure undergoing upper extremity venography at the Radiology Department of Imam Reza Hospital in Mashhad, Iran. We excluded patients with catheters in their jugular and subclavian vein routes, venous hypertension with reverse-function fistula, or sensitivity to contrast agents. Several factors, including age, gender, catheterization record in jugular and subclavian veins, and fistula record in the upper extremity, as well as clinical symptoms consisting of edema, dermatitis, and ulcers in these organs, were recorded in the corresponding form. Then, the patients consecutively underwent indirect venography and CT venography and traces of stenosis (more than 50%) or complete occlusion in the subclavian vein and superior vena were recorded. The data were analyzed using SPSS software by the chi-squared test, and sensitivity, specificity, and positive and negative predictive values were calculated by means of MedCalc Online, version 16.2. The study was conducted on 40 patients (26 males and 14 females) with a mean age of 46.7 ± 10.4 years. In this study, 58 subclavian veins, as well as 32 superior vena cava, were studied. The results showed that the diagnostic value of CTV in the detection of subclavian stenosis had a sensitivity and a specificity

  8. Operative and endovascular management of extracranial vertebral artery aneurysm in Ehlers-Danlos syndrome:a clinical dilemma--case report and literature review.

    LENUS (Irish Health Repository)

    Sultan, Sherif

    2002-01-01

    The most prevalent lesion of the vertebral artery is an atheromatous plaque located at its origin from the subclavian artery. A case of successful management of a symptomatic vertebral artery aneurysm due to Ehlers-Danlos syndrome is reported. The patient had asymptomatic posterior intracerebral artery dissection on the contralateral side. A common carotid artery to V-3 segment bypass using reversed saphenous vein graft was carried out. Avulsion of the V-2 segment occurred peroperatively and endovascular coil embolization of the vertebral artery aneurysm was performed. Endovascular equipment and training must be in the armamentarium of vascular surgeons as more complex cases are being treated, which demands new approaches for ultimate clinical success. This unique case outlines what might unexpectedly occur. Endovascular intervention as an adjuvant procedure provides a satisfactory outcome in what could have been a catastrophe.

  9. Transbrachial artery approach for selective cerebral angiography

    Energy Technology Data Exchange (ETDEWEB)

    Touho, Hajime; Karasawa, Jun; Shishido, Hisashi; Morisako, Toshitaka; Numazawa, Shinichi; Yamada, Keisuke; Nagai, Shigeki; Shibamoto, Kenji (Osaka Neurological Inst., Toyonaka (Japan))

    1990-02-01

    Transaxillary or transbrachial approaches to the cerebral vessels have been reported, but selective angiography of all four vessels has not been possible through one route. In this report, a new technique for selective cerebral angiography with transbrachial approach is described. One hundred and twenty three patients with cerebral infarction, vertebrobasilar insufficiency, intracerebral hemorrhage, epilepsy, or cerebral tumor were examined. Those patients consisted of 85 outpatients and 38 inpatients whose age ranged from 15 years old to 82 years old. The patients were examined via the transbrachial approach (97 cases via the right brachial, 29 cases via the left). Materials included a DSA system (Digital Fluorikon 5000, General Electric Co.), a 4 French tight J-curved Simmons 80-cm catheter, a 19-gauge extra-thin-wall Seldinger needle, and a J/Straight floppy 125-cm guide-wire. Generally, the volume of the contrast agent (300 mgI/ml iopamidol) used in the common carotid artery angiogram was 6 ml, while that used in the vertebral artery angiogram was 4 ml. If catheterization of the vertebral artery or right common carotid artery was unsuccessful, about 8 ml of the contrast agent was injected into the subclavian or branchiocephalic artery. Definitive diagnosis and a decision on proper treatment of the patients can be easily obtained, and the results were clinically satisfactory. Moreover, no complications were encountered in this study. This new technique making a transbrachial approach to the cerebral vessels using the DSA system is introduced here. Neurosurgeons can use this technique easily, and they will find that it provides them with all the information they need about the patient. (author).

  10. An unusual case of multiple aortic abnormalities: total occlusion of aortic arch, left external iliac artery, and bicuspid aortic valve in a 21-year-old man.

    Science.gov (United States)

    Tanindi, Asli; Tavil, Yusuf; Mutluay, Ruya; Taktak, Hacer; Cengel, Atiye

    2007-03-01

    An unusual case of total occlusion of aorta just distal to the left subclavian artery, bicuspid aortic valve, and occluded left external iliac artery in a 21-year-old man who was admitted with headache and severe hypertension is presented. We wish to report this case because so far there have been none reported with such multiple aortic abnormalities, although several documented cases of isolated total occlusion of aorta exist. Our patient underwent a successful surgical correction, i.e., patch plasty to the coarcted segment and end to side - end to side aortal-aortal bypass with Dacron graft.

  11. Successful surgical repair of impending rupture of a pseudoaneurysm of the brachiocephalic artery with prior reconstruction of the carotid artery

    Energy Technology Data Exchange (ETDEWEB)

    Miyahara, Ken; Maeda, Masanobu; Sakai, Yoshimasa; Sakurai, Hajime; Murayama, Hiroomi; Hasegawa, Hiroki [Social Insurance Chukyo Hospital, Nagoya (Japan)

    2003-01-01

    We report the successful repair of impending rupture of a pseudoaneurysm of the brachiocephalic artery (BCA) in a 70-year-old man. He had undergone a mediastinal tumor resection through a median sternotomy in 1995. Pathological examination revealed non-Hodgkin's lymphoma. Two years later, he underwent radiation therapy of 65 Gray for metastasis to the supraclavicular lymph nodes. On January 18, 2000, plastic surgeons planned to perform a pectoralis major musculocutaneous flap to repair a radiation skin ulcer. During the operation, the BCA was lacerated, possibly in an area of radiation tissue damage. We performed a prosthetic graft (10-mm Gelseal) replacement of the BCA. The right subclavian artery had to be ligated. Postoperative digital subtraction angiography (DSA) showed excellent reconstruction of the artery. Magnetic resonance angiography of the brain showed a deficit in the anterior communicating artery and stenosis of the posterior communicating artery, which indicated that the reconstruction procedure was reasonable. Seven months later, on August 18, 2000, the patient was transferred to our hospital because of swelling of the right neck and oozing from the previous cutaneous wound. CT scan and DSA demonstrated the presence of a pseudoaneurysm of the proximal anastomosis site, which required emergency surgery. Before this third sternotomy, a saphenous vein graft was interposed between both external carotid arteries. Removal of the prosthetic graft and resection of the pseudoaneurysm were performed under mild hypothermia and cardiopulmonary bypass with left common carotid arterial perfusion. Then, the wound was closed completely using a left pectoralis major musculocutaneous flap. The postoperative course was uneventful and DSA showed good patency of the graft and intracranial arteries. The patient was discharged without neurological complications. We conclude that prior reconstruction of the carotid artery is a safe and effective procedure for patients

  12. ANOMALOUS ORIGIN OF THE LEFT VERTEBRAL ARTERY. Origen anómalo de la arteria vertebral izquierda

    Directory of Open Access Journals (Sweden)

    Divya Premchandran

    2016-03-01

    Full Text Available Las variaciones de los principales vasos arteriales son de importancia clínica. La arteria vertebral (VA normalmente surge de la arteria subclavia. El presente informe describe un origen anómalo de la arteria vertebral izquierda (LVA desde el arco aórtico entre el origen de la subclavia izquierda y la arteria carótida común izquierda. Esta arteria cruzó superficialmente de medial a lateral el tronco simpático izquierdo. La VA izquierda y derecha entraban en los agujeros transversos de la quinta vértebra cervical. Aunque el origen anómalo de la VA es bien conocida, su origen y la entrada a través del foramen transversal y sus relaciones con tronco simpático son de importancia clínica y durante los procedimientos vasculares en la región de cabeza y cuello tales como los stent de arteria carótida o vertebral y las intervenciones intracraneales. Variations of major arterial vessels are of clinical significance. The vertebral artery (VA normally arises from the subclavian artery. The present report describes an anomalous origin of the left vertebral artery (LVA from the aortic arch between the origin of the left subclavian and the left common carotid arteries. This artery was crossed superficially from medial to lateral by the left sympathetic trunk. The left and right VA entered the foramen on the transverse process of the fifth cervical vertebra. Though the anomalous origin of the VA is known, its origin and entry through the transverse foramen and its relations with sympathetic trunk are of importance during clinical and vascular procedures in the head and neck region like carotid artery stents, VA stents and intracranial interventions.

  13. Coronary Artery Bypass Grafting

    Science.gov (United States)

    ... Health Topics / Coronary Artery Bypass Grafting Coronary Artery Bypass Grafting What Is Coronary artery bypass grafting (CABG) ... multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of the ...

  14. Coronary Arteries

    Science.gov (United States)

    ... animations for grades K-6. The Coronary Arteries Coronary Circulation The heart muscle, like every other organ or ... the heart by its own vascular system, called coronary circulation. The aorta (the main blood supplier to the ...

  15. Arterial stiffness

    Directory of Open Access Journals (Sweden)

    Ursula Quinn

    2012-09-01

    Full Text Available Measurements of biomechanical properties of arteries have become an important surrogate outcome used in epidemiological and interventional cardiovascular research. Structural and functional differences of vessels in the arterial tree result in a dampening of pulsatility and smoothing of blood flow as it progresses to capillary level. A loss of arterial elastic properties results a range of linked pathophysiological changes within the circulation including increased pulse pressure, left ventricular hypertrophy, subendocardial ischaemia, vessel endothelial dysfunction and cardiac fibrosis. With increased arterial stiffness, the microvasculature of brain and kidneys are exposed to wider pressure fluctuations and may lead to increased risk of stroke and renal failure. Stiffening of the aorta, as measured by the gold-standard technique of aortic Pulse Wave Velocity (aPWV, is independently associated with adverse cardiovascular outcomes across many different patient groups and in the general population. Therefore, use of aPWV has been proposed for early detection of vascular damage and individual cardiovascular risk evaluation and it seems certain that measurement of arterial stiffness will become increasingly important in future clinical care. In this review we will consider some of the pathophysiological processes that result from arterial stiffening, how it is measured and factors that may drive it as well as potential avenues for therapy. In the face of an ageing population where mortality from atheromatous cardiovascular disease is falling, pathology associated with arterial stiffening will assume ever greater importance. Therefore, understanding these concepts for all clinicians involved in care of patients with cardiovascular disease will become vital.

  16. Subclavian central venous catheter-related thrombosis in trauma patients: incidence, risk factors and influence of polyurethane type

    Science.gov (United States)

    2013-01-01

    Introduction The incidence of deep venous thrombosis (DVT) related to a central venous catheter varies considerably in ICUs depending on the population included. The aim of this study was to determine subclavian central venous catheter (SCVC)-related DVT risk factors in severely traumatized patients with regard to two kinds of polyurethane catheters. Methods Critically ill trauma patients needing a SCVC for their usual care were prospectively included in an observational study. Depending on the month of inclusion, patients received one of the two available products in the emergency unit: either an aromatic polyurethane SCVC or an aliphatic polyurethane SCVC. Patients were screened weekly by ultrasound for SCVC-related DVT. Potential risk factors were collected, including history-related, trauma-related and SCVC-related characteristics. Results A total of 186 patients were included with a median Injury Severity Sore of 30 and a high rate of severe brain injuries (21% of high intracranial pressure). Incidence of SCVC-related DVT was 37% (95% confidence interval: 26 to 40) in patients or 20/1,000 catheter-days. SCVC-related DVT occurred within 8 days in 65% of cases. There was no significant difference in DVT rates between the aromatic polyurethane and aliphatic polyurethane SCVC groups (38% vs. 36%). SCVC-related DVT independent risk factors were age >30 years, intracranial hypertension, massive transfusion (>10 packed red blood cell units), SCVC tip position in the internal jugular or in the innominate vein, and ipsilateral jugular catheter. Conclusion SCVC-related DVT concerned one-third of these severely traumatized patients and was mostly clinically silent. Incidence did not depend on the type of polyurethane but was related to age >30 years, intracranial hypertension or misplacement of the SCVC. Further studies are needed to assess the cost-effectiveness of routine screening in these patients in whom thromboprophylaxis may be hazardous. PMID:23718723

  17. Ultrasound guided implantation of chest port systems via the lateral subclavian vein; Die sonographisch gezielte Implantation von Portkathetersystemen ueber die laterale Vena subclavia

    Energy Technology Data Exchange (ETDEWEB)

    Zaehringer, M.; Hilgers, J.; Krueger, K.; Strohe, D.; Bangard, C.; Neumann, L.; Lackner, K. [Inst. fuer Radiologische Diagnostik, Univ. zu Koeln (Germany); Warm, M. [Gynaekologie, Univ. zu Koeln (Germany); Reiser, M. [Medizinische Klinik I, Univ. zu Koeln (Germany); Toex, U. [Medizinische Klinik IV, Univ. zu Koeln (Germany)

    2006-03-15

    Purpose: Retrospective analysis of the success and complication rates of chest port implantation via the lateral subclavian vein. Materials and methods: Between January 2003 and June 2004, the lateral subclavian vein in 271 patients (186 women, 85 men, mean age 53.2 years) was punctured guided by ultrasound. This access was used to insert a port system, and the catheter tip was placed at the cavoatrial junction. The port reservoir was implanted in a subcutaneous infraclavicular pocket and fixed to the fascia of the pectoralis muscle. Indications for port implantation were chemotherapy (n=239), total parenteral nutrition (n=2) and intravenous medication (n=30). The patient follow-up was mainly performed either by the oncology division of the department of gynecology or by the department of internal medicine. Results: A chest port catheter system was successfully implanted in all patients. The catheter remained in place for a mean duration of 269.4 days (SD 192.3 days). No complications occurred during implantation. In the post-interventional period, 6 catheter dysfunctions were found (thrombotic 0.09 per 1000 catheter days; mechanic 0.05 per 1000 catheter days). While one local infection occurred in the early post-interventional period, 3 local and 15 systemic infections were independent of the port catheter placement (0.39 per 1000 catheter days). The rate of port catheter explantations due to dysfunction or infection was 0.07 per 1000 catheter days. Conclusion: Ultrasound-guided puncture of the lateral subclavian vein is a safe procedure for the insertion of central venous port catheter systems and had a very low complication rate in our study. For further evaluation of our port placement technique, prospective studies compared to placement through the internal jugular vein are necessary. (orig.)

  18. ARTERIAL VASCULARIZATION OF THIMUS OF BRAZILIAN NORTHEASTERN DONKEY (Equus asinus VASCULARIZAÇÃO ARTERIAL DO TIMO EM FETOS DE JUMENTOS NORDESTINOS (Equus asinus

    Directory of Open Access Journals (Sweden)

    Marcelo Ismar Silva Santana

    2008-04-01

    Full Text Available There were utilised 10 fetuses of jumentos, males and females, to macroscopic study of the thymus vascularization. After the arteries injection, throught the aorta, with Neoprene Latx “450” solution, it was proceded the fixation, in a 10% formalin solution. It was observed that the thymus is reached by direct or indirect arterial branches coming from the right and left internal thoracic, left subclavian arterie, right superficial cervical, left extern thoracic and direct and indirect branches of left and right carotidas arteries. Thymus; vascularization; Equus asinus Foram utilizados 10 fetos de jumentos, machos e fêmeas, para o estudo macroscópico da vascularização do timo. Para a dissecção dos fetos, o conteúdo arterial recebeu solução aquosa a 50% de Neoprene Látex “450”, corada com pigmento específico, em seguida os fetos foram fixados em solução aquosa a 10% de formol. Observou-se que o timo era irrigado por colaterais oriundas das artérias torácicas internas direita e esquerda, da a. subclávia esquerda, da a. cervical superficial direita, da a. torácica externa esquerda e por ramos diretos e indiretos das aa. carótidas comuns direita e esquerda. Timo; vascularização; Equus asinus

  19. End tidal CO2 versus arterial CO2 monitoring in patients undergoing coronary artery bypass graft

    Directory of Open Access Journals (Sweden)

    Hassani E

    2009-12-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Measuring end tidal carbon dioxide (ETCo2 is one of the methods used for estimating arterial carbon dioxide (PaCo2 during general anesthesia. ETCo2 measurements maybe obviate the need for repeating arterial puncture for determination of arterial PaCo2. This study performed to determine the accuracy of ETCo2 levels as a measure of PaCo2 levels in patients undergoing coronary artery bypass graft and also to evaluate variation of the gradient between PaCo2 and ETCo2, peri- cardiopulmonary bypass operation."n"nMethods: In a prospective, cross-sectional study, a total of 40 patients with age 57±11 (35-73 years old undergoing coronary artery bypass graft were enrolled. ETCo2 levels (mmHg were recorded using side stream capnography at the time of arterial blood gas sampling, before (T0 and after (T1 cardiopulmonary bypass."n"nResults: Mean P(a-ETCo2 at T0 was 4.3±4.4mmHg, with the mean PaCo2, 33±6mmHg and mean ETCo2, 29±5mmHg and these values at T1 were 4.5±4.1mmHg, 33±5mmHg and 29±2mmHg respectively. There was no variation of the mean gradient (PaCo2-PETCo2 during, before and after cardiopulmonary bypass (p>0.870. Significant correlation was found between ETCo2 and PaCo2 at T0 and T1 (r=0.754 and 0

  20. Occlusive Peripheral Arterial Disease

    Science.gov (United States)

    ... but also to the worsening of the disease. Obstructive peripheral arterial disease most commonly develops in the arteries of the legs, including the two branches of the aorta (iliac arteries), main arteries of the thighs (femoral arteries), of ... arterial disease may also develop in the part ...

  1. Guidance and examination by ultrasound versus landmark and radiographic method for placement of subclavian central venous catheters: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Perbet, Sébastien; Pereira, Bruno; Grimaldi, Florian; Dualé, Christian; Bazin, Jean-Etienne; Constantin, Jean-Michel

    2014-05-20

    Central venous catheters play an important role in patient care. Real-time ultrasound-guided subclavian central venous (SCV) cannulation may reduce the incidence of complications and the time between skin penetration and the aspiration of venous blood into the syringe. Ultrasonic diagnosis of catheter misplacement and pneumothorax related to central venous catheterization is rapid and accurate. It is unclear, however, whether ultrasound real-time guidance and examination can reduce procedure times and complication rates when compared with landmark guidance and radiographic examination for SCV catheterization. The Subclavian Central Venous Catheters Guidance and Examination by UltraSound (SUBGEUS) study is an investigator-initiated single center, randomized, controlled two-arm trial. Three hundred patients undergoing SCV catheter placement will be randomized to ultrasound real-time guidance and examination or landmark guidance and radiographic examination. The primary outcome is the time between the beginning of the procedure and control of the catheter. Secondary outcomes include the times required for the six components of the total procedure, the occurrence of complications (pneumothorax, hemothorax, or misplacement), failure of the technique and occurrence of central venous catheter infections. The SUBGEUS trial is the first randomized controlled study to investigate whether ultrasound real-time guidance and examination for SCV catheter placement reduces all procedure times and the rate of complications. ClinicalTrials.gov Identifier: NCT01888094.

  2. Novel experience of laser-assisted 'inside-out' central venous access in a patient with bilateral subclavian vein occlusion requiring pacemaker implantation.

    Science.gov (United States)

    Aye, Thandar; Phan, Thanh Trung; Muir, Douglas Findlay; Linker, Nicholas John; Hartley, Richard; Turley, Andrew John

    2017-10-01

    This new laser facilitated 'inside-out' technique was used for transvenous pacemaker insertion in a pacemaker-dependent patient with bilateral subclavian occlusion and a failed epicardial system who is not suitable for a transfemoral approach. Procedure was undertaken under general anaesthesia with venous access obtained from right femoral vein and left axillary vein. 7F multipurpose catheter was used to enter proximal edge of the occluded segment of subclavian vein via femoral approach, which then supported stiff angioplasty wires and microcatheters to tunnel into the body of occlusion. When encountered with impenetrable resistance, 1.4 mm Excimer laser helped delivery of a Pilot 200 wire, which then progressed towards the distal edge of occlusion. Serial balloon dilatations allowed wire tracked into subintimal plane, advanced towards left clavicle using knuckle wire technique, which was then externalized with blunt dissection from infraclavicular pocket area. It was later changed to Amplatz superstiff wire exiting from both ends to form a rail, which ultimately allowed passage of pacing leads after serial balloon dilatation from clavicular end. Our hybrid 'inside-out' technique permitted transvenous pacemaker insertion without complication and this is, to our knowledge, the first case using laser in this context.

  3. The effect of lung deflation on the position of the pleura during subclavian vein cannulation in infants receiving mechanical ventilation: an ultrasound study.

    Science.gov (United States)

    Jang, Y-E; Lee, J-H; Park, Y-H; Byon, H-J; Kim, H-S; Kim, C-S; Kim, J-T

    2013-10-01

    We evaluated the effect of lung deflation on the relative position of the pleura compared with a reference line during supra- and infraclavicular approaches to the right subclavian vein. The reference line was drawn relative to the predicted pathway of the needle. The distances between the pleura and the reference line for supra- and infraclavicular approaches were measured during inspiration and expiration in 41 infants. Measurements were repeated with the application of 5 cmH2O positive end-expiratory pressure (PEEP) and in the Trendelenburg position. Lung deflation during the supraclavicular approach significantly decreased the volume of lung crossing the reference line by a median (IQR [range]) of 1.0 (0.6 to 1.3 [0.0 to 4.8]) mm, p pleura from the reference line regardless of PEEP or patient position. We conclude that lung deflation moves the lung apex caudally and can reduce the potential risk of pneumothorax during a supraclavicular approach to the right subclavian vein in infants. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

  4. Arterial thoracic vascularization in some deer species: pampas deer (Ozotoceros bezoarticus), brown brocket deer (Mazama gouazoubira) and axis deer (Axis axis).

    Science.gov (United States)

    Pérez, W; Erdoğan, S

    2014-12-01

    In this study, the arterial distributions of the aortic arches of three deer species (Axis axis, Ozotoceros bezoarticus and Mazama gouazoubira) were described. The animals were dissected immediately after being found dead. Latex injection method was used to observe the vascularization of the thorax. The branching pattern of the arteries of the thoracic aorta in O. bezoarticus was similar to domestic ruminants. In the M. gouazoubira and A. axis, there were no bicarotid trunk. Interestingly, the first branch of the brachiocephalic trunk was the left costocervical trunk in A. axis. Then, brachiocephalic trunk was divided into right and left subclavian arteries. M. gouazoubira and A. axis in contrast to O. bezoarticus were different when compared with other ruminants, and the absence of bicarotid trunk was more striking than previous reports. © 2014 Blackwell Verlag GmbH.

  5. Morphological comparison of the cardiac autonomic nervous system between normal and abnormal great arterial branching pattern with a brief review of the literature.

    Science.gov (United States)

    Kawashima, Tomokazu; Sasaki, Hiroshi

    2007-03-30

    Information on the topological relationship between arterial and peripheral autonomic nervous systems is insufficient for application to other research fields as each system has been analyzed separately during a long anatomical history. In the present study, we scrutinized the topological changes in the cardiac autonomic nervous system (CANS) in cadavers with a normal great arterial branching pattern of the aortic arch and in those with an anomalous left vertebral artery. These results were then compared with our previous report on cadavers with a retroesophageal right subclavian artery, and we attempted to consider the possible morphological causal principles of the changes. This report would be useful not only for morphological research but also to improve cardiac treatment and animal experiments. Although the CANS shift was considered when a great arterial branching anomaly appeared, additional cardiac nerves along the anomalous artery were found in addition to the normal CANS composition, based on our present and previous anomalous reports. From both developmental and anatomical viewpoints, CANS may depend on the surrounding arterial system. Therefore, a detailed analysis of the peripheral autonomic nervous system with its surrounding structures, especially the arterial system, has filled the gap between morphological and molecular embryological research in addition to the clinical significance in cardiac surgery, the understanding of experimental results, and the application to cardiac functions.

  6. 53. Bilateral ductal stenting for nonconfluent pulmonary arteries in a newborn

    Directory of Open Access Journals (Sweden)

    K. Al Dhahri

    2016-07-01

    Full Text Available Bilateral PDA dependent pulmonary circulation with right and left pulmonary artery discontinuity is very rare. Limited data available for bilateral PDA stenting. Bilateral PDA stenting in nonconfluent pulmonary arteries is challenging procedure but can be considered as an option in the management of complex conditions like this. 12 days old Preterm (36 weeks gestation male baby with birth weight of 2.6 kg developed respiratory distress with severe cyanosis and desaturation upto 50%. Baby was intubated and started on Prostaglandin 0.05 mic/kg/mt. His saturation improved to 80%. Echocardiogram showed complex cyanotic heart disease, Situs ambiguous, dextrocardia, complete unbalanced AV septal defect, pulmonary atresia , nonconfluent small branch pulmonary arteries supplied by the bilateral patent ductus arteriosus (PDA from right aortic arch and all four pulmonary veins form a confluence and drain into superior vena cava(SVC through vertical vein with no obstruction. Baby was taken up for PDA stenting. descending aortogram showed right aortic arch with vertical tortuous duct to right pulmonary artery (RPA and another short duct with acute angle from left subclavian artery to left pulmonary artery (LPA . Both ducti stented with coronary stents. Vertical vein angiogram showed both lungs drain to a confluence and then to SVC via ascending vertical vein with no obstruction. After stenting lung perfusion improved and the baby was stable and maintained 80% saturation on room air. Bilateral PDA dependent pulmonary circulation with right and left pulmonary artery discontinuity is very rare. Our case is unique with Heterotaxy, TAPVC, Dextrocardia and double ducti. Eventhough bilateral ductal stenting is technically challenging it is successful through femoral artery approach.

  7. Transcarotid Artery Endovascular Reconstruction of the Aortic Arch by Modified Bifurcated Stent Graft for Stanford Type A Dissection

    Directory of Open Access Journals (Sweden)

    Wei Guo

    2007-10-01

    Full Text Available A 40-year-old man with Stanford type B dissection underwent his first endovascular repair (EVAR in April 2004 by Talent thoracic stent graft. He had an uncomplicated recovery and maintained good blood pressure control. However, a new retrograde dissection appeared in September 2004. The new dissection involved his aortic arch and ascending thoracic aorta to the opening of the coronary arteries. To reconstruct the aortic arch, bypasses between the right common carotid artery (RCCA, left common carotid artery and left subclavian artery were performed before endovascular repair. A modified bifurcated Talent stent graft was deployed from the RCCA to the ascending thoracic aorta with a long limb in the innominate artery and a short limb in the aortic arch. A further two pieces of graft were deployed via the common femoral artery. The ascending thoracic aorta and aortic arch were reconstructed completely by the bifurcated stent graft. The final angiography confirmed that there was good stent graft configuration, normal blood flow, and stable haemodynamics. No endoleak or other major complications were encountered. This result indicated that it is possible to reconstruct the aortic arch with a bifurcated stent graft and could be a new endovascular repair model for complex thoracic aortic aneurysm and dissection.

  8. [Use of a biological graft for subclavian-femoral bypassing in patients at operational-anaesthesiological risk].

    Science.gov (United States)

    Sukovatykh, B S; Belikov, L N; Rodionov, O A; Rodionov, A O

    2015-01-01

    Analysed herein are the results of an experimental study performed on 30 rabbits and a clinical study of treating a total of 60 patients presenting with critical ischaemia of lower limbs on the background of bilateral atherosclerotic lesions of the aortoiliac segment and running high operational-anaesthesiological risk. The animals were subdivided into three groups: an intact group consisting of 6 animals and two study groups comprising 12 rabbits each. In the first study group onto the wall of the abdominal aorta we implanted a synthetic polytetrafluoroethylene prosthesis, the second study group animals received biological graft "Kemangioprotez" from bovine internal thoracic arteries. The biological prosthesis on day three after implantation onto the arterial wall induced 3.2 times and on day seven 1.2 times more pronounced inflammatory reaction than the polytetrafluoroethylene prosthesis. 30 days after implantation of the synthetic graft the degree of repair connective-tissue processes in the arterial wall was 1.8-fold and 70 days after was 3.3-fold more pronounced than after implantation of the biological prosthesis at the same terms. In the connective-tissue capsule around the synthetic prosthesis predominated cellular elements while around the biological prosthesis - fibrous structures predominated. The patients were subdivided into 2 groups consisting of 30 patients each. In Group One patients the shunt used was a synthetic polytetrafluoroethylene prosthesis, in Group Two being a biological graft from bovine internal thoracic arteries. All patients suffered from severe concomitant diseases in the decompensation stage and a multi-level lesion of lower-limb arteries. Revascularization of the ischaemized extremity was carried out through the system of the deep femoral artery system. The use of a biological prosthesis made it possible in the immediate postoperative period to decrease the frequency of early postoperative complications by 13.3%, that of late graft

  9. PROLONGED RADIAL ARTERY SPASM IN THE CATHETERIZATION LABORATORY - RELIEF BY PHARMACOLOGICAL INTERVENTION

    Directory of Open Access Journals (Sweden)

    Krishna Kumar

    2010-11-01

    Full Text Available Radial spasm is often very prolonged and painful to the patient. Here, we describe a novel way to deal with the same. The total spasm lasted over 4 hours. A 3.4 6 JR catheter was introduced via the femoral route and papav arine one ampoule was injected directly into the right subclavian artery. After about 10 min we were able to pull out the radial catheter. Radial angiography is a simple procedure with reportedly less complications 1,2. How ever ,it has one major complication radial spasm. We describe here a patient with radial spasm that persisted for more than 2 hours and how we dealt with it.

  10. Incidence and predisposing factors of cold intolerance after arterial repair in upper extremity injuries.

    Science.gov (United States)

    Klocker, Josef; Peter, Tobias; Pellegrini, Lukas; Mattesich, Monika; Loescher, Wolfgang; Sieb, Michael; Klein-Weigel, Peter; Fraedrich, Gustav

    2012-08-01

    The purpose of this report was to present abnormal posttraumatic cold intolerance in patients that previously underwent repair of arterial injuries after civilian upper limb trauma in our institution. All patients who underwent repair of arterial lesions after upper limb trauma since 1990 were reviewed, and clinical follow-up studies were performed. Patients were asked to complete the cold intolerance symptom severity (CISS) questionnaire to evaluate presence and severity of self-reported cold sensitivity, and the disabilities of arm, shoulder, and hand (DASH) questionnaire to analyze functional disability. Abnormal cold intolerance was defined as a CISS score over 30. Further analysis included evaluation of epidemiologic, clinical, and perioperative data for factors predisposing to abnormal cold intolerance. A total of 87 patients with previous repair of upper limb arterial injuries were eligible to answer the CISS and DASH questionnaires, and 56 patients (64%; 43 men; median age: 31.9 years) completed both. In our cohort, blunt trauma was the predominant cause of injury (n = 50; 89%). Accompanying lesions of nerves (n = 22; 39%) and/or orthopedic injuries (n = 36; 64%) were present in 48 patients (86%). After a median follow-up period of 5.5 years (range, 0.5-19.7), 23 patients (41% of 56) reported on abnormal cold intolerance. Patients with cold intolerance had worse functional results (as measured by the DASH questionnaire; mean ± SD, 42.7 ± 29.7 vs 11.5 ± 23.9; P < .001) when compared with patients without. Cold intolerance was more frequently seen in patients with previous nerve lesion (P = .027) and in proximal injuries (subclavian or axillary vs brachial or forearm arteries: P = .006), but was not correlated to gender, age, involvement of the dominant or nondominant arm, and the presence of ischemia, bone injury, or an isolated vascular injury. Abnormal cold intolerance is frequently seen in patients with a history of arterial repair in upper limb trauma

  11. Doppler-guided cannulation of internal jugular vein, subclavian vein and innominate (brachiocephalic) vein--a case-control comparison in patients with reduced and normal intracranial compliance.

    Science.gov (United States)

    Schummer, Wolfram; Schummer, Claudia; Niesen, Wolf-Dirk; Gerstenberg, Hendrik

    2003-09-01

    A case-control comparison of Doppler guidance on the success rate of central venous cannulation in patients with normal or reduced intracranial compliance. A single operator performed central venous access procedures with continuous wave Doppler guidance. It was used on patients on a ventilator. The position of patients with reduced intracranial compliance (RIC) was not changed for the procedure. Patients with normal intracranial compliance (NIC) were put in the Trendelenburg position. We prospectively evaluated 249 Doppler-guided central venous access procedures performed over a 12-month period at our 10-bed neuro-intensive care unit at a university hospital. The group with RIC included 26 males and 35 females (n=61) aged 16-79 years. In this group 155 Doppler-guided cannulation procedures (62%) were performed. The group with NIC (n=52) comprised 29 males and 23 females aged 34-76 years; 94 Doppler-guided cannulation procedures (38%) were carried out. The veins cannulated in RIC and NIC, respectively, were: right innominate vein: 24/18, left innominate vein 26/12, right subclavian vein 12/7, left subclavian vein 25/14, and right internal jugular vein 33/18 and left internal jugular vein 35/24. The absence of one left internal jugular vein was identified in the NIC group. The success rate of first needle pass in patients with RIC was 92% and in patients with NIC 89%. This study showed that Doppler guidance allows the cannulation of central veins in patients with RIC placed in head-up position. Cannulation can be ensured and first-pass needle placement maximised.

  12. Echocolor Doppler morpho-functional study of the jugulo-subclavian confluence in chronic cerebro-spinal venous insufficiency and multiple sclerosis patients.

    Science.gov (United States)

    Mandolesi, Sandro; d'Alessandro, Aldo; Desogus, Antonello Ignazio; Ciccone, Marco Matteo; Zito, Annapaola; Stammegna, Immacolata; Niglio, Tarcisio; Orsini, Augusto; Mandolesi, Dimitri; d'Alessandro, Alessandro; Revelli, Luca

    2017-01-01

    The aim of this work is to measure the mean diameter of the confluence jugulo- subclavian, the impact of different types of jugular confluences and the correlation between the types of confluences and the Valsalva maneuver (jugular reflux) in subjects with Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) and Multiple Sclerosis. We investigated by Echo-Color-Doppler (ECD) 103 subjects (67 F 36M) of mean age 45 ± 12 years (a minimum of 22 to a maximum of 79 years, with a median of 44 and a modal value 42 years), mean EDSS of 4.7 and average disease duration of 12 years. The 103 right jugular veins investigated had an average diameter of 8.4 ± 2.4 mm (minimum 4.0, maximum 14.9 mm; median 7.9; modal value 7.6 mm). Three form types were found: 56 cylindrical, 29 conical and 18 funnel. Valsalva maneuver was positive in 30 patients. The 103 left jugular investigated had an average diameter of 8.9 ± 2.4 mm (minimum 2.8, maximum 14.4 mm; median of 8.8; modal value 8.7 mm). The form types were found: 42 cylindrical, 45 conical and 16 funnel. Valsalva maneuver was positive in 30 patients. The mean diameter of the jugular veins was 8.7 mm. Internal jugular veins with cylindrical morphology have a diameter smaller than other forms; this difference is statistically significant. The different morphology of the jugular vein confluence does not increase the possibility of a reflux because the positive Valsalva maneuvers are not statistically significant when compared to the various types. CCSVI, EchoColorDoppler Map, Jugulo-Subclavian Confluence Diameter.

  13. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med . 2016;374(11):1021- ...

  14. Carotid Artery Disease

    Science.gov (United States)

    ... head with blood. If you have carotid artery disease, the arteries become narrow or blocked, usually because ... other substances found in the blood. Carotid artery disease is serious because it can block the blood ...

  15. Coronary artery disease (image)

    Science.gov (United States)

    ... through these arteries is critical for the heart. Coronary artery disease usually results from the build-up of fatty material and plaque, a condition called atherosclerosis. As the coronary arteries narrow, the flow of blood to the ...

  16. Peripheral arterial line (image)

    Science.gov (United States)

    A peripheral arterial line is a small, short plastic catheter placed through the skin into an artery of the arm or leg. The purpose of a peripheral arterial line is to allow continuous monitoring of blood pressure ...

  17. Misplaced central venous catheter in the vertebral artery: endovascular treatment of foreseen hemorrhage during catheter withdrawal.

    Science.gov (United States)

    Akkan, Koray; Cindil, Emetullah; Kilic, Koray; Ilgit, Erhan; Onal, Baran; Erbas, Gonca

    2014-01-01

    We report on the endovascular management of hemorrhage with stent-graft due to a misplaced central venous catheter in the vertebral artery (VA) during percutaneous internal jugular vein catheterization in a child. A 16-year-old female was presented with the diagnosis of familial Mediterranean fever related chronic renal insufficiency. An attempt was made to place a central venous catheter via the right internal jugular vein without image guidance and the patient experienced dyspnea and pain at the catheter insertion site. Computerized tomography (CT) showed hemorrhage in the cervical region and upper mediastinum, also reformatted images showed that the catheter was passing through the proximal part of the VA and terminating in the right mediastinum. The catheter was removed during manual compression under angio-flouroscopic monitoring and ongoing extravasation was observed. A stent-graft was placed to the bleeding site of the VA. Angiography immediately after the stent-graft placement revealed complete disappearance of extravasation and patency of vertebral and subclavian arteries. Central venous catheterization (CVC) is not a risk-free procedure and arterial injuries are in a wide spectrum from a simple puncture to rupture of the artery. Inadvertent VA cannulation is a rare and serious complication necessitating prompt diagnosis and early treatment. If an arterial injury with a large-caliber catheter occurs, endovascular treatment with stent-graft seems to be a safe and effective option in terms of achieving hemostasis and preserving arterial patency. Recent findings suggest that endovascular management of inadvertent cervical arterial injury secondary to CVC seems to be the safest strategy.

  18. Radial Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    Ali Fedakar

    2011-04-01

    Full Text Available Upper limb aneurysms are less frequently seen than the other aneurysm. Radial arterial aneurysm is usually associated with the trauma. Interventional procedures can cause pseudoaneurysm at the radial artery puncture sites. Radial artery aneurysm may cause the thromboembolic events at the fingers and the hand. We present a case of isolated radial arterial aneurysm with idiopathic origin.

  19. Single umbilical artery

    Directory of Open Access Journals (Sweden)

    Shanthi Ramesh

    2015-01-01

    Full Text Available The umbilical cord usually contains two arteries and one vein. The vein carries the oxygenated blood from the placenta to the fetus. The arteries carry the deoxygenated blood and the waste products from the fetus to the placenta. Occasionally, primary agenesis or secondary atrophy of one of the arteries occurs resulting in single umbilical artery.

  20. Single umbilical artery

    OpenAIRE

    Shanthi Ramesh; Sangeetha Hariprasath; Gunasekaran Anandan; P John Solomon; Vijayakumar, V.

    2015-01-01

    The umbilical cord usually contains two arteries and one vein. The vein carries the oxygenated blood from the placenta to the fetus. The arteries carry the deoxygenated blood and the waste products from the fetus to the placenta. Occasionally, primary agenesis or secondary atrophy of one of the arteries occurs resulting in single umbilical artery.

  1. Single umbilical artery.

    Science.gov (United States)

    Ramesh, Shanthi; Hariprasath, Sangeetha; Anandan, Gunasekaran; Solomon, P John; Vijayakumar, V

    2015-04-01

    The umbilical cord usually contains two arteries and one vein. The vein carries the oxygenated blood from the placenta to the fetus. The arteries carry the deoxygenated blood and the waste products from the fetus to the placenta. Occasionally, primary agenesis or secondary atrophy of one of the arteries occurs resulting in single umbilical artery.

  2. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis.

    Science.gov (United States)

    Marik, Paul E; Flemmer, Mark; Harrison, Wendy

    2012-08-01

    Catheter-related bloodstream infections are an important cause of morbidity and mortality in hospitalized patients. Current guidelines recommend that femoral venous access should be avoided to reduce this complication (1A recommendation). However, the risk of catheter-related bloodstream infections from femoral as compared to subclavian and internal jugular venous catheterization has not been systematically reviewed. A systematic review of the literature to determine the risk of catheter-related bloodstream infections related to nontunneled central venous catheters inserted at the femoral site as compared to subclavian and internal jugular placement. MEDLINE, Embase, Cochrane Register of Controlled Trials, citation review of relevant primary and review articles, and an Internet search (Google). Randomized controlled trials and cohort studies that reported the frequency of catheter-related bloodstream infections (infections per 1,000 catheter days) in patients with nontunneled central venous catheters placed in the femoral site as compared to subclavian or internal jugular placement. Data were abstracted on study design, study size, study setting, patient population, number of catheters at each insertion site, number of catheter-related bloodstream infections, and the prevalence of deep venous thrombosis. Studies were subgrouped according to study design (cohort and randomized controlled trials). Meta-analytic techniques were used to summarize the data. Two randomized controlled trials (1006 catheters) and 8 cohort (16,370 catheters) studies met the inclusion criteria for this systematic review. Three thousand two hundred thirty catheters were placed in the subclavian vein, 10,958 in the internal jugular and 3,188 in the femoral vein for a total of 113,652 catheter days. The average catheter-related bloodstream infections density was 2.5 per 1,000 catheter days (range 0.6-7.2). There was no significant difference in the risk of catheter-related bloodstream

  3. Percutaneous implantation of intra-arterial port system for regional drug infusion: results and complications in 110 cases

    Energy Technology Data Exchange (ETDEWEB)

    Won, Je Hwan; Lee, Jong Hyuk [College of Medicine, Ajou University, Seoul (Korea, Republic of); Ko, Kyung Hee; Won, Jong Yoon; Park, Sung Il; Lee, Do Yun [College of Medicine, Yonsei University, Seoul (Korea, Republic of); Kang, Byung Chul [Mokdong Hospital, College of Medicine, Ehwa Womans University, Seoul (Korea, Republic of)

    2000-10-01

    To investigate the feasibility and complications of a percutaneously implantable port system for regional drug infusion. For intra-arterial drug infusion, a 5.8 or 5-F pediatric venous port system was implanted in 110 patients with hepatocellular carcinoma (n=79), liver metastasis (n=16), gallbladder cancer (n=4), stomach cancer (n=3), pancreatic cancer (n=3), Burger's diseases mellitus (n=2), or lymphoma (n=1). All intra-arterial port implantations were performed percutaneously in an angiographic ward through the common femoral artery (n=98), left subclavian artery (n=10), or left superficial femoral artery (n=2). Complications were evaluated during the follow-up period, which ranged from 21 to 530 (mean, 163) days. The technical success rate for percutaneous implantation of the system was 97.3% (107 of 110 patients). The tips of the port catheter were located in the common hepatic artery (n=34), proper hepatic artery (n=49), right hepatic artery quick resulthepatic artery (n=1), descending aorta at T9 level (n=10), left popliteal artery (n=2), right external iliac artery (n=1), left external iliac artery (n=1), or left deep femoral artery (n=1). Complications were encountered in 24 patients (22.4%), namely chamber site infection (n=7), catheter dislodgement (n=7), catheter occlusion (n=3), migration of coil (n=2), disconnection between chamber and catheter (n=1), kinking of catheter (n=1), arterial occlusion (n=1), necrosis of overlying skin (n=1), and leakage around port chamber (n=1). Outcomes of complications included removal of port systems or cessation of therapy in 12 cases (11.2%), correction of catheter location using a guide wire in five (4.7%), thrombolysis with urokinase in three (2.8%), and straightening using a snare in one (0.9%). In three patients, the port system was used without reintervention. Percutaneous implantation of an intra-arterial port system showed a high technical success rate and a low rate of serious complications. The method

  4. Anomalous left coronary artery from the pulmonary artery

    Science.gov (United States)

    ... of the left coronary artery arising from the pulmonary artery; ALCAPA; ALCAPA syndrome; Bland-White-Garland syndrome; ... children with ALCAPA, the LCA originates from the pulmonary artery. The pulmonary artery is the major blood ...

  5. Bilateral renal artery variation

    OpenAIRE

    Üçerler, Hülya; Üzüm, Yusuf; İkiz, Z. Aslı Aktan

    2015-01-01

    Each kidney is supplied by a single renal artery, although renal artery variations are common. Variations of the renal arteryhave become important with the increasing number of renal transplantations. Numerous studies describe variations in renalartery anatomy. Especially the left renal artery is among the most critical arterial variations, because it is the referred side forresecting the donor kidney. During routine dissection in a formalin fixed male cadaver, we have found a bilateral renal...

  6. Artery Bypass Grafting

    African Journals Online (AJOL)

    Unknown

    nary artery disease (CAD) was coronary artery bypass graft (CAB G) using a segment of saphenous vein interposed between the ascend- ing aorta and the coronary artery distal to the obstructing lesion. This was performed by David Sabiston of Duke University in 1962. With the use of the recently developed technique of ...

  7. Carotid artery surgery - slideshow

    Science.gov (United States)

    ... right- and left-internal carotid arteries, and the right- and left-external carotid arteries. The carotid arteries deliver oxygen-rich blood from the heart to both the head and brain. Review Date 6/1/2015 Updated by: Daniel ...

  8. Spontaneous renal artery dissection.

    Science.gov (United States)

    John, Santhosh G; Pillai, Unnikrishnan; Vaidyan, Philip B; Ishiyama, Takaaki

    2010-01-01

    Isolated spontaneous dissection of renal arteries or its branches are extremely rare. Most cases of renal artery dissection are associated with underlying pathology of the renal arteries. We report a case of spontaneous dissection of the left main renal artery and infarction of the left kidney with positive antiphospholipid antibody. Extensive work up of the patient including imaging studies confirmed the diagnosis of SRAD. Antiphospholipid antibodies may have a role in the pathogenesis of arterial dissection by causing endothelial dysfunction. This is a first literature report.

  9. Large mobile thrombus in non-atherosclerotic thoracic aorta as the source of peripheral arterial embolism

    Directory of Open Access Journals (Sweden)

    Brkovic Zoran

    2005-11-01

    Full Text Available Abstract The presence of thrombi in the atherosclerotic and/or aneurysmatic aorta with peripheral arterial embolism is a common scenario. Thrombus formation in a morphologically normal aorta, however, is a rare event. A 50 years old woman was admitted to the mergency department for pain, coldness, and anesthesia in the the left foot. She had a 25 years history of cigarette smoking, a history of postmenopausal hormone replacement therapy (HRT, hypercholesterolemia and hyperfibrinogenemia. An extensive serologic survey for hypercoagulability, including antiphospholipid antibodies, and vasculitis disorders was negative. Transesophageal echocardiography revealed a large, pedunculated and hypermobile thrombus attached to the aortic wall 5 cm distal of the left subclavian artery. The patient was admitted to the surgery department, where a 15 cm long fresh, parietal thrombus could be removed from the aorta showing no macroscopic wall lesions or any other morphologic abnormalities. This case report demonstrates the possibility of evolving a large, pedunculated thrombus in a morphologically intact aorta in a postmenopausal woman with thrombogenic conditions such as hyperfibrinogenemia, hypercholesterolemia, smoking and HRT. For these patients, profiling the individual risk and weighing the benefits against the potential risks is warranted before prescribing HRT.

  10. Nonbronchial systemic feeding arteries in patients with hemoptysis : predictive factors at radiography

    Energy Technology Data Exchange (ETDEWEB)

    Paik, Nam Chull; Park, Kyung Joo; Chung, Kyung Il; Won, Je Hwan; Suh, Jung Ho [Ajou Univ. School of Medicine, Suwon (Korea, Republic of)

    2001-09-01

    To determine the radiographic findings which predict the presence of nonbronchial systemic feeding arteries (NBFAs) in patients undergoing embolotherapy to control hemoptysis. In 48 patients (39 men and 9 women ; mean age, 51 years) who underwent embolotherapeutic procedures for controlling hemoptysis, selective angiography was performed at the intercostal, subclavian and bronchial arteries in 65 hemithoraces (right 11, left 20, bilateral 17). Underlying diseases were tuberculosis (n=34, including three patients with aspergilloma), bronchiectasis )n=11), paragonimiasis (n=2) and metastatic cancer (n=1). The presence of NBFA at angiography was correlated with radiographic findings including pleural thickening, parenchymal distortion, and the location of lung lesions. NBFAs were found in 34 (77%) of 44 hemithoraces with pleural thickening, and in six (29%) of 21 without pleural thickening ; the sensitivity and specificity of prediction were 85% and 60%, respectively. NBFAs were observed with greater frequency as the thickness of the pleura increased, and the extent of pleural thickening correlated less with the presence of NBFA than did thickness. NBFAs were found in 35 (78%) of 45 hemithoraces with parenchymal distortion, and in five (25%) of 20 without distortion (p<0.001). In addition, the distribution of the underlying disease in the upper lung zone showed close correlation with the presence of NBFAs (p<0.05). In patients with hemoptysis, the pleural thickening revealed by radiography has a high sensitivity and a relatively low specificity for predicting the presence of NBFA, and patients with parenchymal distortion and upper lung lesions have a high incidence of NBFA.

  11. testicular artery arising from an aberrant right renal artery

    African Journals Online (AJOL)

    User

    2017-08-17

    Aug 17, 2017 ... Correspondence to Dr. Emmanuel Henry Suluba, Department of Anatomy, School of Medicine,. Muhimbili University of Health and ... vein, left colic artery and the descending colon. Both right and left testicular arteries as ... anatomy of the vessels such as testicular arteries, ovarian arteries, renal arteries and.

  12. [A Case of Axillary Arterial Bleeding after Axillary Metastatic Lymph Node Necrosis during Treatment with Paclitaxel and Bevacizumabfor Breast Cancer].

    Science.gov (United States)

    Abe, Noriko; Ohtake, Tohru; Abe, Sadahiko; Aoto, Keita; Okano, Maiko; Tachibana, Kazunoshin; Yoshida, Sayaka; Yasuda, Mitsuhiko; Kimijima, Izo; Takenoshita, Seiich

    2016-11-01

    A 44-year-old woman was diagnosed cT4bcN3cM1(LYM), Stage IV triple-negative breast cancer.Enhanced computed tomography revealed ipsilateral axillary lymph node metastasis, 10 cm in diameter.The supraclavicular and cervical lymph nodes also had metastases.She received paclitaxel(90mg/m2, on days 1, 8, and 15 every 4 weeks)in combination with bevacizumab(10mg/kg, on days 1 and 15 every 28 days).Her height was 165 cm, and her body weight was 100 kg.After 1 course of chemotherapy, a metastatic axillary lymph node with necrotic changes was removed spontaneously.A few days later, she experienced severe bleeding from her axillary artery, and she went into hypovolemic shock.Despite undergoing surgical hemostasis, the bleeding recurred twice, so we performed coil embolization of her subclavian artery.Thirty -five days after the first occurrence of bleeding, the patient died of sepsis and ARDS due to left arm necrosis.Bevacizumab is effective for the treatment of large tumors, but when the tumor is close to an artery, clinicians should be wary of fatal bleeding after necrosis.

  13. Anatomical description of arterial branches of thoracic and abdominal aorta in the coati (Nasua nasua (Carnivora, Procyonidae

    Directory of Open Access Journals (Sweden)

    Daniel Arrais Biihrer

    2015-05-01

    Full Text Available The coati (Nasua nasua is a widely distributed species in South America, also in Brazil. This study aimed to observe and describe the branching morphology of the main arterial branches of thoracic and abdominal aorta in the coati, by comparing the findings with existing literature on the other domestic and wild species. For this study, two adult male specimens were used, collected from highways in the state of Minas Gerais, Brazil, victims of roadkill. The specimens were fixed in formalin solution and their aortic branches were filled with latex for subsequent dissection and analysis. It was observed that the left subclavian artery is a direct branch of the aortic arch, there is no formation of a bicarotid or celiac-mesenteric trunk, facts similarly described in domestic carnivores. Thus, it was noticed that the arterial branches of aorta in the coati, both in the thoracic and abdominal cavities, show a distribution very similar to that observed in domestic carnivores, something which reflects their evolutionary closeness within the Carnivora order. Thus, this study proves to be relevant by deepening anatomical knowledge on this wild species, enabling that aspects already known in canine veterinary medicine are applied to the coati.

  14. Duplicated middle cerebral artery

    Science.gov (United States)

    Perez, Jesus; Machado, Calixto; Scherle, Claudio; Hierro, Daniel

    2009-01-01

    Duplicated middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery. The incidence DMCA is relatively law, and an association between this anomaly and cerebral aneurysms has been documented. There is a controversy whether DMCA may have perforating arteries. This is an important fact to consider in aneurysm surgery. We report the case of a 34-year-old black woman who suffered a subarachnoid hemorrhage and the angiography a left DMCA, and an aneurysm in an inferior branch of the main MCA. The DMCA and the MCA had perforating arteries. The aneurysm was clipped without complications. The observation of perforating arteries in our patient confirms that the DMCA may have perforating arteries. This is very important to be considered in cerebral aneurysms surgery. Moreover, the DMCA may potentially serve as a collateral blood supply to the MCA territory in cases of MCA occlusion. PMID:22140405

  15. Multivessel coronary artery thrombosis.

    Science.gov (United States)

    Kanei, Yumiko; Janardhanan, Rajesh; Fox, John T; Gowda, Ramesh M

    2009-02-01

    Simultaneous thrombosis of multiple epicardial coronary arteries is an uncommon clinical finding in ST-segment elevation myocardial infarction (STEMI). We describe a 37-year-old male present with inferior wall STEMI who was found to have large thrombi in both the right coronary artery (RCA) and the left anterior descending artery (LAD). We reviewed 23 patients with multivessel thrombosis in acute myocardial infarction in the literature. The mean age of patients was 53 +/- 14 years (32-82 years); 74% were males, and most patients had multiple risk factors for coronary artery disease. The LAD (78%) and RCA (87%) were the arteries involved for most patients. Aspiration thrombectomy was used in 3 cases. Though it is rare, STEMI with multiple culprit arteries can occur, and it is crucial to recognize this condition to determine the proper treatment, since most of these patients are critically ill.

  16. Popliteal artery entrapment syndrome.

    LENUS (Irish Health Repository)

    O'Leary, D P

    2010-01-01

    Popliteal artery entrapment syndrome is a rare abnormality of the anatomical relationship between the popliteal artery and adjacent muscles or fibrous bands in the popliteal fossa. The following is a case report of a 19 year old female, in whom popliteal artery entrapment syndrome was diagnosed, and successfully treated surgically. A review of literature is also presented and provides details on how PAES is classified, diagnosed both clinically and radiologically, and treated surgically.

  17. Celiac Artery Compression Syndrome

    Directory of Open Access Journals (Sweden)

    Mohammed Muqeetadnan

    2013-01-01

    Full Text Available Celiac artery compression syndrome is a rare disorder characterized by episodic abdominal pain and weight loss. It is the result of external compression of celiac artery by the median arcuate ligament. We present a case of celiac artery compression syndrome in a 57-year-old male with severe postprandial abdominal pain and 30-pound weight loss. The patient eventually responded well to surgical division of the median arcuate ligament by laparoscopy.

  18. Renal Branch Artery Stenosis

    DEFF Research Database (Denmark)

    Andersson, Zarah; Thisted, Ebbe; Andersen, Ulrik Bjørn

    2017-01-01

    Renovascular hypertension is a common cause of pediatric hypertension. In the fraction of cases that are unrelated to syndromes such as neurofibromatosis, patients with a solitary stenosis on a branch of the renal artery are common and can be diagnostically challenging. Imaging techniques...... that perform well in the diagnosis of main renal artery stenosis may fall short when it comes to branch artery stenosis. We report 2 cases that illustrate these difficulties and show that a branch artery stenosis may be overlooked even by the gold standard method, renal angiography....

  19. Atherosclerotic femoral artery aneurysms

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Schroeder, T V

    1996-01-01

    Based on a clinical suspicion of an increase in the proportion of deep femoral aneurysms, we reviewed the case records of patients who underwent reconstructive procedures for femoral aneurysms to investigate if this could be confirmed and explained by selection of patient or modality of diagnosis...... femoral artery and 3 the deep femoral artery. The proportion of deep femoral aneurysm was therefore 3/17 = 18%. Previous series report that aneurysms of the profunda femoris artery occurs in only 1% to 2.6% of all femoral artery aneurysms. No explanation was found for this significant increase (p

  20. Heritability of cilioretinal arteries

    DEFF Research Database (Denmark)

    Taarnhøj, Nina Charlotte; Munch, Inger C; Kyvik, Kirsten O

    2005-01-01

    of healthy monozygotic and dizygotic twins were examined using digital fundus photography and visual assessment of grayscale fundus photographs and color transparencies to detect the presence of cilioretinal arteries. RESULTS: Cilioretinal arteries were present in 45.1% of participants and 28.8% of eyes...

  1. Peripheral artery disease - legs

    Science.gov (United States)

    ... the legs, feet, and toes Painful, non-bleeding sores on the feet or toes (most often black) that are slow ... block small arteries Coronary artery disease Impotence Open sores ... (gangrene) The affected leg or foot may need to be amputated

  2. Carotid Artery Screening

    Science.gov (United States)

    ... that look for inherited genetic markers linked to disease, and imaging tests that produce pictures of the inside of the body. These ... a risk factor. Risk factors for carotid artery disease include: age high blood pressure diabetes tobacco smoking high cholesterol coronary artery disease (CAD) obesity ...

  3. BILATERAL DUPLICATION OF RENAL ARTERIES

    OpenAIRE

    Prajkta A Thete; Mehera Bhoir; M.V.Ambiye

    2014-01-01

    Routine dissection of a male cadaver revealed the presence of bilateral double renal arteries. On the right side the accessory renal artery originated from the abdominal aorta just above the main renal artery. On the left side the accessory renal artery originated from the abdominal aorta about 1 cm above the main renal artery. Knowledge of the variations of renal vascular anatomy has importance in exploration and treatment of renal trauma, renal transplantation, renal artery embolization, su...

  4. ANOMALOUS PREVERTEBRAL COURSE OF THE LEFT VERTEBRAL ARTERY. Recorrido prevertebral anómalo de la arteria vertebral izquierda

    Directory of Open Access Journals (Sweden)

    Prakash B Billakanti

    2016-03-01

    Full Text Available La arteria vertebral es una de las arterias que irriga el cerebro. El conocimiento de la anatomía normal y las variantes de la arteria vertebral adquiere importancia en la práctica clínica y la radiología vascular. El origen anómalo de la arteria vertebral del arco de la aorta o cualquiera de las arterias del cuello ha sido reportado por muchos autores. En este informe se presenta una variación del curso prevertebral de la arteria vertebral izquierda. La arteria vertebral tenía su origen habitual en la arteria subclavia con un largo curso prevertebral y entraba en el foramen transversarium de la vértebra CII. El origen y recorrido de la arteria vertebral en el lado derecho fue normal. Clínicamente es importante conocer el origen y curso del segmento prevertebral de la arteria vertebral y las posibles variaciones. El presente informe debería ser de interés para el médico vascular con respecto a las variaciones en el cuello y región torácica, y puede dar idea para dilucidar el mecanismo de desarrollo de la angiogénesis. Vertebral artery is one of the arteries supplying the brain. Knowledge of the normal and variant anatomy of the vertebral artery assumes importance in clinical practice and vascular radiology. Anomalous origins of the vertebral artery from the arch of the aorta or any one of the arteries of the neck have been reported by several authors. In this report a variation of the prevertebral course of the left vertebral artery is being presented. The Vertebral artery had usual origin from the subclavian artery and had a longer prevertebral course to enter the foramen transversarium of the CII vertebra. The origin and course of the vertebral artery on the right side was normal. It is clinically important to know the origin and course of the prevertebral segment of the vertebral artery and possible variations. The present report should be of interest for clinicians with regard to vascular variations in the neck and thoracic

  5. Coronary Artery Bypass

    Directory of Open Access Journals (Sweden)

    Kadri Ceberut

    2011-01-01

    Full Text Available Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.

  6. Presentation of Anatomical Variations Using the Aurasma Mobile App.

    Science.gov (United States)

    Hong, Trudy; Bézard, Georg; Lozanoff, Beth K; Labrash, Steven; Lozanoff, Scott

    2015-09-01

    Knowledge of anatomical variations is critical to avoid clinical complications and it enables an understanding of morphogenetic mechanisms. Depictions are comprised of photographs or illustrations often limiting appreciation of three-dimensional (3D) spatial relationships. The purpose of this study is to describe an approach for presenting anatomical variations utilizing video clips emphasizing 3D anatomical relationships delivered on personal electronic devices. An aberrant right subclavian artery (ARSA) was an incidental finding in a routine dissection of an 89-year-old man cadaver during a medical student instructional laboratory. The specimen was photographed and physical measurements were recorded. Three-dimensional models were lofted and rendered with Maya software and converted as Quicktime animations. Photographs of the first frame of the animations were recorded and registered with Aurasma Mobile App software (www.aurasma.com). Resulting animations were viewed on mobile devices. The ARSA model can be manipulated on the mobile device enabling the student to view and appreciate spatial relationships. Model elements can be de-constructed to provide even greater spatial resolution of anatomical relationships. Animations provide a useful approach for visualizing anatomical variations. Future work will be directed at creating a library of variants and underlying mechanism of formation for presentation through the Aurasma application.

  7. Anatomy of renal arterial supply.

    Science.gov (United States)

    Khamanarong, K; Prachaney, P; Utraravichien, A; Tong-Un, T; Sripaoraya, K

    2004-05-01

    A thorough knowledge of the variations of the renal artery has grown in importance with the increasing numbers of renal transplants, vascular reconstructions, and various surgical and radiologic techniques. The literature indicates that multiple renal arteries are found in 9- 76% of cadavers. The purpose of this study is to establish the incidence and characteristics of variations of renal arteries in Thais. A total of 267 Thai cadavers were dissected in the anatomy laboratory. The anatomical findings included: a single hilar artery in 82% of cases; double renal arteries in 17% of cases (one hilar artery with an upper polar artery occurred in 7%; two hilar arteries in 7%, and one hilar artery combined with one lower polar artery in 3%); and triple renal arteries occurred in 1% (two hilar arteries with one upper polar artery in 0.4% and two hilar arteries with one lower polar artery in 0.6%). In preparation for interventions, such as living renal donation, vascular reconstruction, renovascular hypertension, or radical nephrectomy, the results indicate that preoperative renal imaging is necessary and that operative techniques with attention to multiple renal arteries should be considered. Copyright 2004 Wiley-Liss, Inc.

  8. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... don't help, you may need coronary artery bypass surgery. The surgery creates a new path for ... narrowed area or blockage. This allows blood to bypass (get around) the blockage. Sometimes people need more ...

  9. Pulmonary Arterial Hypertension

    Science.gov (United States)

    Pulmonary Arterial Hypertension What Is Pulmonary Hypertension? To understand pulmonary hypertension (PH) it helps to understand how blood ows throughout your body. While the heart is one organ, it ...

  10. Coronary artery spasm

    Science.gov (United States)

    ... blocker or a long-acting nitrate long-term. Beta-blockers are another type of medicine that is used with other coronary artery problems. However, beta-blockers may make this problem worse. They should be ...

  11. Peripheral Arterial Disease

    Science.gov (United States)

    Peripheral arterial disease (PAD) happens when there is a narrowing of the blood vessels outside of your heart. The cause of ... smoking. Other risk factors include older age and diseases like diabetes, high blood cholesterol, high blood pressure, ...

  12. Arterial bypass leg - slideshow

    Science.gov (United States)

    ... presentations/100155.htm Arterial bypass leg - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  13. Mesenteric artery ischemia

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/001156.htm Mesenteric artery ischemia To use the sharing features on this page, ... be removed. Outlook (Prognosis) The outlook for chronic mesenteric ischemia is good after a successful surgery. However, it ...

  14. Carotid Artery Disease

    Science.gov (United States)

    ... heart. It also helps you lose weight, control diabetes and reduce stress. Limit alcohol. Control chronic conditions. Managing conditions such as diabetes and high blood pressure helps protect your arteries. ...

  15. A middle mesenteric artery

    OpenAIRE

    Milnerowicz, Stanislaw; Milnerowicz, Artur; Taboła, Renata

    2012-01-01

    In 114 cases of the transverse colon isolated from cadavers (50 male, 64 female), anatomical examinations of the arterial system of the colon were performed. Arteriograms were obtained after dissecting and contrasting the colonic vessels with Mixobar contrast. In one case, on arteriography of the colon with its mesentery isolated from a 55-year-old male cadaver, a rare anatomical variant was found. The third mesenteric artery originated directly from the aorta—halfway between the superior and...

  16. Coronary artery fistulas

    Directory of Open Access Journals (Sweden)

    V. M. Subbotin

    2015-01-01

    Full Text Available Coronary artery fistulas are classified as abnormalities of termination and referred to as major congenital anomalies. Most coronary artery fistulas are small, unaccompanied by clinical symptoms, and diagnosed by echocardiography or coronarography performed for an unrelated cause. Such fistulas usually do not cause any complications and can spontaneously resolve. However, larger fistulas are usually >3 tones the size of a normal caliber of a coronary artery and may give rise to clinical symptoms in these cases. The clinical symptoms of coronary artery fistulas may mimic those of various heart diseases depending on which chamber a fistula drains into. Most fistulas are congenital. Congenital coronary artery fistulas may occur as an isolated malformation or be concurrent with other cardiac anomalies, more frequently with critical pulmonary stenosis or atresia with an intact interventricular septum and pulmonary stenoses, Fallot's tetralogy, aortic coarctation, and left heart hypoplasia. When choosing a treatment modality, one should take into account the number of fistula communications, the feeding vessel, localization of drainage, degree of myocardial damage, and hemodynamic relevance of the shunt caused by the presence of a fistula. The goal of treatment is to obliterate a fistula by preserving normal coronary blood flow. The risk for persisting fistula should be balanced with the potential risk of complications related to a procedure of coronarography and fistula occlusion. Percutaneous transcatheter coil occlusion of coronary artery fistulas is the modality of choice in children with the suitable anatomy of fistula communications and without concomitant congenital heart diseases.

  17. Upper limb artery segmental occlusions due to chronic use of ergotamine combined with itraconazole, treated by thrombolysis

    Directory of Open Access Journals (Sweden)

    Nodari Franco

    2011-08-01

    Full Text Available Abstract Background The ergotamine tartrate associated with certain categories of drugs can lead to critical ischemia of the extremities. Discontinuation of taking ergotamine is usually sufficient for the total regression of ischemia, but in some cases it could be necessary thrombolytic and anticoagulant therapy to avoid amputation. Case report A woman of 62 years presented with a severe pain left forearm appeared 10 days ago, with a worsening trend. The same symptoms appeared after 5 days also in the right forearm. Physical examination showed the right arm slightly hypothermic, with radial reduced pulse in presence of reduced sensitivity. The left arm was frankly hypothermic, pulse less on radial and with an ulnar humeral reduced pulse, associated to a decreased sensitivity and motility. Clinical history shows a chronic headache for which the patient took a daily basis for years Cafergot suppository (equivalent to 3.2 mg of ergotamine. From about ten days had begun therapy with itraconazole for vaginal candidiasis. The Color-Doppler ultrasound shown arterial thrombosis of the upper limbs (humeral and radial bilateral, with minimal residual flow to the right and no signal on the humeral and radial left artery. Results Angiography revealed progressive reduction in size of the axillary artery and right humeral artery stenosis with right segmental occlusions and multiple hypertrophic collateral circulations at the elbow joint. At the level of the right forearm was recognizable only the radial artery, decreased in size. Does not recognize the ulnar, interosseous artery was thin. To the left showed progressive reduction in size of the distal subclavian and humeral artery, determined by multiple segmental steno-occlusion with collateral vessels serving only a thin hypotrophic interosseous artery. Arteriographic findings were compatible with systemic drug-induced disease. The immediate implementation of thrombolysis, continued for 26 hours, with

  18. Analysis of the population at high risk of stroke detected with carotid artery ultrasonography in Tianjin urban communities

    Directory of Open Access Journals (Sweden)

    Wei YUE

    2015-04-01

    Full Text Available Objective To investigate the features of carotid atherosclerosis in a population at high risk of stroke in urban communities of Tianjin, so as to provide inspiration for carotid ultrasonography to play a greater role in the prevention and control of stroke.  Methods A total of 956 residents at high risk of stroke were selected from 4 urban communities in Tianjin using cluster random sampling method. Doppler ultrasound screening was performed in bilateral common carotid artery (CCA, internal carotid artery (ICA, external carotid artery (ECA, vertebral artery (VA, subclavian artery (SCA and innominate artery of the population. The intima-media thickness (IMT, atherosclerotic plaque formation and its location and size, vascular stenosis or occlusion, and flow spectrum were detected. The results and features of carotid ultrasound screening were analyzed and compared among different gender and age groups.  Results 1 The detection rate of carotid atherosclerosis was 71.55% (684/956, and the detection rate in males was significantly higher than that in females (79.08% vs 65.87%; χ2 = 20.067, P = 0.000. 2 Among the population with carotid atherosclerosis, the most common manifestation was the formation of atherosclerotic plaques (81.58%, 558/684, secondly intima-media thickening (13.01%, 89/684, followed by moderate to severe stenosis or occlusion (5.41%, 37/684. The proportion of intima-media thickening in males was lower than that in females (7.08% vs 18.38%; χ2 = 19.269, P = 0.000. The proportion of carotid atherosclerotic plaque formation in males was higher than that in females (86.46% vs 77.16%; χ2 = 9.824, P = 0.002. The median rating of carotid atherosclerosis was 1.79, with males higher than females [1.98 (0.70, 3.26 vs 1.52 (0.20, 2.84; Z = 2.304, P = 0.042]. The site of plaque formation was most commonly located in carotid bulb (36.61%, secondly SCA (22.18%. Of the type of carotid stenosis, ICA stenosis was detected in 30 cases, VA

  19. Endovascular uterine artery interventions

    Directory of Open Access Journals (Sweden)

    Chandan J Das

    2017-01-01

    Full Text Available Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs, as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH, placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes.

  20. Endovascular uterine artery interventions

    Science.gov (United States)

    Das, Chandan J; Rathinam, Deepak; Manchanda, Smita; Srivastava, D N

    2017-01-01

    Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs), as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE) may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH), placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes. PMID:29379246

  1. Ruptured jejunal artery aneurysm

    Science.gov (United States)

    Costa, Sílvia; Costa, Alexandre; Pereira, Tiago; Maciel, Jorge

    2013-01-01

    Visceral artery aneurysms (VAAs), unlike aortic aneurysms, are very rare, but are also a potentially lethal vascular disease. Jejunal artery aneurysms only account for less than 3% of VAAs, but have a 30% risk of rupture, with 20% death rate, presenting with only few and vague symptoms. We report the case of a 76-year-old man presenting at the emergency department (ED) with a crampy epigastric pain and vomiting. An ultrasound performed diagnosed free abdominal fluid and immediate CT scan diagnosed jejunal artery aneurysm spontaneously rupturing, followed by hypovolaemic shock. Emergent surgery was undertaken, and aneurysmectomy, followed by partial enterectomy with primary anastomosis were performed, because of segmentary jejunal ischaemia. The patient's recovery was unremarkable. High level of suspicion, rapid diagnosis capability and prompt surgical or endovascular intervention, as well as an effective teamwork in the ED are critical to avoid the devastating consequences of ruptured VAAs. PMID:23771962

  2. Superficial Femoral Artery Intervention by Single Transpedal Arterial Access.

    Science.gov (United States)

    Amoroso, Nicholas S; Shah, Sooraj; Liou, Michael; Ratcliffe, Justin; Lala, Moinakhtar; Diwan, Ravi; Huang, Yili; Rosero, Hugo; Coppola, John; Bertrand, Olivier F; Kwan, Tak W

    2015-11-01

    Atherosclerotic disease of the superficial femoral artery (SFA) is frequently seen and can be treated with percutaneous interventions, traditionally via femoral artery access. There are limited reports of transpedal artery access for peripheral artery interventions, but none to date describing routine primary transpedal artery approach for SFA stenting. In this preliminary study, we report 4 patients who underwent successful endovascular SFA stenting using a single transpedal artery access via a new ultra-low profile 6 Fr sheath (Glidesheath Slender; Terumo Corporation). All patients underwent successful SFA stenting without complication. Procedure time varied from 51 to 72 minutes. The mean contrast amount used was 56 mL; mean fluoroscopy time was 21 minutes; mean radiation dose was 91 mGy. At 1-month follow-up, duplex ultrasonography showed that all pedal arteries had remained patent. Transpedal artery approach as a primary approach to SFA stenting appears feasible and safe. Comparative trials with standard percutaneous femoral approach are warranted.

  3. Isolated celiac artery dissection.

    Science.gov (United States)

    DiMusto, Paul D; Oberdoerster, Molly M; Criado, Enrique

    2015-04-01

    Spontaneous celiac artery dissection is rare, and its natural history is not well studied. The objective of this study was to review our experience with the evaluation and management of this condition. During the last 8 years, 19 patients (14 men, five women) presented with the diagnosis of spontaneous celiac artery dissection. Each patient's clinical course was retrospectively reviewed, and patients were contacted for assessment of current symptoms. All patients had computed tomography scans documenting a celiac artery dissection without concomitant aortic dissection. Ages ranged from 39 to 76 years. Seven patients presented with abdominal pain, and 12 were diagnosed incidentally. All patients were initially treated with observation because none had threatened end organs. Patients presenting with aspirin or clopidogrel therapy were continued on these medications, but no patients were prescribed any medications due to their dissection. Three patients continued to have abdominal pain and eventually underwent celiac artery stenting. Pain improved after the intervention in all three. One patient with aneurysmal degeneration of the celiac artery underwent surgical repair. No other patients required intervention. Eighteen patients had follow-up within a year of data collection in the clinic or over the phone. The average time from the initial diagnosis to follow-up for the entire cohort was 46 months. None had abdominal or back pain related to the celiac dissection, had lost weight, or had to change their eating habits. Celiac artery dissection can be safely managed initially with observation. If abdominal pain is persistent, endovascular stenting may stabilize or improve the pain, and surgical reconstruction can be done for aneurysmal degeneration or occlusion, both unusual events. Long-term anticoagulation does not appear necessary in these patients. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  4. Popliteal Artery Entrapment Syndrome

    DEFF Research Database (Denmark)

    Altintas, Ümit; Helgstrand, Ulf Johan Vilhelm; Hansen, Marc A

    2013-01-01

    The purpose of this study was to report our experience with popliteal artery entrapment syndrome (PAES) with special emphasis on the applicability of duplex ultrasound scanning (DUS) when diagnosing PAES. In addition to examining the correlation between DUS and intraoperative findings in symptoma......The purpose of this study was to report our experience with popliteal artery entrapment syndrome (PAES) with special emphasis on the applicability of duplex ultrasound scanning (DUS) when diagnosing PAES. In addition to examining the correlation between DUS and intraoperative findings...

  5. Carotid artery stenting; Karotisangioplastie

    Energy Technology Data Exchange (ETDEWEB)

    Fiehler, Jens [Universitaetsklinikum Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum

    2009-09-15

    An ipsilateral stenosis of the internal carotid artery is found in 10 - 15 % of all ischemic strokes and indicates an increased risk of a second stroke. Carotid artery stenting (CAS) is a therapy that is established for many years. CAS reveals complication rates and long-term efficacy comparable to carotid endarterectomy (TEA). Especially younger patients seem to benefit from CAS. Abilities and experiences of the therapist and the choice of the techniques used are critical for patient safety. The efficacy of CAS for treatment of asymptomatic carotid stenosis is probable but still unproven in prospective-randomized trial. (orig.)

  6. Location of the internal carotid artery and ophthalmic artery ...

    African Journals Online (AJOL)

    Yasin Hamarat

    2017-10-06

    Oct 6, 2017 ... There are some published results of OA anatomical studies [18,20-22]. .... right eye) and the depth of intracranial segment of ophthal- mic artery ... internal carotid artery and segments of ophthalmic artery in high tension glaucoma patients. No. of glaucoma patients. Eye. ICA edge, mm. IOA, mm. EOA, mm.

  7. Pulmonary arterial hypertension in children after neonatal arterial switch operation

    NARCIS (Netherlands)

    Zijlstra, Willemijn MH; Elmasry, Ola; Pepplinkhuizen, Shari; Ivy, D Dunbar; Bonnet, Damien; Lévy, Marilyne; Gavilan, Jose Luis; Torrent-Vernetta, Alba; Mendoza, Alberto; Del Cerro, Maria Jesus; Moledina, Shahin; Berger, Rolf M. F.

    OBJECTIVES: Paediatric pulmonary arterial hypertension (PAH) after neonatal arterial switch operation (ASO) for transposition of the great arteries (TGA) is a clinically recognised entity with an estimated incidence of 0.6%-1.0%. Nevertheless, a clinical characterisation is lacking. We present an

  8. A rare case of Cystic artery arising from Gastroduodenal artery ...

    African Journals Online (AJOL)

    An uncommon anatomical variation in the origin and course of cystic artery was found during human cadaveric dissection in our laboratory. A blood vessel was seen arising from the gastroduodenal artery about 1 cm distal to its origin from the common hepatic artery. The vessel when traced towards its termination was found ...

  9. Validation of brachial artery pressure reconstruction from finger arterial pressure

    NARCIS (Netherlands)

    Guelen, Ilja; Westerhof, Berend E.; van der Sar, Gertrude L.; van Montfrans, Gert A.; Kiemeneij, Ferdinand; Wesseling, Karel H.; Bos, Willem Jan W.

    2008-01-01

    Objective Measurement of finger artery pressure with Finapres offers noninvasive continuous blood pressure, which, however, differs from brachial artery pressure. Generalized waveform filtering and level correction may convert the finger artery pressure waveform to a brachial waveform. An upper-arm

  10. Tratamento endovascular de lesões arteriais traumáticas Endovascular management of traumatic arterial injuries

    Directory of Open Access Journals (Sweden)

    Ruy Fernandes e Fernandes

    2011-03-01

    . Todos os procedimentos foram realizados com sucesso. Não se verificou mortalidade. No doente com RAS houve necessidade de cirurgia de descorticação pulmonar esquerda, por hematoma organizado, e o doente com FAV foi submetido com sucesso a nova embolização com coils por recorrência precoce de hematúria. Conclusão: O tratamento endovascular é, em casos seleccionados, uma alternativa válida e menos invasiva de lesões traumáticas complexas em regiões anatómicas de difícil acesso e morbi-mortalidade cirúrgica elevada.Introduction: Traumatic vascular injuries are present in less than 10% of patients with multi-organ trauma and, in western countries, the incidence of iatrogenic vascular lesions has been increasing. Conventional surgery in the approach of these lesions usually requires extended surgical exposure, presents increased technical challenges and has high morbidity and mortality. Recently, several authors have described the successful management of traumatic injuries with endovascular techniques with diminished surgical risk. Endovascular surgery has also been increasingly applied in management of chronic traumatic injuries like chronic post-traumatic thoracic aneurysms with significant improved outcomes. The authors present clinical cases with several acute and chronic traumatic vascular injuries treated with endovascular techniques, Clinical reports: Seven patients (21-77 years with traumatic vascular injuries were treated. Four patients presented acute injuries: 1 case of traumatic aortic injury in a patient with multi-organ trauma after automobile crash; 1 case of iatrogenic subclavian artery rupture after inadvertent subclavian artery catheterization during attempted venous central access ; 1 case of iatrogenic renal artery rupture during renal angioplasty and stenting; 1 case of iatrogenic intra-renal arterio-venous fistula (AVF after laparoscopic resection of a renal tumour. Three patients presented with chronic post-traumatic thoracic aneurysms

  11. Screening for Carotid Artery Stenosis

    Science.gov (United States)

    Understanding Task Force Recommendations Screening for Carotid Artery Stenosis The U.S. Preventive Services Task Force (Task Force) ... final recommendation statement on Screening for Carotid Artery Stenosis. This final recommendation statement applies to adults who ...

  12. Pharmacological modulation of arterial stiffness.

    LENUS (Irish Health Repository)

    Boutouyrie, Pierre

    2011-09-10

    Arterial stiffness has emerged as an important marker of cardiovascular risk in various populations and reflects the cumulative effect of cardiovascular risk factors on large arteries, which in turn is modulated by genetic background. Arterial stiffness is determined by the composition of the arterial wall and the arrangement of these components, and can be studied in humans non-invasively. Age and distending pressure are two major factors influencing large artery stiffness. Change in arterial stiffness with drugs is an important endpoint in clinical trials, although evidence for arterial stiffness as a therapeutic target still needs to be confirmed. Drugs that independently affect arterial stiffness include antihypertensive drugs, mostly blockers of the renin-angiotensin-aldosterone system, hormone replacement therapy and some antidiabetic drugs such as glitazones. While the quest continues for \\'de-stiffening drugs\\

  13. Liver cirrhosis and arterial hypertension

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren

    2006-01-01

    blood pressure. This review considers the alterations in systemic hemodynamics in patients with cirrhosis in relation to essential hypertension and arterial hypertension of the renal origin. Subjects with arterial hypertension (essential, secondary) may become normotensive during the development...... of cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial hypertension. This most...

  14. Pulmonary artery sling: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Gil Hyun; Lee, Sun Wha; Cha, Sung Ho [Kyunghee University College of Medicine, Seoul (Korea, Republic of)

    1993-09-15

    Aberrant left-sided pulmonary artery(pulmonary artery sling) is an uncommon anomaly,which may cause significant respiratory abnormality. We report a case of pulmonary artery sling which is combined with persistent left superior vena cava and dextrocardia. This case were identified by esophagogram and CT and confirmed by MRI and angiography. We consider that MRI is a valuable new method for the diagnosis of aberrant left-sided pulmonary artery.

  15. Intracranial artery dissection

    NARCIS (Netherlands)

    Sikkema, T.; Uyttenboogaart, Maarten; Eshghi, O.; De Keyser, J.; Brouns, R.; van Dijk, J.M.C.; Luijckx, G. J.

    The aim of this narrative review is to evaluate the pathogenesis, clinical features, diagnosis, treatment and prognosis of intracranial artery dissection (IAD). IAD is a rare and often unrecognized cause of stroke or subarachnoid haemorrhage (SAH), especially in young adults. Two types of IAD can be

  16. Artery Bypass Grafting

    African Journals Online (AJOL)

    development of CABG without CPB as occurring in three stages. Figure 1: The early stage: Grafts were limited to ... This interest led to the development of techniques such as mini- mally invasive direct coronary artery surgery (MIDCAB), surgery ... Diazepam 0.1 rng/kg P0. Cyclimorph 0.lmg/kg IMI on call to theatre. Theatre ...

  17. Peripheral artery bypass - leg

    Science.gov (United States)

    ... 25638515 www.ncbi.nlm.nih.gov/pubmed/25638515 . White CJ. Endovascular treatment of peripheral artery disease. In: Creager MA, Beckman JA, Loscalzo J, eds. Vascular Medicine: A Companion to Braunwald's Heart Disease . 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 20. Review Date 1/31/2017 ...

  18. Pulmonary artery aneurysm

    African Journals Online (AJOL)

    Enrique

    2). An echocardiogram confirmed pulmonary valvular stenosis with post-stenotic dilatation and pul- monary artery aneurysm formation. The pulmonary valve pressure gradi- ent was > 28 mmHg. The patient set- tled on low-dose diuretic therapy, and following cardiothoracic surgical con- sultation it was decided that no surgi-.

  19. Blood Flow Velocity in Brachial and Subclavian Vessels Immediately After Compressive Procedures for Treatment of Postcancer Therapy Lymphedema in Breast Cancer: A Randomized Blind Clinical Trial.

    Science.gov (United States)

    Rezende, Monique Silva; Marsengo, Ana Luiza; de Jesus Guirro, Rinaldo Roberto; de Oliveira Guirro, Elaine Caldeira

    2017-03-01

    This study sought to evaluate the effect of elastic compression, functional compressive bandaging, and kinesiotherapy on blood flow of the upper limb with lymphedema secondary to the treatment of breast cancer. This was a randomized blind crossover clinical trial with a washout period of 7 days between treatments. We evaluated 20 women with a mean age of 66.85 years (standard deviation = 11.76), undergoing three types of therapeutic procedures randomly applied by lot: kinesiotherapy, functional compressive bandaging + kinesiotherapy (FCB), and elastic compression + kinesiotherapy (EC). Blood flow, including mean and maximum velocity, was assessed by Doppler ultrasound before and after the therapeutic procedure (immediately after, 15 minutes, and 30 minutes). We used two-way analysis of variance for repeated measures followed by Bonferroni's test, considering a significance level of 5%. The EC and FCB groups showed a significant increase in the mean velocity of blood flow in the axillary and brachial arteries and veins compared to the group that received only kinesiotherapy (p  0.05). Moreover, the EC and FCB groups showed greater increase in maximum velocity of blood flow in the brachial artery (p  0.05). Elastic compression and functional compressive bandaging combined with kinesiotherapy increased blood flow of upper limb lymphedema.

  20. Pediatric nonaortic arterial aneurysms.

    Science.gov (United States)

    Davis, Frank M; Eliason, Jonathan L; Ganesh, Santhi K; Blatt, Neal B; Stanley, James C; Coleman, Dawn M

    2016-02-01

    Pediatric arterial aneurysms are extremely uncommon. Indications for intervention remain poorly defined and treatments vary. The impetus for this study was to better define the contemporary surgical management of pediatric nonaortic arterial aneurysms. A retrospective analysis was conducted of 41 children with 61 aneurysms who underwent surgical treatment from 1983 to 2015 at the University of Michigan. Arteries affected included: renal (n = 26), femoral (n = 7), iliac (n = 7), superior mesenteric (n = 4), brachial (n = 3), carotid (n = 3), popliteal (n = 3), axillary (n = 2), celiac (n = 2), ulnar (n = 2), common hepatic (n = 1), and temporal (n = 1). Intracranial aneurysms and aortic aneurysms treated during the same time period were not included in this study. Primary outcomes analyzed were postoperative complications, mortality, and freedom from reintervention. The study included 27 boys and 14 girls, with a median age of 9.8 years (range, 2 months-18 years) and a weight of 31.0 kg (range, 3.8-71 kg). Multiple aneurysms existed in 14 children. Obvious factors that contributed to aneurysmal formation included: proximal juxta-aneurysmal stenoses (n = 14), trauma (n = 12), Kawasaki disease (n = 4), Ehlers-Danlos type IV syndrome (n = 1), and infection (n = 1). Preoperative diagnoses were established using arteriography (n = 23), magnetic resonance angiography (n = 6), computed tomographic arteriography (n = 5), or ultrasonography (n = 7), and confirmed during surgery. Indications for surgery included risk of expansion and rupture, potential thrombosis or embolization of aneurysmal thrombus, local soft tissue and nerve compression, and secondary hypertension in the case of renal artery aneurysms. Primary surgical techniques included: aneurysm resection with reanastomsis, reimplantation, or angioplastic closure (n = 16), interposition (n = 10) or bypass grafts (n = 2), ligation (n = 9), plication (n = 8), endovascular occlusion (n = 3), and nephrectomy (n = 4) in

  1. Caliber-Persistent Artery

    Directory of Open Access Journals (Sweden)

    Sabrina Araújo Pinho Costa

    2015-01-01

    Full Text Available Caliber-persistent artery (CPLA of the lip is a common vascular anomaly in which a main arterial branch extends to the surface of the mucous tissue with no reduction in its diameter. It usually manifests as pulsatile papule, is easily misdiagnosed, and is observed more frequently among older people, suggesting that its development may involve a degenerative process associated with aging; CPLA is also characterized by the loss of tone of the adjacent supporting connective tissue. Although the diagnosis is clinical, high-resolution Doppler ultrasound is a useful noninvasive tool for evaluating the lesion. This report describes the case of a 58-year-old male patient who complained of a lesion of the lower lip with bleeding and recurrent ulceration. The patient was successfully treated in our hospital after a diagnosis of CPLA and is currently undergoing a clinical outpatient follow-up with no complaints.

  2. Coronary Artery Anomalies in Animals

    Directory of Open Access Journals (Sweden)

    Brian A. Scansen

    2017-04-01

    Full Text Available Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.

  3. Management of iatrogenic pulmonary artery injury during pulmonary artery banding

    Directory of Open Access Journals (Sweden)

    Neeti Makhija

    2017-01-01

    Full Text Available Pulmonary Artery banding (PAB is limited to selected patients who cannot undergo primary repair due to complex anatomy, associated co-morbidities, as a part of staged univentricular palliation, and for preparing the left ventricle prior to an arterial switch operation. We report a catastrophic iatrogenic complication in which the pulmonary artery was injured during the PAB. We discuss its multi-pronged management.

  4. Management of Iatrogenic Pulmonary Artery Injury during Pulmonary Artery Banding

    Science.gov (United States)

    Makhija, Neeti; Aggarwal, Shivani; Talwar, Sachin; Ladha, Suruchi; Das, Deepanwita; Kiran, Usha

    2017-01-01

    Pulmonary Artery banding (PAB) is limited to selected patients who cannot undergo primary repair due to complex anatomy, associated co-morbidities, as a part of staged univentricular palliation, and for preparing the left ventricle prior to an arterial switch operation. We report a catastrophic iatrogenic complication in which the pulmonary artery was injured during the PAB. We discuss its multi-pronged management. PMID:28701613

  5. An Aberrant Artery Arising From Common Hepatic Artery

    Directory of Open Access Journals (Sweden)

    Surekha D. Jadhav

    2015-01-01

    Full Text Available Common hepatic artery is the branch of celiac trunk which is chief artery of the foregut. Branches of celiac trunk supply the gastrointestinal tract and its associated glands which are derived from foregut. Anatomy and variations of hepatic arterial system have become increasingly important due to increasing number of laparoscopic procedures, oncologic surgical interventions, and organ transplant cases. This case report describes a rare anatomical variation of an aberrant artery arising from common hepatic artery before the origin of gastroduodenal artery and proper hepatic artery.The aberrant artery traversed inferiorly and behind the body of the pancreas which divided into a right and left branches. The right branch ran behind the neck of the pancreas and it ended after giving few branches to head and body of pancreas. However, the left branch gave off branches to the proximal part of the jejunum. The presence of a branch arising directly from the common hepatic artery supplying the pancreas and jejunum is uncommon. Knowledge of such a rare variation is important not only for surgeons but also interventional radiologists and those studying anatomy

  6. Arterial responses during migraine headache

    DEFF Research Database (Denmark)

    Iversen, Helle Klingenberg; Nielsen, T H; Olesen, J

    1990-01-01

    The superficial temporal artery has been thought to be the main focus of pain during migraine attacks, but its diameter has never been measured directly. The use of a new, high-resolution ultrasound machine to measure arterial size in 25 migraine patients with unilateral head pain showed...... that the lumen was wider on the painful than on the non-painful side during a migraine attack. The diameters of both radial arteries and the temporal artery on the non-painful side were smaller during than between attacks. The generalised vasoconstriction was not shared by the temporal artery on the affected...... side, which suggests a local vasodilatory response. The findings suggest that cephalic arteries may play a role in migraine pathogenesis....

  7. Trombose venosa da veia subclávia após fratura de clavícula: relato de caso Subclavian vein thrombosis following fracture of the clavicle: case report

    Directory of Open Access Journals (Sweden)

    Bernardo Barcellos Terra

    2011-04-01

    Full Text Available A trombose venosa profunda no membro superior não é frequente na literatura ortopédica. Relatamos um caso de trombose da veia subclávia durante o tratamento conservador de fratura do terço médio da clavícula. O diagnóstico é difícil e requer um alto grau de suspeição e o tratamento pode prevenir um tromboembolismo fatal. Há raros casos descritos associados à fratura de clavícula.Deep vein thrombosis in the upper limbs is uncommon in the orthopedic literature. We report on a case of subclavian vein thrombosis that occurred during conservative treatment of a fracture in the middle third of the clavicle. This is difficult to diagnose and requires a high degree of suspicion. Treating it may prevent fatal thromboembolism. In some rare cases, it has been described in association with fractures of the clavicle.

  8. Understanding Arteries | Coronary Artery Disease | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... Artery If plaque continues to build up, the space inside the artery narrows. The artery walls become ... Plaque forms within the artery walls, narrowing the space inside and sometimes blocking blood flow. This process ...

  9. Resistant spontaneous coronary artery spasm.

    Science.gov (United States)

    Keskin, Kudret; Şahin, Alparslan; Yıldız, Süleyman Sezai; Aksan, Gökhan

    2015-10-01

    Coronary artery spasm should always be suspected in patients who have myocardial infarction with normal coronary arteries. This case report presents a 33-year-old woman with anterior myocardial infarction, whose coronary angiograph revealed normal left anterior descending artery and new onset complete occlusion of the circumflex artery at the time of the procedure. Nitroglycerin up to 800 mcg was administered without success. In such resistant cases, when all efforts fail, including prompt recognition and application of vasodilator drugs, retracting the catheter and waiting may play a role.

  10. Multiple Giant Coronary Artery Aneurysms

    Science.gov (United States)

    Usuku, Hiroki; Kojima, Sunao; Kuyama, Naoto; Hanatani, Shinsuke; Araki, Satoshi; Tsujita, Kenichi; Tsunoda, Ryusuke; Fukui, Toshihiro; Hokimoto, Seiji

    2017-01-01

    A 74-year-old man was admitted to our hospital with chest pain and dyspnea associated with ST elevation in leads II, III and aVF. An echocardiogram showed an enlarged mass lesion measuring nearly 80 mm. Coronary angiography showed two giant coronary artery aneurysms (CAAs) in the right coronary artery (RCA). CAAs were also seen in the left main trunk and left anterior descending artery. Computed tomography showed the CAA in the RCA was ruptured into the right atrium. We therefore diagnosed this patient with multiple CAAs, myocardial infarction and coronary artery rupture. He underwent successful surgical excision and coronary bypass surgery. PMID:28768966

  11. [Single umbilical artery (SUA)].

    Science.gov (United States)

    Staribratova, D; Belovezhdov, V; Milchev, N; Batashki, I; Apiosjan, Zh

    2010-01-01

    Single umbilical artery (SUA) is the most common abnormality of the umbilical cord. It is associated with an increased incidence of atresia of hollow organs, renal abnormalities, limb reduction defects and spontaneous abortions. The aim of our study is to establish the association of SUA with types of malformations and the corresponding pathology of pregnancy and parturition. Although our investigation is in proof of the association of SUA with anomalies of GIT, CCS and CNS, most of our cases exhibit circulatory disturbances leading to pathology of pregnancy and delivery.

  12. Anomalous left the pulmonary dilemma coronary artery artery from a ...

    African Journals Online (AJOL)

    a continuous murmur associated with angina-like attacks in older patients. Autopsy on these patients reveals a grossly dilated left coronary artery with viable anastomoses between the two coro- nary arteries. Finalll' sudden death is reported in 30% of adults with this anomaly.4, ,10 Characteristically, autopsy shows a large.

  13. Arterial occlusion to treat basilar artery dissecting aneurysm

    NARCIS (Netherlands)

    Cui, Qing Ke; Liu, Wei Dong; Liu, Peng; Li, Xue Yuan; Zhang, Lian Qun; Ma, Long Jia; Ren, Yun Fei; Wu, Ya Ping; Wang, Zhi Gang

    2015-01-01

    Object: To explore the clinical feasibility of employing occlusion to treat basilar artery dissecting aneurysm. Methods: One patient, male and 46 years old, suffered transient numbness and weakness on the right limbs. Cerebral angiography indicated basilar artery dissecting aneurysm. The patient

  14. Anomalous left the pulmonary dilemma coronary artery artery from a ...

    African Journals Online (AJOL)

    ; 8: 787-80I. 6. Wilson CL, Dlabal PW, Holeyfield RW, Akins CW, Knauf DG. Anomalous origin of left coronary artery from pulmonary artery: case report and review of. lileralUre concerning teenagers and adults.J Thorac Cardicn'asc SlIrg 1977; ...

  15. Association between internal carotid artery dissection and arterial tortuosity

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca; Piga, Mario [Azienda Ospedaliero Universitaria (A.O.U.), Department of Radiology, Monserrato, Cagliari (Italy); Argiolas, Giovanni Maria; Siotto, Paolo [Azienda Ospedaliero Brotzu (A.O.B.), Department of Radiology, di Cagliari (Italy); Sumer, Suna; Wintermark, Max [Neuroradiology Division, Neuroradiology, UVA Department of Radiology, Charlottesville, VA (United States); Raz, Eytan [New York University School of Medicine, Department of Radiology, New York, NY (United States); Sapienza University of Rome, Department of Neurology and Psychiatry, Rome (Italy); Sanfilippo, Roberto; Montisci, Roberto [Azienda Ospedaliero Universitaria (A.O.U.), Department of Vascular Surgery, di Cagliari (Italy)

    2014-10-18

    Carotid artery dissection is an important cause of ischemic stroke in all age groups, particularly in young patients. The purpose of this work was to assess whether there is an association between the presence of an internal carotid artery dissection (ICAD) and the arterial tortuosity. This study considered 124 patients (72 males and 52 females; median age 57 years) with CT/MR diagnosis of ICAD of the internal carotid artery were considered in this multi-centric retrospective study. The arterial tortuosity was evaluated and, when present, was categorized as elongation, kinking, or coiling. For each patient, both the right and left sides were considered for a total number of 248 arteries in order to have the same number of cases and controls. Fisher's exact test was applied to test the association between elongation, kinking, coiling, dissection, and the side affected by CAD. Fisher's exact test showed a statistically significant association between the ICAD and kinking (p = 0.0089) and coiling (p = 0.0251) whereas no statistically significant difference was found with arterial vessel elongation (p = 0.444). ICAD was more often seen on the left side compared to the right (p = 0.0001). These results were confirmed using both carotid arteries of the same patient as dependent parameter with p = 0.0012, 0.0129, and 0.3323 for kinking, coiling, and elongation, respectively. The presence of kinking and coiling is associated with ICAD. (orig.)

  16. Size and blood flow of central and peripheral arteries in highly trained able-bodied and disabled athletes.

    Science.gov (United States)

    Huonker, M; Schmid, A; Schmidt-Trucksass, A; Grathwohl, D; Keul, J

    2003-08-01

    In a cross-sectional study, central and peripheral arteries were investigated noninvasively in high-performance athletes and in untrained subjects. The diastolic inner vessel diameter (D) of the thoracic and abdominal aorta, the subclavian artery (Sub), and common femoral artery (Fem) were determined by duplex sonography in 18 able-bodied professional tennis players, 34 able-bodied elite road cyclist athletes, 26 athletes with paraplegia, 17 below-knee amputated athletes, and 30 able-bodied, untrained subjects. The vessel cross-sectional areas (CSA) were set in relation to body surface area (BSA), and the cross-section index (CS-index = CSA/BSA) was calculated. Volumetric blood flow was determined in Sub and Fem via a pulsed-wave Doppler system and was set in relation to heart rate to calculate the stroke flow. A significantly increased D of Sub was found in the racket arm of able-bodied tennis players compared with the opposite arm (19%). Fem of able-bodied road cyclist athletes and of the intact limb in below-knee amputated athletes showed similar increases. D of Fem was lower in athletes with paraplegia (37%) and in below-knee amputated athletes proximal to the lesion (21%) compared with able-bodied, untrained subjects; CS-indexes were reduced 57 and 31%, respectively. Athletes with paraplegia demonstrated a larger D (19%) and a larger CS-index in Sub (54%) than able-bodied, untrained subjects. No significant differences in D and CS-indexes of the thoracic and abdominal aorta were found between any of the groups. The changes measured in Sub and Fem were associated with corresponding alterations in blood flow and stroke flow in all groups. The study suggests that the size and blood flow volume of the proximal limb arteries are adjusted to the metabolic needs of the corresponding extremity musculature and underscore the impact of exercise training or disuse on the structure and the function of the arterial system.

  17. Development of an Experimental and Digital Cardiovascular Arterial Model for Transient Hemodynamic and Postural Change Studies: "A Preliminary Framework Analysis".

    Science.gov (United States)

    Hewlin, Rodward L; Kizito, John P

    2017-11-09

    The ultimate goal of the present work is to aid in the development of tools to assist in the treatment of cardiovascular disease. Gaining an understanding of hemodynamic parameters for medical implants allow clinicians to have some patient-specific proposals for intervention planning. In the present work an experimental and digital computational fluid dynamics (CFD) arterial model consisting of a number of major arteries (aorta, carotid bifurcation, cranial, femoral, jejunal, and subclavian arteries) were fabricated to study: (1) the effects of local hemodynamics (flow parameters) on global hemodynamics (2) the effects of transition from bedrest to upright position (postural change) on hemodynamics, and (3) diffusion of dye (medical drug diffusion simulation) in the arterial system via experimental and numerical techniques. The experimental and digital arterial models used in the present study are the first 3-D systems reported in literature to incorporate the major arterial vessels that deliver blood from the heart to the cranial and femoral arteries. These models are also the first reported in literature to be used for flow parameter assessment via medical drug delivery and orthostatic postural change studies. The present work addresses the design of the experimental and digital arterial model in addition to the design of measuring tools used to measure hemodynamic parameters. The experimental and digital arterial model analyzed in the present study was developed from patient specific computed tomography angiography (CTA) scans and simplified geometric data. Segments such as the aorta (ascending and descending) and carotid bifurcation arteries of the experimental and digital arterial model was created from online available patient-specific CTA scan data provided by Charite' Clinical and Research Hospital. The cranial and coronary arteries were simplified arterial geometries developed from dimensional specification data used in previous work. For the patient

  18. Carotid artery stenosis -- self-care

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000717.htm Carotid artery stenosis - self-care To use the sharing features on ... feel their pulse under your jawline. Carotid artery stenosis occurs when the carotid arteries become narrowed or ...

  19. Genetics Home Reference: pulmonary arterial hypertension

    Science.gov (United States)

    ... Home Health Conditions Pulmonary arterial hypertension Pulmonary arterial hypertension Printable PDF Open All Close All Enable Javascript ... view the expand/collapse boxes. Description Pulmonary arterial hypertension is a progressive disorder characterized by abnormally high ...

  20. Capsaicin and arterial hypertensive crisis

    National Research Council Canada - National Science Library

    Patanè, Salvatore; Marte, Filippo; La Rosa, Felice Carmelo; La Rocca, Roberto

    2010-01-01

    ...] . A case has also been reported of an arterial hypertensive crisis in a patient with a large ingestion of peppers and chili peppers the day before [5] . We present a case of an arterial hypertensive crisis in a 19-year-old Italian man with an abundant ingestion of peppers and chili peppers the preceding day. On August 4, 2008, a 19-year-...

  1. Heart Attack Coronary Artery Disease

    Science.gov (United States)

    ... prevent or slow the progression of coronary artery disease. A heart-healthy diet, exercise, and other lifestyle choices are the basic steps to keeping your heart strong and healthy. Coronary artery disease begins when fatty deposits (plaques) containing cholesterol build ...

  2. Epigenetics and Peripheral Artery Disease.

    Science.gov (United States)

    Golledge, Jonathan; Biros, Erik; Bingley, John; Iyer, Vikram; Krishna, Smriti M

    2016-04-01

    The term epigenetics is usually used to describe inheritable changes in gene function which do not involve changes in the DNA sequence. These typically include non-coding RNAs, DNA methylation and histone modifications. Smoking and older age are recognised risk factors for peripheral artery diseases, such as occlusive lower limb artery disease and abdominal aortic aneurysm, and have been implicated in promoting epigenetic changes. This brief review describes studies that have associated epigenetic factors with peripheral artery diseases and investigations which have examined the effect of epigenetic modifications on the outcome of peripheral artery diseases in mouse models. Investigations have largely focused on microRNAs and have identified a number of circulating microRNAs associated with human peripheral artery diseases. Upregulating or antagonising a number of microRNAs has also been reported to limit aortic aneurysm development and hind limb ischemia in mouse models. The importance of DNA methylation and histone modifications in peripheral artery disease has been relatively little studied. Whether circulating microRNAs can be used to assist identification of patients with peripheral artery diseases and be modified in order to improve the outcome of peripheral artery disease will require further investigation.

  3. Arterial stiffness and cognitive impairment.

    Science.gov (United States)

    Li, Xiaoxuan; Lyu, Peiyuan; Ren, Yanyan; An, Jin; Dong, Yanhong

    2017-09-15

    Arterial stiffness is one of the earliest indicators of changes in vascular wall structure and function and may be assessed using various indicators, such as pulse-wave velocity (PWV), the cardio-ankle vascular index (CAVI), the ankle-brachial index (ABI), pulse pressure (PP), the augmentation index (AI), flow-mediated dilation (FMD), carotid intima media thickness (IMT) and arterial stiffness index-β. Arterial stiffness is generally considered an independent predictor of cardiovascular and cerebrovascular diseases. To date, a significant number of studies have focused on the relationship between arterial stiffness and cognitive impairment. To investigate the relationships between specific arterial stiffness parameters and cognitive impairment, elucidate the pathophysiological mechanisms underlying the relationship between arterial stiffness and cognitive impairment and determine how to interfere with arterial stiffness to prevent cognitive impairment, we searched PUBMED for studies regarding the relationship between arterial stiffness and cognitive impairment that were published from 2000 to 2017. We used the following key words in our search: "arterial stiffness and cognitive impairment" and "arterial stiffness and cognitive impairment mechanism". Studies involving human subjects older than 30years were included in the review, while irrelevant studies (i.e., studies involving subjects with comorbid kidney disease, diabetes and cardiac disease) were excluded from the review. We determined that arterial stiffness severity was positively correlated with cognitive impairment. Of the markers used to assess arterial stiffness, a higher PWV, CAVI, AI, IMT and index-β and a lower ABI and FMD were related to cognitive impairment. However, the relationship between PP and cognitive impairment remained controversial. The potential mechanisms linking arterial stiffness and cognitive impairment may be associated with arterial pulsatility, as greater arterial pulsatility

  4. Patent arterial duct

    Directory of Open Access Journals (Sweden)

    Martin Robin P

    2009-07-01

    Full Text Available Abstract Patent arterial duct (PAD is a congenital heart abnormality defined as persistent patency in term infants older than three months. Isolated PAD is found in around 1 in 2000 full term infants. A higher prevalence is found in preterm infants, especially those with low birth weight. The female to male ratio is 2:1. Most patients are asymptomatic when the duct is small. With a moderate-to-large duct, a characteristic continuous heart murmur (loudest in the left upper chest or infraclavicular area is typical. The precordium may be hyperactive and peripheral pulses are bounding with a wide pulse pressure. Tachycardia, exertional dyspnoea, laboured breathing, fatigue or poor growth are common. Large shunts may lead to failure to thrive, recurrent infection of the upper respiratory tract and congestive heart failure. In the majority of cases of PAD there is no identifiable cause. Persistence of the duct is associated with chromosomal aberrations, asphyxia at birth, birth at high altitude and congenital rubella. Occasional cases are associated with specific genetic defects (trisomy 21 and 18, and the Rubinstein-Taybi and CHARGE syndromes. Familial occurrence of PAD is uncommon and the usual mechanism of inheritance is considered to be polygenic with a recurrence risk of 3%. Rare families with isolated PAD have been described in which the mode of inheritance appears to be dominant or recessive. Familial incidence of PAD has also been linked to Char syndrome, familial thoracic aortic aneurysm/dissection associated with patent arterial duct, and familial patent arterial duct and bicuspid aortic valve associated with hand abnormalities. Diagnosis is based on clinical examination and confirmed with transthoracic echocardiography. Assessment of ductal blood flow can be made using colour flow mapping and pulsed wave Doppler. Antenatal diagnosis is not possible, as PAD is a normal structure during antenatal life. Conditions with signs and symptoms of

  5. Coronary Artery Disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh

    2017-01-01

    A family history of coronary artery disease (CAD) is an important risk factor for adverse coronary events, in particular if the disease has an early onset. The risk of CAD is influenced by genetic and environmental factors with a greater genetic contribution earlier in life. Through recent years......), and to characterize and quantify subclinical atherosclerosis in their relatives. Furthermore, the aim was to explore the impact of common genetic risk variants on the age of onset, familial clustering and disease severity. In study I, 143 patients with early- onset CAD were recruited from the Western Denmark Heart...... burden compared with late-onset CAD patients and healthy controls; however, the burden did not associate with familial clustering of CAD. Additionally, familial clustering seemed to be stronger associated with CAD disease severity than the polygenetic burden. Our findings emphasize the hereditary...

  6. Habitual exercise and arterial aging.

    Science.gov (United States)

    Seals, Douglas R; Desouza, Christopher A; Donato, Anthony J; Tanaka, Hirofumi

    2008-10-01

    Aging affects the function and structure of arteries and increases the risk of cardiovascular diseases (CVD). In healthy sedentary adults, aging is associated with increased stiffness (reduced compliance) of large elastic arteries; impaired vascular endothelial function, including reductions in endothelium-dependent dilation (EDD), release of tissue-type plasminogen activator (fibrinolytic capacity) and endothelial progenitor cell number and function; increased intima-media wall thickness (IMT); and peripheral vasoconstriction (decreased basal leg blood flow). Habitual physical activity/increased aerobic exercise capacity is associated with reduced risk of CVD. Compared with their sedentary peers, adults who regularly perform aerobic exercise demonstrate smaller or no age-associated increases in large elastic artery stiffness, reductions in vascular endothelial function, and increases in femoral artery IMT. A short-term, moderate-intensity aerobic exercise intervention (brisk daily walking for 12 wk) improves carotid artery compliance and can restore vascular endothelial function in previously sedentary middle-aged and older adults. Reduced oxidative stress may be an important mechanism contributing to these effects. Habitual resistance exercise increases (high-intensity) or does not affect (moderate-intensity) large elastic artery stiffness, and prevents/restores the age-associated reduction in basal leg blood flow independent of changes in leg fat-free mass. Habitual exercise favorably modulates several expressions of arterial aging, thus preserving vascular function and possibly reducing the risk of CVD.

  7. Endoscopic Radial Artery Harvest for Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Kuan-Ming Chiu

    2006-01-01

    Conclusion: Endoscopic harvest of the radial artery is technically demanding, but excellent results can be achieved. The endoscopic approach can provide suitable conduits in a less invasive way than the open harvest technique.

  8. Local intra-arterial fibrinolysis without arterial occlusion?

    Energy Technology Data Exchange (ETDEWEB)

    Schumacher, M.; Yin, L.; Klisch, J. [Section Neuroradiology, Univ. Hospital, Freiburg (Germany); Hetzel, A. [Dept. of Neurology, Univ. Hospital, Freiburg (Germany)

    1999-07-01

    Local intra-arterial fibrinolysis (LIF) is the best choice at present for treatment of acute vessel occlusion in the vertebrobasilar teritory and also, in selected cases, in the carotid territory. In almost all cases angiography demonstrates the site of occlusion exactly and gives information about collateral circulation. Contrary to this common approach, we report five patients with severe acute thromboembolic stroke in whom angiography revealed no occlusion of relevant arteries or their main branches. Under the hypothesis of persisting occlusion of perforating arteries to the brain stem we performed LIF in patients with a clinical basilar artery syndrome. Outcome in all but one of them was good following LIF. The clinical details are described and possible reasons discussed. (orig.)

  9. Peripheral arterial stenosis and coronary artery disease coincidence

    Directory of Open Access Journals (Sweden)

    Reza Ghasemi

    2014-12-01

    Full Text Available Atherosclerosis is a chronic slow-developing condition affecting medium-size and large blood vessels. It is the principal underlying pathology of coronary heart disease and stroke. In some countries, coronary artery disease (CAD is the cause of nearly half (48% of the deaths and, loss of productivity life. Peripheral arterial disease (PAD is defined as atherosclerosis in peripheral arteries instead of coronary arteries. CAD and PAD have same risk factors and underlying pathophysiological processes. Therefore, patient with CAD should be considered for PAD. Ankle brachial index (ABI, duplex sonography, and some other non-invasive techniques are recommended for PAD diagnosis in patients with the history of CAD. Pharmacotherapy, endovascular interventions, and surgical management could be chosen according to the patient’s situation. Cardiologists and general practitioners should consider PAD in a patient with CAD or DM as a strong correlated disease.      

  10. Embolisation of the splenic artery

    Energy Technology Data Exchange (ETDEWEB)

    Essler, G.; Duex, A.

    1982-09-01

    In bleeding of oesophageal varices with resistance to common treatment embolisation of the splenic artery causes depression of the portal hypertension by forty per cent. Thrombosis of the splenic or portal vein as in splenectomies are not to be expected. The splenic vein remains open for later spleno-renal anastomosis. By occlusion of the splenic artery we were successful in stopping oesophageal bleeding. In a patient with dominant hypersplenism in portal hypertension the severity of the syndrome decreased after embolisation of the splenic artery. Thrombocytes, leukocytes and gammaglobulin increased.

  11. Cerebellar arteries originating from the internal carotid artery: angiographic evaluation and embryologic explanations

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Young; Han, Moon Hee; Yu, In Gyu; Chang, Ki Hyun [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Kim, Eui Jong [Kyunghee Univ. College of Medicine, Seoul (Korea, Republic of); Kim, Dae Ho [Soonchunhyang Univ. College of Medicine, Asan(Korea, Republic of)

    1997-06-01

    To find and describe the cerebellar arteries arising from the internal carotid artery, explain them embryologically, and evaluate their clinical implication. To determine the point in the internal carotid artery from which the cereballar artery arose anomalously, consecutive angiographic studies performed in the last three years were reviewed. The distribution of such anomalous cerebellar arteries, the point in the internal carotid artery from which the anomalous vessels originated, and associated findings were analyzed. Five anomalous origins of cerebellar arteries arising arising directly from the internal carotid artery were found in five patients. Three anterior inferior cerebellar arteries (AICA) and one common trunk of an AICA and a posterior inferior cerebellar artery (PICA) were found to originate from the internal carotid artery at a point close to the origin of the primitive trigeminal artery. A PICA arose from an artery presenting a course similar to the proatlantal intersegmental artery. Intracranial aneurysms in two patients, Moyamoya disease in one, and facial arteriovenous malformation in one. In our series, AICAs supplied from the arteries considered to be persistent trigeminal artery variants were the most common type. A correlation between type of anomalous cerebellar artery and type of carotid-vertebrobasilar anastomosis may exist. Cerebellar arteries originating anomalously from the internal carotid artery seem to occur as a result of the persistence of carotid-vertebrobasilar anastomoses associated with incomplete fusion of the longitudinal neural arteries. An understanding of these anomalous cerebellar arteries may help prevent accidents during therapeutic embolization and surgical treatment, as well as misinterpretation.

  12. Access to the ophthalmic artery by retrograde approach through the posterior communicating artery for intra-arterial chemotherapy of retinoblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Pham, Chi-Tuan; Blanc, Raphael; Pistocchi, Silvia; Bartolini, Bruno; Piotin, Michel [Fondation Rothschild Hospital, Department of Interventional Neuroradiology, Paris (France); Lumbroso-Le Rouic, Livia [Institut Curie, Department of Ocular Oncology, Paris (France)

    2012-08-15

    Intra-arterial infusion of chemotherapy into the ophthalmic artery for treatment of retinoblastoma has been realized after catheterization of the internal carotid and temporary balloon occlusion beyond the orifice of the ophthalmic artery, or more recently after superselective canulation of the ophthalmic artery by a microcatheter. The superselective catheterization of the ophthalmic artery could be cumbersome because of the implantation of the ostium on the carotid siphon or because of the tortuosity of the carotid siphon. We report our experience of using a retrograde approach through the posterior communicating artery that allows a more direct angle of access to the origin of the ophthalmic artery. (orig.)

  13. Straight artery sign in extracranial carotid artery dissection.

    Science.gov (United States)

    Suwanwela, Nijasri C; Phanthumchinda, Kammant; Suwanwela, Nitaya

    2003-06-01

    Magnetic resonance imaging (MRI) has become generally accepted as a non-invasive method to provide the definitive diagnosis of cervicocerebral vessel dissection. The finding of an intramural hematoma on axial MR images is the characteristic sign of the disease. However, there has been no previous report of the characteristic magnetic resonance angiographic (MRA) findings. The authors retrospectively reviewed MRI and MRA findings of patients with spontaneous extracranial carotid dissection. The most striking finding on MRA was the straightness of the affected artery when compared to the non-affected side of the same patient. For quantitative measurement, "Carotid Straightness Index (CSI)" was developed to measure the straightness of the arteries and compared the indices of both extracranial internal carotid arteries in the same patient. The patients' age range was from 21-55 years (mean 38 years). There were 6 males and 3 females. All patients had the classical "Straight artery sign" on the MRA. The carotid straightness index was significantly higher in the affected artery when compared to the normal side of the same patient. The straight artery sign and the carotid straightness index can be very useful for early detection of the extracranial carotid dissection. It can be found in early stage disease or in less severe forms of carotid dissection where significant narrowing is not demonstrated.

  14. Giant coronary artery aneurysm after Takeuchi repair for anomalous left coronary artery from the pulmonary artery.

    Science.gov (United States)

    Dunlay, Shannon M; Bonnichsen, Crystal R; Dearani, Joseph A; Warnes, Carole A

    2014-01-01

    A 33-year-old woman with an anomalous left coronary artery arising from the pulmonary artery who had undergone Takeuchi repair at age 7 years presented for evaluation. The Takeuchi procedure creates an aortopulmonary window and an intrapulmonary tunnel that baffles the left coronary artery to the aorta. A mediastinal mass was identified as a giant aneurysm of the left coronary artery resulting in compression of the pulmonary artery and left upper pulmonary vein. The patient underwent open repair with patch closure at the aortic entrance of the left coronary Takeuchi repair and resection and evacuation of the aneurysm. A saphenous vein graft to the left anterior descending artery was performed. Postoperative echocardiography demonstrated normal left ventricular function. This is the first reported case of giant aneurysm formation after Takeuchi repair. The reported complications have included the development of pulmonary artery stenosis at the intrapulmonary baffle, baffle leak, decreased left ventricular function, and mitral regurgitation. In conclusion, late complications of the Takeuchi procedure are common, underscoring the importance of lifelong follow-up at a center with experience in treating coronary anomalies. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Coronary artery problems late after arterial switch operation for transposition of the great arteries.

    Science.gov (United States)

    Tsuda, Takeshi; Bhat, Abdul M; Robinson, Bradley W; Baffa, Jeanne M; Radtke, Wolfgang

    2015-01-01

    The incidence of late coronary artery abnormalities after arterial switch operation (ASO) for d-loop transposition of the great arteries may be underestimated. We retrospectively reviewed coronary artery morphology in 40 of 97 patients who survived the first year after ASO. Seven asymptomatic patients developed significant late coronary artery abnormalities. One patient died suddenly at home with severe left coronary artery (LCA) ostial stenosis at age 3.8 years. The second patient collapsed during exercise at age 9.6 years due to ventricular fibrillation and severe LCA ostial stenosis despite prior negative exercise stress test (EST) and myocardial perfusion imaging (MPI). The third patient was found to have moderate ostial stenosis of the LCA with negative EST and MPI. The fourth patient with exercise-induced ST-T depression and myocardial perfusion defect was shown to have complete LCA occlusion with collateral vessel formation. Three other patients had complete proximal obliteration of either of the coronary arteries with collateral supply. An additional 4 asymptomatic patients had trivial-mild narrowing of the LCA on routine selective coronary angiogram. Incidence of late coronary stenosis or occlusion was not infrequent after ASO (11.3%) and presented usually without preceding symptoms and often after negative non-invasive screening. We advocate routine coronary imaging in all patients after ASO before they participate in competitive sports.

  16. Therapeutic arterial embolisation in children

    Energy Technology Data Exchange (ETDEWEB)

    Legge, D.

    1984-05-01

    Arterial embolisation was performed in five paediatric patients. Indications were hypersplenism in two, gastrointestinal bleeding in two and treatment of an aneurysmal bone cyst in one. Embolisation provided definitive treatment in each case with no complications.

  17. Coronary artery anatomy and variants.

    Science.gov (United States)

    Malagò, Roberto; Pezzato, Andrea; Barbiani, Camilla; Alfonsi, Ugolino; Nicolì, Lisa; Caliari, Giuliana; Pozzi Mucelli, Roberto

    2011-12-01

    Variants and congenital anomalies of the coronary arteries are usually asymptomatic, but may present with severe chest pain or cardiac arrest. The introduction of multidetector CT coronary angiography (MDCT-CA) allows the detection of significant coronary artery stenosis. Improved performance with isotropic spatial resolution and higher temporal resolution provides a valid alternative to conventional coronary angiography (CCA) in many patients. MDCT-CA is now considered the ideal tool for three-dimensional visualization of the complex and tortuous anatomy of the coronary arteries. With multiplanar and volume-rendered reconstructions, MDCT-CA may even outperform CCA in determining the relative position of vessels, thus providing a better view of the coronary vascular anatomy. The purpose of this review is to describe the normal anatomy of the coronary arteries and their main variants based on MDCT-CA with appropriate reconstructions.

  18. Coronary artery anatomy and variants

    Energy Technology Data Exchange (ETDEWEB)

    Malago, Roberto; Pezzato, Andrea; Barbiani, Camilla; Alfonsi, Ugolino; Nicoli, Lisa; Caliari, Giuliana; Pozzi Mucelli, Roberto [Policlinico G.B. Rossi, University of Verona, Department of Radiology, Verona (Italy)

    2011-12-15

    Variants and congenital anomalies of the coronary arteries are usually asymptomatic, but may present with severe chest pain or cardiac arrest. The introduction of multidetector CT coronary angiography (MDCT-CA) allows the detection of significant coronary artery stenosis. Improved performance with isotropic spatial resolution and higher temporal resolution provides a valid alternative to conventional coronary angiography (CCA) in many patients. MDCT-CA is now considered the ideal tool for three-dimensional visualization of the complex and tortuous anatomy of the coronary arteries. With multiplanar and volume-rendered reconstructions, MDCT-CA may even outperform CCA in determining the relative position of vessels, thus providing a better view of the coronary vascular anatomy. The purpose of this review is to describe the normal anatomy of the coronary arteries and their main variants based on MDCT-CA with appropriate reconstructions. (orig.)

  19. Living with Carotid Artery Disease

    Science.gov (United States)

    ... arteries and highlights them on x-ray pictures. Magnetic Resonance Angiography Magnetic resonance angiography (MRA) uses a large magnet and ... symptoms start (do not drive yourself to the hospital). For more detailed information about the warning signs ...

  20. Liver cirrhosis and arterial hypertension

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren

    2006-01-01

    Characteristic findings in patients with cirrhosis are vasodilatation with low overall systemic vascular resistance, high arterial compliance, increased cardiac output, secondary activation of counter-regulatory systems (renin-angiotensin-aldosterone system, sympathetic nervous system, release of...

  1. Coronary artery balloon angioplasty - slideshow

    Science.gov (United States)

    ... and the right heart; the left coronary artery supplies the left heart. Review Date 6/6/2016 Updated by: Deepak Sudheendra, MD, RPVI, Assistant Professor of Interventional Radiology & Surgery at the University of Pennsylvania Perelman School ...

  2. Peripheral Artery Disease and Diabetes

    Science.gov (United States)

    ... Venous Thromboembolism Aortic Aneurysm More Peripheral Artery Disease & Diabetes Updated:Jan 26,2016 People with diabetes are ... life. This content was last reviewed January 2016. Diabetes • Home • About Diabetes • Why Diabetes Matters Introduction Cardiovascular ...

  3. Idiopathic arterial calcification in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Maya [Department of Paediatric Radiology, Red Cross Children' s Hospital, Cape Town (South Africa); Red Cross Children' s Hospital, School of Child and Adolescent Health, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town (South Africa); Andronikou, Savvas; Solomon, Rustum; Sinclair, Paul; McCulloch, Mignon [Department of Paediatric Radiology, Red Cross Children' s Hospital, Cape Town (South Africa)

    2004-08-01

    Idiopathic arterial calcification in infancy is usually fatal with death in early life and diagnosis at post mortem. This report describes a unique, late presentation with hypertension and cardiac failure in a child aged 33 months, found to have widespread arterial calcification at radiological imaging. The calcium-phosphate axis was normal and there was no other demonstrable cause for calcification. Additionally, the histological features of arterial calcification at renal biopsy paralleled the findings in infants with this disorder. The late presentation in this case is unusual and has not been previously reported. Ultrasound and CT are sensitive for calcification, and the disease should be suspected in children presenting with cardiac or respiratory manifestations and features of arterial calcification, where no metabolic cause is established. (orig.)

  4. Flow measurements in the major visceral arteries

    Energy Technology Data Exchange (ETDEWEB)

    Schroeder, J.; Gerhardt, P.; Terwey, B.; Krastel, A.

    1982-02-01

    Arterial flow was measured by the spill-over technique in 202 coeliac arteries and 158 superior mesenteric arteries during the course of visceral angiography in 250 patients. In the coeliac artery a mean value of 15.8 +- 4.3 ml/sec was obtained, flow in the super mesenteric artery was significantly less at 12.1 +- 3.4 ml/sec. The wide variation from 4 to 26 ml/sec in the coeliac artery was remarkable, as well as flows from six to 20 ml/sec in the superior mesenteric artery.

  5. Aberrant ovarian artery arising from the common Iliac artery: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Won Kyung [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of); Yang, Seung Boo; Lee, Jae Myeong [Dept. of Radiology, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi (Korea, Republic of); Goo, Dong Erk; Kim, Yong Jae; Chang, Yun Woo [Dept. of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul (Korea, Republic of)

    2013-01-15

    A 46-year-old Vietnamese woman received embolization therapy in order to control postpartum hemorrhage. Angiography revealed an aberrant ovarian artery arising from the right common iliac artery. Superselective catheterization and subsequent embolization of the aberrant ovarian artery and bilateral uterine arteries were performed. Precise knowledge of the anatomic variations of the ovarian artery is important for successful embolization.

  6. Arterial compression during overhead throwing: a risk for arterial injury?

    Science.gov (United States)

    Stapleton, Claire H; Elias, Jade; Green, Danny J; Cable, N Tim; George, Keith P

    2010-08-01

    Case studies reporting aneurysm formation in the axillary artery have been described in overhead throwing athletes, possibly due to repetitive arterial compression by the humeral head that has been transiently observed during sonographic diagnostic arm manoeuvres. Whether compression negatively alters arterial health has not been investigated and was the focus of this study. The throwing arm of elite overhead athletes was screened for inducible axillary artery compression. Compressors (COMP, n = 11, mean age: 20 (SD: 2) year, 7 male, 4 female) were age and sex matched with noncompressing (NONCOMP) athlete controls. Four indices of arterial health (flow mediated dilation [FMD], conduit artery vasodilatory capacity [CADC], glyceryl-trinitrate [GTN]-induced vasodilation and intima-media thickness [IMT]) were assessed with high-resolution ultrasound at the brachial and the axillary, artery. No significant between-group differences were observed at the brachial, or axillary, artery for FMD (brachial: COMP: mean (SD) 6.2 (3.1)%, NONCOMP: 6.1 (3.5)%, p = 0.967, axillary: COMP: 8.0 (5.5)%, NONCOMP: 9.0 (3.6)%, p = 0.602), CADC (brachial: COMP: 10.4 (3.4)%, NONCOMP: 10.4 (5.4)%, p = 0.999, axillary: COMP: 9.6 (4.2)%, NONCOMP: 8.5 (3.2)%, p = 0.492), GTN-induced vasodilation (brachial: COMP: 17.9 (5.1)%, NONCOMP:14.1 (7.2)%, p = 0.173, axillary: COMP: 9.5 (4.3)%, NONCOMP: 7.7 (3.1)%, p = 0.302) or IMT (brachial: p = 0.084, axillary: p = 0.581). These results suggest that transient arterial compression, observed during diagnostic arm manoeuvres in overhead throwing athletes, is not associated with abnormal indices of artery function or structure and that other mechanisms must be responsible for the published cases of aneurysm formation in elite athletes performing overhead throwing actions. Copyright 2010 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  7. Habitual exercise and arterial aging

    OpenAIRE

    Seals, Douglas R.; DeSouza, Christopher A.; Donato, Anthony J.; Tanaka, Hirofumi

    2008-01-01

    Aging affects the function and structure of arteries and increases the risk of cardiovascular diseases (CVD). In healthy sedentary adults, aging is associated with increased stiffness (reduced compliance) of large elastic arteries; impaired vascular endothelial function, including reductions in endothelium-dependent dilation (EDD), release of tissue-type plasminogen activator (fibrinolytic capacity) and endothelial progenitor cell number and function; increased intima-media wall thickness (IM...

  8. Arterial function of carotid and brachial arteries in postmenopausal vegetarians

    Directory of Open Access Journals (Sweden)

    Su T

    2011-08-01

    Full Text Available Ta-Chen Su1, Pao-Ling Torng2, Jiann-Shing Jeng3, Ming-Fong Chen1, Chiau-Suong Liau1,41Division of Cardiology, Department of Internal Medicine, 2Department of Obstetrics and Gynecology, 3Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, 4Cardiovascular Center, Taipei Buddist Tzu-Chi Hospital, Hsin-Dian, Taipei, TaiwanBackground: Vegetarianism is associated with a lower risk of cardiovascular disease. However, studies of arterial function in vegetarians are limited.Methods: This study investigated arterial function in vegetarianism by comparing 49 healthy postmenopausal vegetarians with 41 age-matched omnivores. The arterial function of the common carotid artery was assessed by carotid duplex, while the pulse dynamics method was used to measure brachial artery distensibility (BAD, compliance (BAC, and resistance (BAR. Fasting blood levels of glucose, lipids, lipoprotein (a, high-sensitivity C-reactive protein, homocysteine, and vitamin B12 were also measured.Results: Vegetarians had significantly lower serum cholesterol, high-density and low-density lipoprotein, and glucose compared with omnivores. They also had lower vitamin B12 but higher homocysteine levels. Serum levels of lipoprotein (a and high-sensitivity C-reactive protein were no different between the two groups. There were no significant differences in carotid beta stiffness index, BAC, and BAD between the two groups even after adjustment for associated covariates. However, BAR was significantly lower in vegetarians than in omnivores. Multiple linear regression analysis revealed that age and pulse pressure were two important determinants of carotid beta stiffness index and BAD. Vegetarianism is not associated with better arterial elasticity.Conclusion: Apparently healthy postmenopausal vegetarians are not significantly better in terms of carotid beta stiffness index, BAC, and BAD, but have significantly decreased BAR than

  9. Tratamento de síndrome de roubo de subclávia com angioplastia transluminal percutânea e stenting: relato de caso

    OpenAIRE

    Fregni, Felipe; Castelo-Branco, Luiz Eduardo Coutinho; Conforto, Adriana Bastos; Yamamoto, Fabio Iuji; Campos, Cynthia Resende; Puglia Jr., Paulo; Caldas, José Guilherme Mendes Pereira; Scaff, Milberto

    2003-01-01

    Subclavian steal syndrome refers to the association of neurological symptoms related to vertebrobasilar insufficiency and the phenomenon of subclavian steal. We report the case of a 63 year-old male patient that presented subclavian steal syndrome and severe proximal (80%) stenosis of the left subclavian artery. The patient was submitted to percutaneous transluminal angioplasty and stenting on the left SA. The procedure was well tolerated and immediately afterwards, there was complete remissi...

  10. Intra-arterial thrombolysis of digital artery occlusions in a patient with polycythemia vera.

    Science.gov (United States)

    Jud, Philipp; Hafner, Franz; Gary, Thomas; Ghanim, Leyla; Lipp, Rainer; Brodmann, Marianne

    2017-01-01

    There are limited therapeutic options for the resolution of digital artery occlusions. Intra-arterial thrombolysis with anticoagulative and thrombolytic drugs successfully restored the blood flow in the affected digital arteries.

  11. Signs and Symptoms of Artery Disease | Coronary Artery Disease | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Coronary Artery Disease Signs and Symptoms of Artery Disease Past Issues / ... narrows or blocks these arteries—a condition called coronary artery disease (CAD) or coronary heart disease (CHD) occurs. A ...

  12. A case report: accessory right renal artery

    Directory of Open Access Journals (Sweden)

    Patasi B

    2009-10-01

    Full Text Available Anatomical variations in the origin of the arteries in the abdominal area are very common. The arteries that show frequent variations include the celiac trunk, renal and gonadal arteries. During a routine dissection of a male cadaver, one main and one inferior accessory renal artery were found in the abdominal region. We discovered that the inferior accessory renal artery that originated from the right anterolateral aspect of abdominal aorta was running into the lower pole of the right kidney. The origin of the main right renal artery and the inferior accessory right renal artery were 19.8 mm and 53 mm below the superior mesenteric artery, respectively. The inferior accessory right renal artery ran directly into the inferior pole of the right kidney, in the area where the accessory right renal vein was leaving the right kidney. These anatomical variations and anomalies are important to know before any therapeutic or diagnostic procedures are performed in the abdominal area.

  13. Endarterectomized superficial femoral artery as an arterial patch.

    Science.gov (United States)

    Rollins, D L; Towne, J B; Bernhard, V M; Baum, P L

    1985-03-01

    Eighty-six patients underwent 90 profundaplasties for lower extremity ischemia using endarterectomized superficial femoral artery (ESFA) or vein as an arterial patch. Standard length profundaplasty was performed in 60 limbs and extended profundaplasty in 28. Seventy-two were performed for limb salvage and 18 for severe claudication. Fifty-four limbs underwent inflow reconstruction and profundaplasty, while 36 others had profundaplasty alone. Three-year cumulative patency rates were employed to compare the type of autogenous patch material to the profundaplasty length, operative indications, and procedures. In all groups, ESFA performed as well as vein. Endarterectomized superficial femoral artery patch angioplasty provides comparable long-term results to vein patch in patients undergoing profundaplasty, and demonstrates its durability as a vascular patch in situations where autogenous tissue is required or preferred while preserving the saphenous vein for later use.

  14. Vascular Aging and Arterial Stiffness

    Directory of Open Access Journals (Sweden)

    Luana de Rezende Mikael

    Full Text Available Abstract Cardiovascular diseases (CVD account annually for almost one third of all deaths worldwide. Among the CVD, systemic arterial hypertension (SAH is related to more than half of those outcomes. Type 2 diabetes mellitus is an independent risk factor for SAH because it causes functional and structural damage to the arterial wall, leading to stiffness. Several studies have related oxidative stress, production of free radicals, and neuroendocrine and genetic changes to the physiopathogenesis of vascular aging. Indirect ways to analyze that aging process have been widely studied, pulse wave velocity (PWV being considered gold standard to assess arterial stiffness, because there is large epidemiological evidence of its predictive value for cardiovascular events, and it requires little technical knowledge to be performed. A pulse wave is generated during each cardiac contraction and travels along the arterial bed until finding peripheral resistance or any bifurcation point, determining the appearance of a reflected wave. In young individuals, arteries tend to be more elastic, therefore, the reflected wave occurs later in the cardiac cycle, reaching the heart during diastole. In older individuals, however, the reflected wave occurs earlier, reaching the heart during systole. Because PWV is an important biomarker of vascular damage, highly valuable in determining the patient’s global cardiovascular risk, we chose to review the articles on vascular aging in the context of cardiovascular risk factors and the tools available to the early identification of that damage.

  15. Celiac artery thrombosis and superior mesenteric artery stenosis

    Directory of Open Access Journals (Sweden)

    Mohit Sharma

    2016-01-01

    Full Text Available Acute thrombosis of the celiac artery trunk or elsewhere in mesenteric blood supply is a rare cause of acute abdominal pain. Celiac artery thrombosis carries high mortality and morbidity rates if the diagnosis and treatment are delayed. It is frequently associated with other cardiovascular events. The most common etiology is atherosclerosis. The main goal of the treatment is to revascularize and start the diminished or stopped mesenteric blood flow and to avoid end-organ ischemia. Thrombolysis with urokinase followed by anticoagulation with heparin in an emergency situation can save the life of the patient before surgical intervention.

  16. Bilateral variations of renal and testicular arteries

    Directory of Open Access Journals (Sweden)

    Gurses IA

    2009-05-01

    Full Text Available The variations of the arteries that develop from the mesonephric arteries – including renal, gonadal and suprarenal arteries – are common. Understanding the anatomy of the vascular variations of this region is essential for the clinicians to perform procedures such as renal transplantation, interventional radiologic procedures and renal vascular operations more safely and efficiently. In order to facilitate the clinical approaches, we present a male cadaver with bilateral double renal arteries accompanied with doubled right testicular arteries and a left testicular artery of high origin, and we discuss the surgical, radiologic and possible embryologic aspects.

  17. TRANSPOSISI ARTERI BESAR PADA DEWASA

    Directory of Open Access Journals (Sweden)

    Deni Arisanti

    2011-09-01

    Full Text Available AbstrakSeorang laki-laki umur 50 tahun dirawat di Emergensi Penyakit Dalam RSUP Dr. M. Djamil Padang dengan keluhan utama sesak nafas meningkat sejak 1 hari yang lalu. Sesak nafas semakin meningkat jika beraktifitas, dan berkurang jika istirahat dengan posisi bantal yang ditinggikan. Jika sesak nafas sering diikuti dengan bibir dan kuku yang membiru. Pasien sudah dikenal menderita penyakit jantung bawaan, awalnya lahir dengan kulit kebiruan dan mudah tersedak jika menyusu. Dari pemeriksaan fisik didapatkan: Clubbing finger, sianosis, peningkatan Vena Jugolaris, kardiomegali, dan pitting oedema. Dari laboratorium didapatkan: Hemoglobin: 17,1 gr/dl, Hematokrit : 62%, Ureum : 39 mg/dl, Kreatinin : 2,0 mg/dl, TKK :31, Echo Cardiography: Transposisi Arteri Besar, Large Ventrikel Septal Devect, trikuspit regurgitasi dengan hipertensi pulmonal dan moderat Mitral Regurgitasi. Pasien di diagnosa dengan Congestive Heart Failure Functional Class IV LVH- RVH, irama RBBB karena transposisi Arteri Besar dengan Ventrikel Septal Defek.Kata kunci: Transposisi Arteri Besar, Kelainan Jantung Bawaan.AbstractHas been treated a 50 years old man was hospitallized in Internal emengency Department of Dr. M. Djamil Hospital Padang with cief complaints of shortness of breath influenced activity, frequent night waking due to shortness of breath, and an elevated bed with a pillow. On physical examination found: clubbing, cyanosis, increased Jugolaris veins, cardiomegaly, and pitting edema. From the laboratium: Hemoglobin: 17,1 gr/dl, Hematokrit : 62%, Ureum : 39 mg/dl, Kreatinin : 2,0 mg/dl, TKK :31, Echo Cardiography shows: Transposition of the Great Arteries, Large Ventricle Septal Defect, Tricuspid Regurgitation with pulmonary hypertension, and moderate Mitral Regurgitation. Patients with definitife diagnosis: Congestive Heart Failure Functional Class IV LVH- RVH, RBBB rhythm Cause By Transposition of the Great Arteries with a Ventrikel Septal Defec.Key word

  18. Revascularisation of atherosclerotic mesenteric arteries

    DEFF Research Database (Denmark)

    Christensen, Max Greve; Lorentzen, Jørgen Ewald; Schroeder, T V

    1994-01-01

    : Department of Vascular Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark. MATERIALS: 54 women and 36 men, aged 56 (median; range: 34-78 years) underwent 109 consecutive mesenteric reconstructions. The indication in 90 primary procedures was acute mesenteric ischaemia of non-embolic origin...... in 25 patients, chronic ischaemia in 53 and prophylactic reconstruction in connection with aortic surgery in 12 patients. The superior mesenteric artery (SMA) was revascularised in 87 patients and the coeliac axis or common hepatic artery in six. Thus, only three patients had both territories...

  19. Intimal injury from arterial clamps.

    Science.gov (United States)

    Slayback, J B; Bowen, W W; Hinshaw, D B

    1976-08-01

    Preliminary experimental data have been presented indicating that intimal injury of some degree is a virtually constant finding at the site of application of any arterial occluding clamp. These injuries vary from intimal distortion to complete fracture into the media of the vessel. The degree of injury appears directly proportional to the amount of pressure exerted through a given clamp. Atherosclerotic arteries are particularly subject to severe degrees of intimal injury. Preliminary observations suggest that heparin is not helpful in preventing platelet aggregation and initial thrombus formation at intimal injury sites. The problem of anticoagulation at such injury sites is being studied further.

  20. Coronary Artery Bypass in Octogenarians

    Directory of Open Access Journals (Sweden)

    Chen-Yen Chien

    2012-09-01

    Full Text Available Prevalence of coronary artery disease (CAD has increased with the expansion of life span among the elderly population in the world. Hence, the issue of the coronary artery bypass in octogenarians has attracted more attention. Recent literature about the topic revealed nearly the same excellent results as those in the younger population under the newly developed operative techniques and improving concept in perioperative management and postoperative care. In this article, we review the current status of the procedure that was thought to be dangerous in the earlier era, including its risk factors, result, and benefit.

  1. Spontaneous isolated celiac artery dissection

    Directory of Open Access Journals (Sweden)

    Tuba Cimilli Ozturk

    2011-01-01

    Full Text Available Dyspepsia with mild, stabbing epigastric discomfort without history of trauma is a very common symptom that emergency physicians see in their daily practice. Vascular emergencies, mostly the aortic dissection and aneurysm, are always described in the differential diagnosis with persistent symptoms. Isolated celiac artery dissection occurring spontaneously is a very rare diagnosis. The involvement of branch vessels is generally observed and patients show various clinical signs and symptoms according to the involved branch vessel. Here we are presenting a case with spontaneous isolated celiac artery dissection, without any branch vessel involvement or visceral damage, detected by computed tomography scans taken on admission.

  2. Obesity and carotid artery remodeling

    DEFF Research Database (Denmark)

    Kozakova, M; Palombo, C; Morizzo, C

    2015-01-01

    characterized by body size-dependent increase in stroke volume (SV) and blood pressure (BP). SUBJECTS/METHODS: Common carotid artery (CCA) luminal diameter (LD), IMT and CWS were measured in three different populations in order to study: (A) cross-sectional associations between SV, BP, anthropometric parameters...... the luminal enlargement caused by body size-induced increase in SV, and therefore, to normalize the wall stress. CCA diameter in obesity could represent an additional biomarker, depicting the impact of altered hemodynamics on arterial wall....

  3. Collateral artery pathways of the femoral and popliteal artery

    NARCIS (Netherlands)

    Kruse, R.R.; Doomernik, D.E.; Maltha, K.V.; Kooloos, J.G.M.; Kozicz, T.; Reijnen, M.

    2017-01-01

    BACKGROUND: The role of collateral artery circulation in the lower limb is under debate but clinically relevant, particularly when using covered stents for occlusive disease. Covered stents seem to outperform nitinol stents in extensive disease, but collaterals could be essential in case of acute

  4. Collateral artery pathways of the femoral and popliteal artery.

    Science.gov (United States)

    Kruse, Rombout R; Doomernik, Denise E; Maltha, Kasper V; Kooloos, Jan G M; Kozicz, Tamas L; Reijnen, Michel M P J

    2017-05-01

    The role of collateral artery circulation in the lower limb is under debate but clinically relevant, particularly when using covered stents for occlusive disease. Covered stents seem to outperform nitinol stents in extensive disease, but collaterals could be essential in case of acute thrombosis. In the present study, we describe the collateral pathways of the deep and superficial femoral artery (DFA, SFA) and the popliteal artery (PA), observed in human cadavers. Ten fresh frozen cadaver legs were selected. The SFA and DFA were separately cannulated and injected with a different colored latex mixture simultaneously. After curing of the latex, the circulation was dissected thus visualizing the main arteries and their collateral vessels. The process was photographed and recorded, and collateral pathways were analyzed using a standardized vessel segmentation. The upper leg was divided in three regions, that is, the femoral triangle (F), the adductor canal (H), and the popliteal fossa (P) that, in turn, were split in three segments (1, 2, and 3, from proximal to distal). Overall, 113 collateral vessels were found; 69 originated from the DFA, 34 from the SFA, and 10 from the PA. The majority of collaterals originating from the DFA terminated in the SFA (57%). Fifty-six of 113 collaterals (50%) ended in either the distal adductor channel (H3) or the proximal PA (P1). Another 28 collateral arteries (25%) had their origin in this segment (H3, P1) and mostly connected to the P2 and P3 segments. Forty-three collaterals of the DFA and H3 segment had a direct or indirect connection to below the knee muscles. The majority of collaterals originate from the DFA, and the greater part of all collaterals has a connection with the H3-P1 segment. This observation may have clinical implications in the planning of endovascular procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Angioplasty and stent placement - carotid artery

    Science.gov (United States)

    ... and stenting; CAS; Angioplasty - carotid artery; Carotid artery stenosis - angioplasty; ... Stenting versus endarterectomy for treatment of carotid-arery stenosis. N Engl J Med . 2010;363(1):11- ...

  6. Genetics Home Reference: arterial tortuosity syndrome

    Science.gov (United States)

    ... B, De Paepe A. Mutations in the facilitative glucose transporter GLUT10 alter angiogenesis and cause arterial tortuosity syndrome. ... or Free article on PubMed Central Segade F. Glucose transporter 10 and arterial tortuosity syndrome: the vitamin C ...

  7. Variations in arterial supply of vermiform appendix

    Directory of Open Access Journals (Sweden)

    Kulkarni UK

    2011-03-01

    Full Text Available Till date appendix holds the same surgical significance, which it had previously. The appendicular artery is considered to be a branch from posterior caecal artery or ileocolic artery entering the mesoappendix from behind the ileum and supplying it. During routine cadaveric dissections some variations were seen in number and course of the appendicular artery. Such three cases of surgical importance along with their review of literature are discussed herewith.

  8. An unreported type of coronary artery naomaly in congenitally corrected transposition of great arteries

    Energy Technology Data Exchange (ETDEWEB)

    Kwak, Min Kyu; Jeong, Yeon Joo; Lee, Gee Won; Lee, Nam Kyung; Choi, Jung Hyun; Lee, Ji Won [Medical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of)

    2016-07-15

    Coronary artery variations are associated anomalies in 45% of congenitally corrected transposition of the great arteries (ccTGA) cases, and it is important to detect any coronary artery anomalies before cardiac surgery. We report a case of a 51-year-old woman with ccTGA and an unreported type of coronary artery anomaly.

  9. Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease

    OpenAIRE

    Ohba, Keisuke; Sugiyama, Seigo; Sumida, Hitoshi; Nozaki, Toshimitsu; Matsubara, Junichi; Matsuzawa, Yasushi; Konishi, Masaaki; Akiyama, Eiichi; Kurokawa, Hirofumi; Maeda, Hirofumi; Sugamura, Koichi; Nagayoshi, Yasuhiro; Morihisa, Kenji; Sakamoto, Kenji; Tsujita, Kenichi

    2012-01-01

    Background Angina without significant stenosis, or nonobstructive coronary artery disease, attracts clinical attention. Microvascular coronary artery spasm (microvascular CAS) can cause nonobstructive coronary artery disease. We investigated the clinical features of microvascular CAS and the therapeutic efficacy of calcium channel blockers. Methods and Results Three hundred seventy consecutive, stable patients with suspected angina presenting nonobstructive coronary arteries (

  10. Coronary Artery Disease | Coronary Artery Disease | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Coronary Artery Disease Coronary Artery Disease Past Issues / Fall 2010 Table of Contents David ... up inside your arteries. One atherosclerosis-related disease, coronary artery disease (CAD) is the most common heart disease and ...

  11. Case Report: Variant Origin of an Arterial Trunk from Axillary Artery ...

    African Journals Online (AJOL)

    Conclusion: Since the axillary artery is next choice of artery for arterial canulation in cardiopulmonary bypass procedures, prior knowledge of existence of such variation in its branching pattern helps in avoiding possible diagnostic or interventional therapeutic errors. Keywords: axillary artery, common trunk, profunda brachii, ...

  12. Moyamoya disease associated with an anterior inferior cerebellar artery arising from a persistent trigeminal artery

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, A.; Sawada, A.; Takase, Y.; Kudo, S. [Department of Radiology, Saga Medical School, 5-1-1, Nabeshima, Saga, 849-8501 (Japan); Koizumi, T. [Department of Neurosurgery, Saga Medical School, 5-1-1, Nabeshima, Saga, 849-8501 (Japan)

    2002-07-01

    The authors present a case of moyamoya disease associated with a persistent trigeminal artery from which the anterior inferior cerebellar artery arose. We reviewed previously reported cases of moyamoya disease associated with persistent carotid-basilar arterial anastomosis and investigated the embryology of this rare arterial variation. (orig.)

  13. Pregnancy after uterine arterial embolization

    Directory of Open Access Journals (Sweden)

    Cláudio E. Bonduki

    2011-01-01

    Full Text Available OBJECTIVE: To evaluate pregnancy outcomes, complications and neonatal outcomes in women who had previously undergone uterine arterial embolization. METHODS: A retrospective study of 187 patients treated with uterine arterial embolization for symptomatic uterine fibroids between 2005-2008 was performed. Uterine arterial embolization was performed using polyvinyl alcohol particles (500-900 mm in diameter. Pregnancies were identified using screening questionnaires and the study database. RESULTS: There were 15 spontaneous pregnancies. Of these, 12.5% were miscarriages (n = 2, and 87.5% were successful live births (n = 14. The gestation time for the pregnancies with successful live births ranged from 36 to 39.2 weeks. The mean time between embolization and conception was 23.8 months (range, 5-54. One of the pregnancies resulted in twins. The newborn weights (n = 14 ranged from 2.260 to 3.605 kg (mean, 3.072 kg. One (7.1% was considered to have a low birth weight (2.260 kg. There were two cases of placenta accreta (12.5%, treated with hysterectomy in one case [6.3%], one case of premature rupture of the membranes (PRM (6.3%, and one case of preeclampsia (6.3%. All of the patients were delivered via Cesarean section. CONCLUSION: In this study, there was an increased risk of Cesarean delivery. There were no other major obstetric risks, suggesting that pregnancy after uterine arterial embolization is possible without significant morbidity or mortality.

  14. EMERGENCY STATES IN ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    M. A. Gurevich

    2014-01-01

    Full Text Available The article describes in detail potential emergency states in patients with different stages of arterial hypertension with special attention to diagnosis and rational management of hypertensive crisis. Differentiated approach to management of different forms of hypertensive crisis is specified.

  15. ORIGINAL ARTICLES Peripheral arterial disease

    African Journals Online (AJOL)

    arterial disease is confirmed by its adverse prognostic significance for coronary and cerebrovascular events.2. •. 5. ·. 8 ABPI has been found to be an independent predictor even when the effects of advanced age, hypertension, diabetes mellitus, and pre-existing cardiovascular disease have been taken into account using ...

  16. Genetics of Coronary Artery Disease

    DEFF Research Database (Denmark)

    McPherson, Ruth; Tybjærg-Hansen, Anne

    2016-01-01

    Genetic factors contribute importantly to the risk of coronary artery disease (CAD), and in the past decade, there has been major progress in this area. The tools applied include genome-wide association studies encompassing >200,000 individuals complemented by bioinformatic approaches, including...

  17. [Intracranial carotid artery bifurcation aneurysms].

    Science.gov (United States)

    Vega-Basulto, S D; Montejo-Montejo, J

    Intracranial carotid artery bifurcation aneurysms are infrequent but its clinical behavior, high risk of bleeding and complex anatomic relationships of the sac permit to consider these lesions as a challenge cases. 497 patients harboring intracranial aneurysms were operated on at Manuel Ascunce Domenech Hospital, Camagüey, Cuba between January 1982 to august 2001. We utilized microsurgical procedures, optical magnification, specialized neuroanesthesia and Intensive Care Unit postoperatory following. All patients were evaluated clinically with World Federation Neurological Surgeon Scale and Glasgow Outcome Scale. There were 16 patients with intracranial carotid artery bifurcation aneurysms (3.2 %). 12 patients were under 40 years and 50% were between 16 and 30 years old. All patients present intracranial bleeding. There was 87.5% of total or partial recuperation. There was one death only. Postoperative deficit were observed at 44% but 31% disappeared three month later. Intracranial carotid artery bifurcation aneurysms are complex anatomoclinical lesions. Clinically, we observed high tendency to bleed and multiplicity. Anatomically, these sacs have complex arterial relationship that difficult dissection and clipping. They have frequent postoperative morbidity. Multiple or bilateral aneurysmal sacs will be clipped by one surgical procedure.

  18. Management of pulmonary arterial hypertension.

    LENUS (Irish Health Repository)

    Judge, Eoin P

    2013-02-01

    Pulmonary arterial hypertension (PAH) is a complex disease with a high mortality. Management of this disease is underpinned by supportive and general therapies delivered by multidisciplinary teams in specialist centres. In recent years, a number of PAH-specific therapies have improved patient outcomes. This article will discuss the management of PAH in the context of relevant recently published studies in this area.

  19. Capsaicin and arterial hypertensive crisis.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; La Rosa, Felice Carmelo; La Rocca, Roberto

    2010-10-08

    Chili peppers are rich in capsaicin. The potent vasodilator calcitonin gene-related peptide (CGRP) is stored in a population of C-fiber afferents that are sensitive to capsaicin. CGRP and peptides released from cardiac C fibers have a beneficial effect in myocardial ischemia and reperfusion. It has been reported that capsaicin pretreatment can deplete cardiac C-fiber peptide stores. Furthermore, it has also been reported that capsaicin-treated pigs have significantly increased mean arterial blood pressure compared with controls, and that the decrease in CGRP synthesis and release contributes to the elevated blood pressure. A case has also been reported of an arterial hypertensive crisis in a patient with a large ingestion of peppers and chili peppers the day before. We present a case of an arterial hypertensive crisis in a 19-year-old Italian man with an abundant ingestion of peppers and of chili peppers the preceding day. This case describes an unusual pattern of arterial hypertensive crisis due to capsaicin. Copyright © 2008 Elsevier Ireland Ltd. All rights reserved.

  20. Maternal Arterial Murmur in Pregnancy

    DEFF Research Database (Denmark)

    Riknagel, Diana

    2017-01-01

    Alternative methods of assessing the placental function are called for in the attempt to clarify the pathophysiology behind adverse pregnancy outcome as fetal growth restriction. A new concept of using cardiovascular sounds emitted near the uterine arteries in pregnancy is investigated...

  1. Carotid Artery Disease and Stroke

    Science.gov (United States)

    ... and high blood pressure.  High Blood Pressure: Excess pressure on the arteries can cause them to weaken and become more prone to damage.  High Cholesterol: Having a high LDL and low HDL can increase fat in the blood stream.  ...

  2. Coronary artery disease: medical therapy

    African Journals Online (AJOL)

    one in three for women.1 Atherosclerotic coronary artery disease begins in childhood and the risk factors influence the development of atherosclerosis throughout one's lifetime.2. A standardised case-control study of acute myocardial infarction in 52 countries, representing every inhabited continent, demonstrated that nine ...

  3. RUPTURED RETINA ARTERY MACRO- ANEURYSM ...

    African Journals Online (AJOL)

    TAIWO

    macroaneurysms:clinical and fluorescein angiographic features in 34 patients. Eye 2006; 20: 1011–1020. 3. Panton RW, Goldberg MF, Farber MD. Retinal arterial macroaneurysms: risk factors and natural history. Br J. Ophthalmol. 1990; 74(10): 595-600. 4. Abdel-Khalek MN, Richardson J. Retinal macroaneurysm:.

  4. Diagnosis and treatment of renal artery stenosis.

    NARCIS (Netherlands)

    Plouin, P.F.; Bax, L.

    2010-01-01

    A reduction in the diameter of the renal arteries can lead to hypertension, renal dysfunction and/or pulmonary edema. About 90% of patients with renal artery stenosis have atherosclerosis, and 10% have fibromuscular dysplasia. Atherosclerotic renal artery stenosis is a common condition that

  5. Duplex ultrasound for identifying renal artery stenosis

    DEFF Research Database (Denmark)

    Zachrisson, Karin; Herlitz, Hans; Lönn, Lars

    2017-01-01

    Background Renal artery duplex ultrasound (RADUS) is an established method for diagnosis of renal artery stenosis (RAS), but there is no consensus regarding optimal RADUS criteria. Purpose To define optimal cutoff values for RADUS parameters when screening for RAS using intra-arterial trans...

  6. Isolated origin of the left internal carotid artery from the pulmonary artery.

    Science.gov (United States)

    Hurley, Michael C; Nguyen, Pamela H; DiPatri, Arthur J; Shaibani, Ali

    2008-09-01

    The authors describe what is, to their knowledge, the first reported case of the anomalous origin of an internal carotid artery from the pulmonary artery. An otherwise asymptomatic 6-year-old girl, who presented with headaches and hypertension, underwent a comprehensive workup that revealed extensive meningeal and cerebral artery anastomoses to the left internal carotid artery--itself arising from the origin of the left pulmonary artery. This unique anatomical anomaly, caused by a disturbed pattern of aortic arch regression, resulted in a right-to-left vascular shunt into the pulmonary artery and a disturbance of intracranial artery flow patterns, complicating the management options.

  7. Effects of Mechanical Pumping on the Arterial Pulse Wave Velocity: Peripheral Artery and Micro-Vessels

    Science.gov (United States)

    2001-10-25

    EFFECTS OF MECHANICAL PUMPING ON THE ARTERIAL PULSE WAVE VELOCITY : PERIPHERAL ARTERY AND MICRO -VESSELS Shu-Mei Wu*†, Yio-Wha Shau**, Bor-Shyh...was contributed from the results of BA-RA, the PWV for the micro -vessels (BA-finger) on the contrary was increased. Keywords- Mechanical Pumping ...arterial conduit (brachial artery-radial artery; BA-RA) and the micro -vessels (RA-ring finger) to mechanical pumping was evaluated. II

  8. Occipital artery to middle cerebral artery bypass in cases of unavailable superficial temporal artery.

    Science.gov (United States)

    Hirano, Tsukasa; Mikami, Takeshi; Suzuki, Hime; Hirano, Toru; Kimura, Yusuke; Komatsu, Katusya; Akiyama, Yukinori; Wanibuchi, Masahiko; Mikuni, Nobuhiro

    2018-01-22

    In neurosurgery, extracranial-to-intracranial (EC-IC) bypass surgery is necessary for patients who have undergone surgery in which the superficial temporal artery (STA) was already used for a different bypass procedure or was damaged. Here, we report our experience with EC-IC bypass using the occipital artery (OA) in cases in which the STA is unavailable, and discuss the technical considerations and pitfalls. Five patients with ischemic-onset moyamoya disease and atherosclerotic disease were included. Two patterns of skin incisions were planned according to the OA pathway and recipient artery location. In one method, a skin incision is made above the OA and a craniotomy is performed under this incision after OA dissection. In the other method, a skin incision is made above the OA to enable its dissection and a craniotomy is performed via a separate skin incision. No major perioperative complications developed in any of the five cases, and bypass patency was confirmed in all patients. There was a significant difference between the pre- and postoperative asymmetry ratio of the mean transit time values. OA-to- middle cerebral artery (MCA) bypass is a simple and effective method in patients in whom the STA was already used or was damaged by previous intracranial revascularization or a craniotomy. This procedure could be an alternative to STA-MCA bypass in patients without an available STA. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Correção de aneurisma do tronco braquiocefálico, 10 anos após traumatismo torácico fechado Correction of an innominate artery aneurysm, 10 years after a blunt chest trauma

    Directory of Open Access Journals (Sweden)

    José Almeida Lopes

    2012-03-01

    Full Text Available Aneurismas do tronco braquiocefálico são extremamente raros. Os autores apresentam o caso clínico de um doente de 22 anos de idade, com antecedente de atropelamento de alta energia há cerca de 10 anos por motociclo, com traumatismo toraco-abdominal anterior, em quem foi acidentalmente descoberto um aneurisma do tronco braquiocefálico com 52mm. Para a exclusão do referido aneurisma o doente foi submetido com sucesso à construção de um bypass aorta ascendente-carotídio-subclávio com prótese bifurcada de Dacron® (14x7mm, com abordagem por esternotomia mediana, cervical e supra-clavicular. É feita uma revisão da literatura, sendo descritas e discutidas as características clínicas, o tratamento cirúrgico e o mecanismo de traumatismo torácico sobre o tronco braquiocefálico.Innominate artery aneurysms are extremely rare. The authors present a case report of a 22-year-old patient, in whom was accidently discovered an innominate artery aneurysm of 52 mm, 10 years after a blunt thoraco-abdominal trauma caused by a high energy running over by a motorcycle. For the exclusion of the aneurysm, the patient was successfully submitted to the construction of an ascending aorta-carotid-subclavian bypass with bifurcated Dacron® graft (14x7mm, by means of a median sternotomy, right cervical and supra-clavicular approaches. Review of the literature, clinical features, surgical treatment and chest trauma mechanisms over the innominate artery are described and discussed.

  10. [Sports-related carotid artery dissection].

    Science.gov (United States)

    Berrouschot, J; Bormann, A; Routsi, D; Stoll, A

    2009-09-01

    Sports-related carotid artery dissection are very rare and were described in different kinds of sports. We report on a 45-year old man who suffered bilateral brain infarctions caused by bilateral extracranial internal carotid artery dissection after excessive weight lifting in a gym. As possible trigger factors for the dissections we assumed the abrupt extension of the neck during weight lifting and the frequent Valsalva manoeuvers with massive rise in the pressure in the carotid artery system. The patient underwent angioplasty and stenting of the stenosis of right carotid artery, the primarily occluded left carotid artery recanalized spontaneously. Secondary prevention was established by platelet aggregation inhibitors. The patient recovered completely. The pathogenesis of sports-related dissections is multifactorial. In addition to sporting activities hereditary or acquired structural aberrations in the arterial walls could be discussed. Acute focal neurological symptoms after sport should always focus on carotid or vertebral artery dissection. (c) Georg Thieme Verlag KG Stuttgart-New York.

  11. Arterial endothelial function measurement method and apparatus

    Science.gov (United States)

    Maltz, Jonathan S; Budinger, Thomas F

    2014-03-04

    A "relaxoscope" (100) detects the degree of arterial endothelial function. Impairment of arterial endothelial function is an early event in atherosclerosis and correlates with the major risk factors for cardiovascular disease. An artery (115), such as the brachial artery (BA) is measured for diameter before and after several minutes of either vasoconstriction or vasorelaxation. The change in arterial diameter is a measure of flow-mediated vasomodification (FMVM). The relaxoscope induces an artificial pulse (128) at a superficial radial artery (115) via a linear actuator (120). An ultrasonic Doppler stethoscope (130) detects this pulse 10-20 cm proximal to the point of pulse induction (125). The delay between pulse application and detection provides the pulse transit time (PTT). By measuring PTT before (160) and after arterial diameter change (170), FMVM may be measured based on the changes in PTT caused by changes in vessel caliber, smooth muscle tone and wall thickness.

  12. New Technologies in Coronary Artery Surgery

    Directory of Open Access Journals (Sweden)

    David Taggart

    2013-07-01

    Full Text Available Coronary artery disease remains the leading cause of death in developed countries. Major recent studies such as SYNTAX and FREEDOM have confirmed that coronary artery bypass grafting (CABG remains the gold standard treatment in terms of survival and freedom from myocardial infarction and the need for repeat revascularization. The current review explores the use of new technologies and future directions in coronary artery surgery, through 1 stressing the importance of multiple arterial conduits and especially the use of bilateral mammary artery; 2 discussing the advantages and disadvantages of off-pump coronary artery bypass; 3 presenting additional techniques, e.g. minimally invasive direct coronary artery bypass grafting, hybrid, and robotic-assisted CABG; and, finally, 4 debating a novel external stenting technique for saphenous vein grafts.

  13. Arteriosclerotic femoral artery aneurysms. A short review

    DEFF Research Database (Denmark)

    Levi, N; Schroeder, T V

    1997-01-01

    True arteriosclerotic aneurysms of the femoral artery are rare but they are dangerous lesions that may thrombose, embolise or rupture. They are often bilateral and frequently the patient has other aneurysms in the abdominal aortic or popliteal artery. True femoral aneurysms were originally...... classified by Cutler and Darling in 1973 as type 1 and type 2 according to their relationship to the common femoral bifurcation. Case reports of isolated superficial and profunda femoral artery aneurysms have been published, but these are exceedingly rare although isolated aneurysms of the profunda femoris...... artery may be more common in Denmark. True femoral artery aneurysms are attributed to weakening of the arterial wall due to atherosclerosis. True femoral artery aneurysms are relatively rare and are found in elderly smoking men. Aortic aneurysms are approximately 10 times more common. Distal embolization...

  14. Coronary arteries bypass grafting stenosis

    Directory of Open Access Journals (Sweden)

    Mahmoud Ebrahimi

    2014-12-01

    Full Text Available Coronary artery disease (CAD is a major global problem. In addition, it is higher risk of mortality for women more than men are when develop in female gender Atherosclerotic plaques consist of deposits of fatty material in the tunica intima. The role of inflammatory process in CAD has been known from 1980’s. Several studies investigated the innate immunity and adaptive immunity roles in atherosclerosis and they concluded that it plays a key role in atherosclerosis. Coronary artery bypass grafting (CABG is a widely used method for the treatment of CAD. Based on the literature, CABG is the most common surgical operation done worldwide. In During the first 10 years after CABG, up to 50% of saphenous grafts will occlude. Graft restenosis is beginning with acute thrombosis, intima hyperplasia, and plaque formation. In this review, some molecular pathways of graft failure and restenosis such as apoptosis and nuclear factor kappa B (NF-ĸB are described.

  15. Posterior communicating artery giving rise to a shared-origin anterior choroidal artery: case illustration.

    Science.gov (United States)

    Tonetti, Daniel A; Andrews, Edward G; Stabingas, Kristen; Tyler-Kabara, Elizabeth; Gross, Bradley A; Jadhav, Ashutosh

    2017-10-27

    The origin point of the anterior choroidal artery is variable, typically arising from the supraclinoid internal carotid artery (ICA) distal to the posterior communicating artery (PComA) on either the posterolateral or posterior aspect of the ICA. Variations of anterior choroidal artery origin have important clinical implications, and rare origins previously reported include the internal carotid artery bifurcation or from the middle cerebral artery. We provide illustrations of a case of a shared-origin posterior communicating artery and anterior choroidal artery. A young girl presented with intracranial hemorrhage and underwent angiography to evaluate for an underlying cause. Ultimately, three-dimensional rotational angiography incidentally demonstrated a common origin of the anterior choroidal artery with the posterior communicating artery. A rare case of a shared-origin anterior choroidal artery and posterior communicating artery is reported for angiographic illustration. The radiological findings, embryology behind the development of the anterior choroidal artery, and the neurosurgical and neurovascular relevance of this variant are discussed. The importance of recognizing the origin of the anterior choroidal artery is emphasized. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. 5-Fluorouracil induces arterial vasocontractions.

    Science.gov (United States)

    Südhoff, T; Enderle, M-D; Pahlke, M; Petz, C; Teschendorf, C; Graeven, U; Schmiegel, W

    2004-04-01

    From 2% to 10% of cancer patients treated with 5-fluorouracil (5-FU) will develop symptomatic cardiotoxicity. Nevertheless, the underlying pathophysiology is mostly unknown. We investigated the influence of intravenous chemotherapy (CTX) on the diameter of the brachial artery using high resolution ultrasound in patients with malignant tumors, mostly gastrointestinal cancer. Cytostatic drugs included 30 cases with 5-FU and 30 cases with non-5-FU CTX (cis/carboplatin, anthracycline and cyclophosphamide). In addition, plasma levels of big endothelin were assessed prior to and after CTX. Fifteen of 30 patients (50%) showed a contraction of the brachial artery after the end of 5-FU application (median 11%, range 4.3-18.5), whereas no single contraction was noticed in 30 patients following non-5-FU-based CTX. Vessel tonus generally normalized within 30 min after stopping 5-FU. Five patients positive for 5-FU associated vessel contraction were repeatedly exposed to 5-FU. Vessel contractions reoccurred in 86% (18/21) of these administrations. When patients with 5-FU bolus application were pre-treated with glyceroltrinitrate no contraction of the brachial artery was detected in five out of five occasions. There was a trend towards increased big endothelin plasma levels after 5-FU application (median 1.52 versus 1.99 fmol/ml; P = 0.07), whereas big endothelin levels remained unchanged after non-5-FU CTX (1.83 versus 1.83 fmol/ml; P = 0.99). Application of 5-FU is commonly accompanied by arterial vessel contractions, which is likely to represent the first step in 5-FU-induced cardiotoxicity. 5-FU-associated vessel contractions were highly reproducible on re-exposure and were in the case of bolus application completely preventable by glyceroltrinitrate.

  17. [Peripheral arterial disease and diabetes].

    Science.gov (United States)

    Malý, R; Chovanec, V

    2010-04-01

    Peripheral arterial disease (PAD) is a disease characterised by narrowing and blockade of peripheral arteries, usually based on underlying obliterating atherosclerosis. According to the results of large epidemiological studies, the risk of PAD in patients with diabetes mellitus (DM) is fourfold higher compared to non-diabetic population. Patients with DM and PAD have a high risk of cardiovascular morbidity and mortality. Diabetes worsens the prognosis of patients with PAD; the onset of PAD in diabetics occurs at an earlier age, the course is faster than in non-diabetic patients and the disease is often diagnosed at its advanced stages. All these factors reduce the likelihood of revascularisation in DM patients with PAD. A range of factors (higher age, arterial hypertension, smoking, obesity, hyperfibrinogenaemia, insulin resistance etc.) contribute to the development of PAD in DM. Diabetes control is an independent risk factor of PAD as every 1% increase of hemoglobin A1C is associated with 28% increase of PAD. There are different clinical signs of PAD in diabetic and non-diabetic patients. In addition to the history of claudications, PAD diagnostic criteria include the presence of murmur over the large arteries, signs of chronic ischemia on the skin and distal ulcerations and gangrene. Among the imaging techniques, non-invasive investigations including Doppler pressure measurement, ankle brachial pressure index, color duplex ultrasonography, plethysmography, transcutaneous tension measurement, MR and CT angiography are preferred. Ankle brachial pressure index measurement is the easiest and the main investigation technique. The key principles of PAD treatment in diabetic patients include modification of risk factors, pharmacotherapy and revascularisation interventions aimed at improving clinical signs and prevention of cardiovascular morbidity and mortality. Antiplatelet treatment may prevent PAD progression and reduce cardiovascular events in DM patients. Early

  18. Radial artery pseudoaneurysm: A rare complication after a single arterial puncture for blood-gas analysis.

    Science.gov (United States)

    Patel, Kajal Nitin; Gandhi, Shruti P; Sutariya, Harsh C

    2016-10-01

    With a reported incidence of 0.048%, radial artery pseudoaneurysm (PA) is a rare but serious complication of arterial cannulation. We report a case of PA developing after a single puncture of the right radial artery for arterial blood-gas analysis diagnosed by Doppler ultrasound in young male patient. The development of PA after puncture of radial artery for continuous blood pressure monitoring and serial blood-gas analysis has been reported in the past; however, to the best of our knowledge, there is only one case report of development of PA after a single arterial puncture for blood-gas analysis is reported in the past.

  19. Aberrant Ovarian Collateral Originating from External Iliac Artery During Uterine Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Joon Ho; Kim, Man Deuk, E-mail: mdkim@yuhs.ac; Lee, Kwang-hun; Lee, Myungsu; Lee, Mu Sook; Won, Jong Yun; Park, Sung Il; Lee, Do Yun [Yonsei University College of Medicine, Department of Radiology, Research Institute of Radiological Science, Severance Hospital (Korea, Republic of)

    2013-02-15

    We report a case of a 35-year-old woman who underwent uterine artery embolization (UAE) for symptomatic multiple uterine fibroids with collateral aberrant right ovarian artery that originated from the right external iliac artery. We believe that this is the first reported case in the literature of this collateral uterine flow by the right ovarian artery originated from the right external iliac artery. We briefly present the details of the case and review the literature on variations of ovarian artery origin that might be encountered during UAE.

  20. Assessment of conduit artery vasomotion using photoplethysmography

    Science.gov (United States)

    Kanders, Karlis; Grabovskis, Andris; Marcinkevics, Zbignevs; Aivars, Juris Imants

    2013-11-01

    Vasomotion is a spontaneous oscillation of vascular tone. The phenomenon has been observed in small arterioles and capillaries as well as in the large conduit arteries. The layer of smooth muscle cells that surrounds a blood vessel can spontaneously and periodically change its tension and thereby the arterial wall stiffness also changes. As the understanding of the phenomenon is still rather obscure, researchers would benefit from a low-cost and reliable investigation technique such as photoplethysmography (PPG). PPG is an optical blood pulsation measurement technique that can offer substantial information about the arterial stiffness. The aims of this pilot study were to evaluate the usefulness of the PPG technique in the research of vasomotion and to investigate vasomotion in the relatively large conduit arteries. Continuous 15 minute long measurements of posterior tibial artery wall stiffness were taken. Artery diameter, electrocardiogram, blood pressure and respiration were also simultaneously registered. Fast Fourier Transform power spectra were calculated to identify unique stiffness oscillations that did not correspond to fluctuations in the systemic parameters and thus would indicate vasomotion. We concluded that photoplethysmography is a convenient method for the research of the vasomotion in large arteries. Local stiffness parameter b/a is more accurate to use and easier to measure than the pulse wave velocity which describes stiffness of a segment of an artery. Conduit arteries might exhibit a low amplitude high frequency vasomotion ( 9 to 27 cycles per minute). Low frequency vasomotion is problematic to distinguish from the passive oscillations imposed by the arterial pressure.

  1. Anomalous Origin of Left Circumflex Artery

    Science.gov (United States)

    Çitaku, Hajdin; Kamberi, Lulzim; Gorani, Daut; Koçinaj, Dardan; Krasniqi, Xhevdet

    2015-01-01

    Introduction: The coronary anatomic variation of the left circumflex artery (LCx) is considered as the most common anatomic variation with a separate ostium from the right sinus, and very unusual variation as a proximal branch of right coronary artery (RCA). Case report: We report two cases, the first case is a 64-year-old man with chest pain and with history of hypertension, obesity, dyslipidemia and current smoker, and the second case is a 67-year-old who presented to the emergency department with chest pain and with a past medical history of arterial hypertension and type 2 diabetes mellitus. In the coronarography of the first case is detected an ectopic left circumflex coronary artery from the right coronary sinus with stenotic changes in RCA and LCx. The second case in the coronary angiography revealed an ectopic left circumflex coronary artery from the proximal part of the right coronary artery with stenotic changes in LAD, RCA and LCx. Based on guidelines for revascularization our patients successfully underwent treatment procedures. We present two cases that because of the atherosclerotic coronary artery disease leads to the need of coronarography find out the presence of coronary artery anomalies. Conclusion: During the coronarography we should think about coronary artery anomaly or missing artery knowing that type of these anomalies, considering that may be a contributing factor in the development of the atherosclerosis determines the method of the treatment. PMID:26843740

  2. Single umbilical artery and its associated findings.

    Science.gov (United States)

    Hua, Meiling; Odibo, Anthony O; Macones, George A; Roehl, Kimberly A; Crane, James P; Cahill, Alison G

    2010-05-01

    To estimate whether the presence of a single umbilical artery is associated with intrauterine growth restriction (IUGR), fetal demise, or major congenital anomalies. We performed a retrospective cohort study of all consecutive singleton pregnancies undergoing routine anatomic survey between 1990 and 2007 at a major tertiary medical center. Two dedicated research nurses obtained complete pregnancy outcome data in an ongoing manner. Pregnancies with a diagnosis of single umbilical artery were compared with those with two umbilical arteries. The primary outcomes were IUGR (less than 10th percentile), renal, and cardiac anomalies. Multivariable logistic regression was used to refine the risk association between single umbilical artery and adverse pregnancy outcomes while adjusting for confounding effects. Of 72,373 pregnancies, 64,047 (88.5%) had pregnancy follow-up information and were available for this analysis. There were 392 cases of single umbilical artery (0.61%) diagnosed at anatomic survey; slightly lower than previously reported. Single umbilical artery as compared with double umbilical artery was associated with increased risk of renal anomalies (adjusted odds ratio [OR] 3.0, 95% confidence interval [CI] 1.9-4.9, PSingle umbilical artery was also associated with an increased risk of IUGR (adjusted OR 2.1, 95% CI 1.6-2.7, Psingle umbilical artery is made, making a clinical recommendation for serial growth assessments in the setting of single umbilical artery reasonable.

  3. Pulmonary Artery Catheter Placement Using Transesophageal Echocardiography.

    Science.gov (United States)

    Cronin, Brett; Robbins, Robin; Maus, Timothy

    2017-02-01

    To assess the feasibility of pulmonary artery catheter placement using transesophageal echocardiography inclusive of a description of the technique. A prospective, proof-of-concept study. Single university hospital. Twenty patients with chronic thromboembolic pulmonary hypertension scheduled for pulmonary thromboendarterectomy. Pulmonary artery catheters were placed in 20 patients solely by transesophageal echocardiographic guidance. Placement of the pulmonary artery catheter in the pulmonary artery with transesophageal echocardiography guidance in fewer than 10 minutes was considered successful placement. The time to placement was measured from advancement of the pulmonary artery catheter in the superior vena cava (20 cm) to a final location at the junction of the right pulmonary artery and main pulmonary artery. All 20 pulmonary artery catheters were placed successfully using transesophageal echocardiography guidance and the median time to placement was 43 seconds. In 9 of the 20 patients (45%), the catheter was placed successfully on the first attempt without any adjustments. However, in 9 others (45%), the catheter required manipulation under transesophageal echocardiography vision. In 3 patients (15%), the pulmonary artery catheter was observed to be coiled in the right atrium and in 1 instance (5%) manipulation of the catheter in the right ventricle was required to enter the outflow tract. Transesophageal echocardiography is a viable adjunctive method to conventional pressure waveform placement of pulmonary artery catheters in potentially difficult patients. Published by Elsevier Inc.

  4. Higher magnification microsurgical repair of donor artery dissection in superficial temporal artery to middle cerebral artery anastomosis--technical note.

    Science.gov (United States)

    Matsumura, Nobuhisa; Shibata, Takashi; Kamiyama, Hironaga; Tomita, Takahiro; Okamoto, Soushi; Kubo, Michiya; Horie, Yukio

    2011-01-01

    Donor artery dissection is a known cause of technical failure in microvascular anastomosis. A method for detection and direct repair of donor artery dissection before superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis is described using a high magnification operating microscope (maximum 50.4× magnification). Before STA-MCA anastomosis, the stump of the STA is stained using methylrosaniline chloride (pyoctaninum blue) and is observed under higher magnifications. Microsurgical suturing of the arterial dissection is performed before the anastomosis procedure under the high magnification microscope. This method was used in two patients with symptomatic hemodynamic cerebrovascular occlusive disease. Postoperative angiography revealed good patency and no complications occurred. This method may be useful for detection and direct repair of arterial dissection in small vessel walls before STA-MCA anastomosis.

  5. Long-term facial artery catheter implantation for serial arterial blood sampling and invasive arterial blood pressure measurement in horses.

    Science.gov (United States)

    Dias, Deborah Penteado Martins; Teixeira, Luisa Gouvêa; Canola, Paulo Aléscio; Albernaz, Raquel Mincarelli; Marques, José Antônio; Neto, José Corrêa de Lacerda

    2012-06-01

    The purpose of this investigation was to evaluate surgical catheter implantation in the facial artery of horses and the long-term maintenance of such arteries using heparin and ascorbic acid as filling solution. Nine horses were implanted with a polyurethane catheter. The catheters were flushed with a heparin/ascorbic acid solution every 8h and remained patent for 25 days. Arterial blood samples were collected twice a day, and one exercise test that included serial blood samples and arterial pressure recordings was performed on a treadmill. Polyurethane catheters surgically implanted in the facial artery can be kept patent by filling with a heparin/ascorbic acid solution and provide convenient invasive arterial access in horses which is suitable for use for serial blood sampling and blood pressure recordings, even during exercise on treadmill. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. Carotid artery intima-media thickness, but not coronary artery calcium, predicts vascular resistance in patients evaluated for coronary artery disease

    NARCIS (Netherlands)

    Danad, I.; Raijmakers, P.G.; Kamali, P.; Harms, H.J.; de Haan, S.; Lubberink, J.M.; van Kuijk, C.; Hoekstra, O.S.; Lammertsma, A.A.; Smulders, Y.M.; Heijmans, M.W.; Tulevski, I.I.; van Rossum, A.C.; Knaapen, P.

    2012-01-01

    Aims: There is growing evidence that coronary artery disease (CAD) affects not only the conduit epicardial coronary arteries, but also the microvascular coronary bed. Moreover, coronary microvascular dysfunction (CMVD) often precedes the stage of clinically overt epicardial CAD. Coronary artery

  7. Intracranial cerebral artery stenosis with associated coronary artery and extracranial carotid artery stenosis in Turkish patients

    Energy Technology Data Exchange (ETDEWEB)

    Alkan, Ozlem [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey)], E-mail: yalinozlem@hotmail.com; Kizilkilic, Osman; Yildirim, Tulin [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey); Atalay, Hakan [Department of Cardiovascular Surgery, Baskent University, Faculty of Medicine, Ankara (Turkey)

    2009-09-15

    Purpose: Although it has been demonstrated that there is a high prevalence of extracranial carotid artery stenosis (ECAS) in patients with severe coronary artery disease, intracranial cerebral artery stenosis (ICAS) is rarely mentioned. We evaluated the prevalence of ICAS in patients with ECAS having elective coronary artery bypass grafting (CABG) surgery to determine the relations between ICAS, ECAS and atherosclerotic risk factors. Methods: We retrospectively reviewed the digital subtraction angiography findings of 183 patients with ECAS {>=} 50% preparing for CABG surgery. The analyses focused on the intracranial or extracranial location and degree of the stenosis. The degree of extracranial stenoses were categorized as normal, <50%, 50-69%, 70-89%, and 90-99% stenosis and occluded. The degree of intracranial stenosis was classified as normal or {<=}25%, 25-49%, and {>=}50% stenosis and occluded. Traditional atherosclerotic risk factors were recorded. Results: ECAS < 70% in 42 patients and ECAS {>=} 70% in 141 patients. ICAS was found in 51 patients and ICAS {>=} 50% in 30 patients. Regarding risk factors, we found hypertension in 135 patients, diabetes mellitus in 91 patients, hyperlipidemia in 84 patients, and smoking in 81 patients. No risk factor was significant predictors of intracranial atherosclerosis. The severity of ICAS was not significantly associated with that of the ECAS. Conclusions: We found ICAS in 27.8% of the patients with ECAS > 50% on digital subtraction angiography preparing for CABG. Therefore a complete evaluation of the neck vessels with magnetic resonance or catheter angiography seems to be indicated as well as intracranial circulation for the risk assessment of CABG.

  8. Right Gastroepiploic Artery as an Alternative for Arterial Reconstruction in Living Donor Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Klaus Steinbrück

    2014-01-01

    Full Text Available Background. An adequate blood flow is directly related to graft survival in living donor liver transplantation. However, in some cases, unfavorable conditions prevent the use of the hepatic artery for arterial reconstruction. Herein, we report a case in which the recipient right gastroepiploic artery was used as an option for arterial reconstruction in adult-to-adult living donor liver transplantation. Case Report. A 62-year-old woman, with cirrhosis due to hepatitis B associated with hepatocellular carcinoma, was submitted to living donor liver transplantation. During surgery, thrombosis of the hepatic artery with intimal dissection until the celiac trunk was observed, which precluded its use in arterial reconstruction. We decided to use the right gastroepiploic artery for arterial revascularization of the liver graft. Despite the discrepancy in size between donor hepatic artery and recipient right gastroepiploic artery, anastomosis was performed successfully. Conclusions. The use of the right gastroepiploic artery as an alternative for arterial revascularization of the liver graft in living donor liver transplantation should always be considered when the hepatic artery of the recipient cannot be used. For performing this type of procedure, familiarity with microsurgical techniques by the surgical team is necessary.

  9. Transarterial embolization of acute intercostal artery bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Ik; Park, Auh Whan; Lee, Seon Joo [Inje University College of Medicine, Busan (Korea, Republic of); Ko, Gi Young; Yoon, Hyun Ki [University of Ulsan College of Medicine, Seoul (Korea, Republic of); Yoon, Chang Jin [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Shin, Tae Beom [Donga University College of Medicine, Busan (Korea, Republic of); Kim, Young Hwan [Kyimyung University School of Medicine, Daegu (Korea, Republic of)

    2005-09-15

    To report our experiences of transarterial embolization for acute intercostal artery bleeding. A retrospectively analysis of the causes, clinical manifestations, angiographic findings and transarterial embolization technique in 8 patients with acute intercostal artery bleeding, with a review of the anatomical basis. The causes of intercostal artery bleeding were iatrogenic and traumatic in 88 and 12% of cases, respectively. Active bleeding from the collateral intercostal or posterior intercostal arteries was angiographically demonstrated in 75 and 25% of cases, respectively. Transarterial embolization successfully achieved hemostasis in all cases. However, two patient with hypovolemic shock expired due to a massive hemothorax, despite successful transarterial embolization. Intercostal access should be performed through the middle of the intercostal space to avoid injury to the collateral intercostal artery. Transarterial embolization is an effective method for the control of intercostal artery bleeding.

  10. Aberrant Radial Artery Causing Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Zinon T. Kokkalis

    2016-07-01

    Full Text Available Anatomical vascular variations are rare causes of carpal tunnel syndrome. An aberrant medial artery is the most common vascular variation, while an aberrant radial artery causing carpal tunnel syndrome is even more rare, with an incidence ranging less than 3%. This article reports a patient with compression of the median nerve at the carpal tunnel by an aberrant superficial branch of the radial artery. An 80- year- old man presented with a 5-year history of right hand carpal tunnel syndrome; Tinel sign, Phalen test and neurophysiological studies were positive. Open carpal tunnel release showed an aberrant superficial branch of the radial artery with its accompanying veins running from radially to medially, almost parallel to the median nerve, ending at the superficial palmar arterial arch. The median nerve was decompressed without ligating the aberrant artery. At the last follow-up, 2 years after diagnosis and treatment the patient is asymptomatic.

  11. Aberrant Radial Artery Causing Carpal Tunnel Syndrome.

    Science.gov (United States)

    Kokkalis, Zinon T; Tolis, Konstantinos E; Megaloikonomos, Panayiotis D; Panagopoulos, Georgios N; Igoumenou, Vasilios G; Mavrogenis, Andreas F

    2016-06-01

    Anatomical vascular variations are rare causes of carpal tunnel syndrome. An aberrant medial artery is the most common vascular variation, while an aberrant radial artery causing carpal tunnel syndrome is even more rare, with an incidence ranging less than 3%. This article reports a patient with compression of the median nerve at the carpal tunnel by an aberrant superficial branch of the radial artery. An 80- year- old man presented with a 5-year history of right hand carpal tunnel syndrome; Tinel sign, Phalen test and neurophysiological studies were positive. Open carpal tunnel release showed an aberrant superficial branch of the radial artery with its accompanying veins running from radially to medially, almost parallel to the median nerve, ending at the superficial palmar arterial arch. The median nerve was decompressed without ligating the aberrant artery. At the last follow-up, 2 years after diagnosis and treatment the patient is asymptomatic.

  12. Sex differences in intracranial arterial bifurcations

    DEFF Research Database (Denmark)

    Lindekleiv, Haakon M; Valen-Sendstad, Kristian; Morgan, Michael K

    2010-01-01

    Subarachnoid hemorrhage (SAH) is a serious condition, occurring more frequently in females than in males. SAH is mainly caused by rupture of an intracranial aneurysm, which is formed by localized dilation of the intracranial arterial vessel wall, usually at the apex of the arterial bifurcation. T....... The female preponderance is usually explained by systemic factors (hormonal influences and intrinsic wall weakness); however, the uneven sex distribution of intracranial aneurysms suggests a possible physiologic factor-a local sex difference in the intracranial arteries....

  13. Coronary Artery Disease and Carotid Artery Intima-Media Thickness in Japanese Type 2 Diabetic Patients

    National Research Council Canada - National Science Library

    Naomi Mitsuhashi; Tomio Onuma; Sayaka Kubo; Naoko Takayanagi; Motoe Honda; Ryuzo Kawamori

    2002-01-01

    Coronary Artery Disease and Carotid Artery Intima-Media Thickness in Japanese Type 2 Diabetic Patients Naomi Mitsuhashi , MD , Tomio Onuma , MD , Sayaka Kubo , MD , Naoko Takayanagi , MD , Motoe Honda...

  14. Aberrant overian artery originating from the Ilolumbar artery: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Eun; Lee, Jae Myeong [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon (Korea, Republic of)

    2016-05-15

    Here, we report a case of a 30-year-old woman who presented with primary postpartum hemorrhage due to uterine atony. She received uterine artery embolization (UAE). During left internal iliac arteriography, an aberrant left ovarian artery originating from the left iliolumbar artery was visualized. The aberrant left ovarian artery was connected to the left uterine artery via prominent collateral vessels. It supplied a significant amount of blood to the fundus of the uterus. Bilateral hypertrophied uterine arteries were embolized very carefully so that the embolic material did not reflux into the aberrant left ovarian artery. After the procedure, her vaginal bleeding was successfully controlled. Accurate understanding of anatomical variations of the ovarian artery is essential to avoid failure in controlling postpartum hemorrhage with UAE.

  15. Arterial prehabilitation: can exercise induce changes in artery size and function that decrease complications of catheterization?

    NARCIS (Netherlands)

    Alkarmi, A.; Thijssen, D.H.J.; Albouaini, K.; Cable, N.T.; Wright, D.J.; Green, D.J.; Dawson, E.A.

    2010-01-01

    Coronary angiography and angioplasty are common invasive procedures in cardiovascular medicine, which involve placement of a sheath inside peripheral conduit arteries. Sheath placement and catheterization can be associated with arterial thrombosis, spasm and occlusion. In this paper we review the

  16. Low prevalence of significant carotid artery disease in Iranian patients undergoing elective coronary artery bypass

    Directory of Open Access Journals (Sweden)

    Karimi Fatemeh

    2007-01-01

    Full Text Available Abstract Background Coronary artery bypass grafting ranks as one of the most frequent operations worldwide. The presence of carotid artery stenosis may increase the stroke rate in the perioperative period. Routine preoperative noninvasive assessment of the carotid arteries are recommended in many institutions to reduce the stroke rate. Methods 271 consecutive patients undergoing coronary artery bypass grafting at Shaheed Madani hospital of Tabriz, Iran (age, 58.5 Y; 73.1% male underwent preoperative ultrasonography for assessment of carotid artery wall thickness. Results Plaque in right common, left common, right internal and left internal carotid arteries was detected in 4.8%, 7.4%, 43.2% and 42.1% of patients respectively. 5 patients (1.8% had significant ( Conclusion Consecutive Iranian patients undergoing elective coronary artery bypass surgery show a very low prevalence of significant carotid artery disease.

  17. Minimally invasive coronary artery bypass grafting: a systematic review.

    Science.gov (United States)

    Kikuchi, Keita; Mori, Makoto

    2017-06-01

    To minimize surgical morbidity in coronary artery bypass grafting, minimally invasive cardiac surgery has gained popularity. Minimally invasive coronary artery bypass grafting offers unique advantages compared to conventional off-pump coronary artery bypass or minimally invasive direct coronary artery bypass in that it enables the surgeon to harvest and graft bilateral internal thoracic arteries via a small thoracotomy while being conducted completely off-pump. This review focuses on current evidence behind off-pump coronary artery bypass, multi-arterial revascularization, patient populations that would most benefit from bilateral internal thoracic artery minimally invasive coronary artery bypass grafting, the surgical technique, and early outcomes. By overcoming the perceived inability to utilize bilateral internal thoracic arteries in minimally invasive coronary artery bypass grafting, the new technique further expands the armamentarium of surgeons and cardiologists. Hybrid coronary revascularization with bilateral internal thoracic artery minimally invasive coronary artery bypass grafting further augments the appeal of the next generation of minimally invasive cardiac surgery.

  18. Pulmonary artery intramural leiomyosarcoma mimicking pulmonary aneurysm.

    Science.gov (United States)

    Kanaoka, Rie; Takahashi, Yusuke; Morita, Shigeki; Dejima, Hitoshi; Matsutani, Noriyuki; Kawamura, Masafumi

    2016-11-01

    Chest radiography indicated a well-defined rounded mass at the left lung hilum in a 77-year-old former smoker. Chest computed tomography revealed a longitudinal saccular enlargement of the left pulmonary artery with surrounding soft tissue opacity. Resection of the left lower lobe with segment 1 + 2c was carried out to completely remove the dilated pulmonary artery. The resected specimen revealed obvious dilatation of the interlobar pulmonary artery and its branches. A small yellowish well-demarcated myxoid tumor was contained in this lesion, which was diagnosed as a primary pulmonary artery intramural leiomyosarcoma. © The Author(s) 2016.

  19. Blood flow distribution in cerebral arteries.

    Science.gov (United States)

    Zarrinkoob, Laleh; Ambarki, Khalid; Wåhlin, Anders; Birgander, Richard; Eklund, Anders; Malm, Jan

    2015-03-31

    High-resolution phase-contrast magnetic resonance imaging can now assess flow in proximal and distal cerebral arteries. The aim of this study was to describe how total cerebral blood flow (tCBF) is distributed into the vascular tree with regard to age, sex and anatomic variations. Forty-nine healthy young (mean 25 years) and 45 elderly (mean 71 years) individuals were included. Blood flow rate (BFR) in 21 intra- and extracerebral arteries was measured. Total cerebral blood flow was defined as BFR in the internal carotid plus vertebral arteries and mean cerebral perfusion as tCBF/brain volume. Carotid/vertebral distribution was 72%/28% and was not related to age, sex, or brain volume. Total cerebral blood flow (717 ± 123 mL/min) was distributed to each side as follows: middle cerebral artery (MCA), 21%; distal MCA, 6%; anterior cerebral artery (ACA), 12%, distal ACA, 4%; ophthalmic artery, 2%; posterior cerebral artery (PCA), 8%; and 20% to basilar artery. Deviating distributions were observed in subjects with 'fetal' PCA. Blood flow rate in cerebral arteries decreased with increasing age (Psystem.

  20. TRAS principles blight arterial bypass and plasty.

    Directory of Open Access Journals (Sweden)

    Kothari M

    1997-04-01

    Full Text Available A new concept--Tissue Requisitions (Principle I/Relinquishes (Principle II Arterial Supply--of TRAS principles is introduced to help appreciate the failures/successes of modern medicine′s attempts at restoring arterial flow in luminally compromised coronary/carotid fields, an invasive branch rightly called vascular ReRheology, which comprises diagnosing/treating arterial blocks. The technical wizardry of arterial reconstruction (bypass or lumen--restoration (plasty has to reckon with the TRAS principles all the time.

  1. Arterial anatomy of the hallucal sesamoids.

    Science.gov (United States)

    Rath, Bjoern; Notermans, Hans-Peter; Frank, Daniel; Walpert, Juergen; Deschner, James; Luering, Christian M; Koeck, Franz X; Koebke, Juergen

    2009-09-01

    The aim of this study was to analyze the arterial supply of the sesamoid bones of the hallux. Twenty-two feet from adult cadavers were injected with epoxide resin or an acrylic polymer in methyl methacrylate (Acrifix) and subsequently processed by two slice plastination methods and the enzyme maceration technique. Afterwards, the arterial supply of the sesamoid bones was studied. The first plantar metatarsal artery provided a medial branch to the medial sesamoid bone. The main branch of the first plantar metatarsal artery continued its course distally along the lateral side of the lateral sesamoid and supplied it. The supplying arteries penetrated the sesamoid bones on the proximal, plantar, and distal sides. The analysis and cataloging of the microvascular anatomy of the sesamoids revealed the first plantar metatarsal artery as the main arterial source to the medial and lateral sesamoid bones. In addition, the first plantar metatarsal artery ran along the lateral plantar side of the lateral sesamoid bone, suggesting that this artery is at increased risk during soft-tissue procedures such as hallux valgus surgery.

  2. [Coronary artery aneurysm with various clinical course].

    Science.gov (United States)

    Morishima, A; Kaneda, K; Yoshida, Y; Heima, D; Hirao, S; Nagasaka, S; Yokoyama, S; Nishiwaki, N

    2009-12-01

    Case 1: A 77-year-old woman had effort angina pectoris. Coronary angiography (CAG) revealed a coronary artery aneurysm on the left descending artery. Coronary artery bypass grafting (CABG) and patch angioplasty for the aneurysm were performed. Case 2 : A 69-year-old woman had effort dyspnea CAG showed dilation of the left main trunk and beaded aneurysms (maximum 6 cm in diameter) behind the ascending aorta with a fistula to the right atrium. We closed the fistula and performed CABG to the circumflex branch. Case 3 : A 78-year-old woman had had general fatigue for 2 weeks. Previous CAG had revealed coronary artery aneurysms and current chest computered tomography revealed pericardial effusion. She was, therefore, diagnosed with the rupture of the coronary artery aneurysm. We closed the coronary artery aneurysm and performed CABG. Case 4: A 55-year-old man had been diagnosed with acute myocardial infarction and had undergone percutaneous coronary intervention 3 years before. CAG revealed a coronary artery aneurysm on the right coronary artery. We resected the aneurysm and interposed with saphenous vein graft. Although coronary artery aneurysm often has no symptoms, in the cases of angina, myocardial infarction, rupture or large aneurysm more than 3 times larger than the normal diameter, surgical repair should be considered.

  3. Mechanical instability of normal and aneurysmal arteries.

    Science.gov (United States)

    Lee, Avione Y; Sanyal, Arnav; Xiao, Yangming; Shadfan, Ramsey; Han, Hai-Chao

    2014-12-18

    Tortuous arteries associated with aneurysms have been observed in aged patients with atherosclerosis and hypertension. However, the underlying mechanism is poorly understood. The objective of this study was to determine the effect of aneurysms on arterial buckling instability and the effect of buckling on aneurysm wall stress. We investigated the mechanical buckling and post-buckling behavior of normal and aneurysmal carotid arteries and aorta's using computational simulations and experimental measurements to elucidate the interrelationship between artery buckling and aneurysms. Buckling tests were done in porcine carotid arteries with small aneurysms created using elastase treatment. Parametric studies were done for model aneurysms with orthotropic nonlinear elastic walls using finite element simulations. Our results demonstrated that arteries buckled at a critical buckling pressure and the post-buckling deflection increased nonlinearly with increasing pressure. The presence of an aneurysm can reduce the critical buckling pressure of arteries, although the effect depends on the aneurysm's dimensions. Buckled aneurysms demonstrated a higher peak wall stress compared to unbuckled aneurysms under the same lumen pressure. We conclude that aneurysmal arteries are vulnerable to mechanical buckling and mechanical buckling could lead to high stresses in the aneurysm wall. Buckling could be a possible mechanism for the development of tortuous aneurysmal arteries such as in the Loeys-Dietz syndrome. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Doppler study of cerebral arteries in hypercholesterolemia

    Directory of Open Access Journals (Sweden)

    Ghabili K

    2011-03-01

    Full Text Available Mehdi Farhoudi1, Kaveh Mehrvar2, Naser Aslanabadi3, Kamyar Ghabili1, Nazila Rasi Baghmishe4, Farzad Ilkhchoei41Neuroscience Research Center, 2Razi Hospital, 3Department of Cardiology, 4Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, IranBackground: Hypercholesterolemia is one of the major modifiable risk factors for atherosclerosis of the coronary and carotid arteries. Although transcranial Doppler (TCD studies of the cerebral arteries are indicative of decreased cerebral blood flow velocities in patients with hypercholesterolemia, the number of these studies has been limited. The aim of this study was to assess the hemodynamic status of the cerebral arteries in patients with hypercholesterolemia using TCD.Methods: In a case-control study, 60 individuals, including 30 hypercholesterolemic cases (low-density lipoprotein [LDL] > 160 mg/dL and 30 healthy controls were enrolled. Other arterial risk factors, including diabetes mellitus, hypertension, smoking, and obesity (body mass index > 30, were evaluated and matched as well. TCD was used to assess the hemodynamics of the intracranial arteries as well as the internal carotid arteries. The mean blood flow velocity, pulsatility index, and resistance index were recorded in all the arteries.Results: The mean blood flow velocity, pulsatility index, and resistance index of the intracranial arteries and internal carotid arteries were not significantly different between the two groups (P > 0.05. However, those with higher levels of LDL (>180 mg/dL showed significantly lower mean blood flow velocity and resistance index of the internal carotid arteries than the healthy controls. In addition, individuals with high-density lipoprotein (HDL <35 mg/dL had significantly lower mean blood flow velocity in the internal carotid arteries.Conclusion: Hypercholesterolemia (LDL > 160 mg/dL does not seem to have a detrimental effect on the hemodynamic status of the intracranial arteries and internal

  5. Electronic database of arterial aneurysms

    Directory of Open Access Journals (Sweden)

    Fabiano Luiz Erzinger

    2014-12-01

    Full Text Available Background:The creation of an electronic database facilitates the storage of information, as well as streamlines the exchange of data, making easier the exchange of knowledge for future research.Objective:To construct an electronic database containing comprehensive and up-to-date clinical and surgical data on the most common arterial aneurysms, to help advance scientific research.Methods:The most important specialist textbooks and articles found in journals and on internet databases were reviewed in order to define the basic structure of the protocol. Data were computerized using the SINPE© system for integrated electronic protocols and tested in a pilot study.Results:The data entered onto the system was first used to create a Master protocol, organized into a structure of top-level directories covering a large proportion of the content on vascular diseases as follows: patient history; physical examination; supplementary tests and examinations; diagnosis; treatment; and clinical course. By selecting items from the Master protocol, Specific protocols were then created for the 22 arterial sites most often involved by aneurysms. The program provides a method for collection of data on patients including clinical characteristics (patient history and physical examination, supplementary tests and examinations, treatments received and follow-up care after treatment. Any information of interest on these patients that is contained in the protocol can then be used to query the database and select data for studies.Conclusions:It proved possible to construct a database of clinical and surgical data on the arterial aneurysms of greatest interest and, by adapting the data to specific software, the database was integrated into the SINPE© system, thereby providing a standardized method for collection of data on these patients and tools for retrieving this information in an organized manner for use in scientific studies.

  6. MR imaging of subcallosal artery infarct causing amnesia after surgery for anterior communicating artery aneurysm.

    Science.gov (United States)

    Mugikura, S; Kikuchi, H; Fujii, T; Murata, T; Takase, K; Mori, E; Marinković, S; Takahashi, S

    2014-12-01

    During surgery to treat an aneurysm in the anterior communicating artery, injury to the subcallosal artery, a perforator of the anterior communicating artery, may lead to infarction that produces basal forebrain amnesia after surgery. Our purpose was to examine whether 3D MR imaging can detect subcallosal artery infarction in patients with amnesia after surgery for an anterior communicating artery aneurysm. We evaluated 3D-T2-weighted MR images obtained a median of 4 months after treatment of anterior communicating artery aneurysm for the presence of infarcted foci in 10 consecutive patients with postoperative amnesia. Because the subcallosal artery and its neighboring perforator, the recurrent artery of Heubner, were considered the most easily affected vessels during that surgery, we focused mainly on 8 regions of the subcallosal artery territory per hemisphere and 5 regions of the recurrent artery of Heubner territory per hemisphere. All 10 patients had infarcts in the territory of the subcallosal artery (median, 9 regions per patient), and most were bilateral (9 of 10 patients). Five patients had additional infarcted foci in the territory of the recurrent artery of Heubner (median, 1 region per patient), all unilateral. Among the regions perfused by the subcallosal artery, the column of the fornix was involved in all patients; the anterior commissure, in 9; and the paraterminal gyrus, in 8 patients. 3D MR imaging revealed subcallosal artery infarction, the distribution of which was mostly bilateral, presumably owing to the unpairedness of that artery, in patients with postoperative amnesia after anterior communicating artery aneurysm repair. © 2014 by American Journal of Neuroradiology.

  7. Resection of Celiac Artery Aneurysm with Bypass Grafting to the Splenic and Common Hepatic Arteries.

    Science.gov (United States)

    Pattakos, Gregory; Tolpin, Daniel; Ott, David A

    2017-02-01

    Celiac artery aneurysms are rare and typically warrant surgical treatment. Atherosclerosis is their chief cause. Symptomatic patients usually present with abdominal pain. Surgical resection of celiac artery aneurysms is associated with low morbidity and mortality rates. We report the case of a patient whose 2.2-cm celiac artery aneurysm we resected, with subsequent saphenous vein bypass grafting from the celiac trunk to the splenic and common hepatic arteries. In addition, we briefly discuss other treatment options.

  8. Origin of left accessory hepatic artery from the left gastric artery in a ...

    African Journals Online (AJOL)

    We report a case of accessory hepatic artery that arose from the left gastric artery, entered the liver at an independent site from the porta hepatis to supply the left lobe of the liver. Transplantation of such livers with multi vascular pedicles may pose a challenge during anastomosis of these accessory hepatic arteries of the ...

  9. Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome.

    NARCIS (Netherlands)

    van Petersen, Andre S.; Kolkman, Jeroen; Gerrits, Dick G; van der Palen, Job; Zeebregts, Clark J.; Geelkerken, Robert H

    OBJECTIVE: Although extensive collateral arterial circulation will prevent ischemia in most patients with stenosis of a single mesenteric artery, mesenteric ischemia may occur in these patients, for example, in patients with celiac artery compression syndrome (CACS). Variation in the extent of

  10. Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome

    NARCIS (Netherlands)

    van Petersen, Andre S.; Kolkman, Jeroen J.; Gerrits, Dick G.; van der Palen, Job; Zeebregts, Clark J.; Geelkerken, Robert H.

    Objective: Although extensive collateral arterial circulation will prevent ischemia in most patients with stenosis of a single mesenteric artery, mesenteric ischemia may occur in these patients, for example, in patients with celiac artery compression syndrome (CACS). Variation in the extent of

  11. Total Arterial Minimally Invasive Direct Coronary Artery Bypass Surgery Facilitated by the Trinity Clip Connector

    NARCIS (Netherlands)

    Stecher, David; Bronkers, Glenn; Höfer, Imo E.; Pasterkamp, Gerard; Buijsrogge, Marc P

    2015-01-01

    OBJECTIVE: This pilot study evaluated the feasibility of total arterial minimally invasive direct coronary artery bypass surgery by using the Trinity Clip anastomotic connector in an acute porcine model. METHODS: In 3 pigs, the left and right internal thoracic arteries (LITA and RITA) were harvested

  12. Accessory Renal Arteries: A Cadaveric Study.

    Directory of Open Access Journals (Sweden)

    Bina.K.Katariya

    2015-12-01

    Full Text Available Objectives: Renal arteries normally arise from the abdominal aorta at the level L1 vertebra. Accessory renal arteries were arising from abdominal aorta below the normal renal artery. Understanding anatomy of the vascular variation of kidney is essential for the clinician to perform procedures such as renal transplantation, interventional radiological procedures and renal vascular operations more safely and efficiently. No medical history of the cadaver was available to corroborate the clinical findings. The aim of the study was to establish the incidence and characteristics of accessory arteries in human kidneys. Methods: The present study was conducted on formalin fixed thirty two cadavers (irrespective of sex during routine dissection of abdomen by the undergraduate medical students from the department of anatomy, B.J.Medical College, Ahmedabad, Gujarat. Results: In present study we found accessory arteries were seen in three kidneys .All were arising from the abdominal aorta below the normal renal artery. These were more common on the left side and at the lower pole. The artery cranial to the normal renal artery entered the anterior aspect of the kidney 4 cm below the upper pole. Two accessory arteries were seen in one kidney on right side which is cranial & caudal to normal renal artery at the distance of 1.6 cm &3.9 cm from lower part of hilum respectively. Conclusion: Knowledge of the variations in the renal arteries is important for urologists, radiologists and surgeons in general. It is of great importance in performing operations like segmental resections, partial nephrectomy, and renal transplantation

  13. Nitroglycerine-induced vasodilation in coronary and brachial arteries in patients with suspected coronary artery disease.

    Science.gov (United States)

    Maruhashi, Tatsuya; Kajikawa, Masato; Nakashima, Ayumu; Iwamoto, Yumiko; Iwamoto, Akimichi; Oda, Nozomu; Kishimoto, Shinji; Matsui, Shogo; Higaki, Tadanao; Shimonaga, Takashi; Watanabe, Noriaki; Ikenaga, Hiroki; Hidaka, Takayuki; Kihara, Yasuki; Chayama, Kazuaki; Goto, Chikara; Aibara, Yoshiki; Noma, Kensuke; Higashi, Yukihito

    2016-09-15

    Nitroglycerine-induced vasodilation, an index of endothelium-independent vasodilation, is measured for the assessment of vascular smooth muscle cell function or alterations of vascular structure. Both coronary and brachial artery responses to nitroglycerine have been demonstrated to be independent prognostic markers of cardiovascular events. The purpose of this study was to evaluate the nitroglycerine-induced vasodilation in coronary and brachial arteries in the same patients. We measured nitroglycerine-induced vasodilation in coronary and brachial arteries in 30 subjects with suspected coronary artery disease who underwent coronary angiography (19 men and 11 women; mean age, 69.0±8.8years; age range, 42-85years). The mean values of nitroglycerine-induced vasodilation in the brachial artery, left anterior descending coronary artery, and left circumflex coronary artery were 12.6±5.2%, 11.6±10.3%, and 11.9±11.0%, respectively. Nitroglycerine-induced vasodilation in the brachial artery correlated significantly with that in the left anterior descending coronary artery (r=0.43, P=0.02) and that in the left circumflex coronary artery (r=0.49, P=0.006). There was also a significant correlation between nitroglycerine-induced vasodilation in the left anterior descending coronary artery and that in the left circumflex coronary artery (r=0.72, Parteries and that in coronary arteries are simultaneously present. Nitroglycerine-induced vasodilation in the brachial artery could be used as a surrogate for that in a coronary artery and as a prognostic marker for cardiovascular events. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Heterogeneity in conduit artery function in humans: impact of arterial size.

    Science.gov (United States)

    Thijssen, Dick H J; Dawson, Ellen A; Black, Mark A; Hopman, Maria T E; Cable, N Timothy; Green, Daniel J

    2008-11-01

    To determine whether conduit artery size affects functional responses, we compared the magnitude, time course, and eliciting shear rate stimulus for flow-mediated dilation (FMD) in healthy men (n = 20; 31 +/- 7 yr). Upper limb (brachial and radial) and lower limb (common and superficial femoral) FMD responses were simultaneously assessed, whereas popliteal responses were measured in the same subjects during a separate visit. Glyceryl trinitrate (GTN)-mediated responses were similarly examined. Edge detection and wall tracking of high-resolution B-mode arterial ultrasound images, combined with synchronized Doppler waveform envelope analysis, were used to calculate conduit artery diameter, blood flow, and shear rate continuously across the cardiac cycle. Baseline artery size correlated inversely with the FMD response (r = -0.57, P < 0.001). Within-artery comparisons revealed a significant inverse correlation between artery size and FMD% for the radial (r = -0.66, P = 0.001), brachial (r = -0.55, P = 0.01), and popliteal artery (r = -0.48, P = 0.03), but not for the superficial and common femoral artery. Normalization of FMD responses for differences in eliciting shear rate did not abolish the between-artery relationship for artery function and size (r = -0.48, P < 0.001), suggesting that differences between artery function responses were not entirely due to size-related differences in shear rate. This was reinforced by a significant between-artery correlation for GTN responses and baseline artery size (r = -0.74, P < 0.001). In summary, systematic differences exist in vascular function responses of conduit arteries that differ in size. This raises the possibility that differences in artery size within or between individuals may influence functional responses.

  15. Carotid stenosis, x-ray of the right artery (image)

    Science.gov (United States)

    ... the right carotid artery showing a severe narrowing (stenosis) of the internal carotid artery just past the ... artery or ulceration in the area after the stenosis in this close-up film. Note the narrowed ...

  16. Contrast Media Delivery in the Assessment of Anomalous Left Coronary Artery From the Pulmonary Artery.

    Science.gov (United States)

    Saade, Charbel; Al-Hamra, Salam; Al-Mohiy, Hussain; El-Merhi, Fadi

    2016-05-01

    A patient with a history of mitral valve prolapse and regurgitation that was corrected with a mitral ring repair 15 years earlier received a diagnosis of anomalous left coronary artery arising from the pulmonary artery and underwent repair. Coronary computed tomography angiography (CTA) was employed to image the patient before surgical intervention. Synchronizing contrast media administration to opacify the right coronary artery in the arterial phase and the left coronary artery in the venous phase required a test-bolus approach. Matching compromised cardiovascular dynamics with patient-specific contrast media administration protocols was improved considerably with the use of a test-bolus technique during electrocardiography-gated coronary CTA.

  17. Coronary artery bypass grafting following simultaneous treatment of abdominal aortic aneurysm and peripheral arterial disease.

    Science.gov (United States)

    Temizkan, Veysel; Ugur, Murat; Alp, Ibrahim; Ucak, Alper; Yedekci, Erturk; Yilmaz, Ahmet Turan

    2014-01-01

    Atherosclerosis might affect all arterial segments of the vascular system, thus peripheral arterial disease (PAD) accompanying coronary artery disease (CAD) is not uncommon. In addition to this coexistence, abdominal aortic aneurysm (AAA) is frequently associated with CAD. Although treatment strategies of CAD and PAD or CAD and AAA has been reported previously, treatment of these three pathologies has not been reported. The management of a therapeutic strategy is important for avoiding perioperative mortality and morbidity in CAD associated with AAA and PAD. We are reporting our simultaneous treatment strategy of three pathologies with endovascular AAA repair, stent implantation into the superficial femoral artery (SFA) and coronary artery bypass grafting (CABG).

  18. La revascularisation chirurgicale des lésions occlusives de l'artère ...

    African Journals Online (AJOL)

    The most common etiology was atherosclerosis. Ischemic disorders of the upper limb were the main indications for correction of these lesions. All patients underwent surgery mainly by a carotid-axillary artery bypass. We had no complications in surgery follow-up. Keys words: Subclavian artery, subclavian steal syndrome, ...

  19. Case report

    African Journals Online (AJOL)

    raoul

    2011-08-17

    Aug 17, 2011 ... 3. Davidovic LB, Markovic DM, Pejkic SD, Kovacevic NS, Colic MM, Doric PM. Subclavian artery aneurysms. Asian J Surg. 2003; 26: 7-11. This article on PubMed. 4. Windfuhr JP, Schubert D, Remmert S. Aneurysm of the subclavian artery. An unusual cause of dysphagia. HNO. 2004 Dec;52(12):1097-. 102.

  20. Animal models of cerebral arterial gas embolism

    NARCIS (Netherlands)

    Weenink, Robert P.; Hollmann, Markus W.; van Hulst, Robert A.

    2012-01-01

    Cerebral arterial gas embolism is a dreaded complication of diving and invasive medical procedures. Many different animal models have been used in research on cerebral arterial gas embolism. This review provides an overview of the most important characteristics of these animal models. The properties

  1. Multimodality imaging of coronary artery bypass grafts

    NARCIS (Netherlands)

    Salm, Liesbeth Pauline

    2006-01-01

    This thesis describes multiple imaging modalities to examine coronary artery bypass grafts, and the research which was performed to further develop noninvasive imaging techniques to detect stenoses in native coronary arteries and bypass grafts in patients who experienced recurrent chest pain after

  2. Venous and arterial thrombosis in dialysis patients

    NARCIS (Netherlands)

    Ocak, Gurbey; Vossen, Carla Y.; Rotmans, Joris I.; Lijfering, Willem M.; Rosendaal, Frits R.; Parlevliet, Karien J.; Krediet, Ray T.; Boeschoten, Els W.; Dekker, Friedo W.; Verduijn, Marion

    2011-01-01

    Whether the risk of both venous and arterial thrombosis is increased in dialysis patients as compared to the general population is unknown. In addition, it is unknown which subgroups are at highest risk. Furthermore, it is unknown whether having a history of venous thrombosis or arterial thrombosis

  3. Totally thrombosed giant anterior communicating artery aneurysm

    Directory of Open Access Journals (Sweden)

    V R Roopesh Kumar

    2015-01-01

    Full Text Available Giant anterior communicating artery aneurysmsarerare. Apatient presented with visual dysfunction, gait ataxia and urinary incontinence. MRI showed a giant suprasellar mass.At surgery, the lesion was identified as being an aneurysm arising from the anterior communicating artery.The difficulty in preoperative diagnosis and relevant literature are reviewed.

  4. Alcohol consumption and arterial stiffness in men

    NARCIS (Netherlands)

    Sierksma, A.; Muller, M.; Schouw, Y.T. van der; Grobbee, D.E.; Hendriks, H.F.J.; Bots, M.L.

    2004-01-01

    Objective: Moderate alcohol consumption has been proposed to be anti-atherogenic and protect against coronary heart disease. Arterial stiffness provides a summary measure of atherosclerotic arterial damage and cardiovascular risk. A vascular protective effect of moderate alcohol consumption would be

  5. Secondary postpartum haemorrhage with uterine artery ...

    African Journals Online (AJOL)

    a left uterine artery PA, which measured 4 cm in diameter, with extravasation of contrast into a pocket that connected to the uterine cavity. After obtaining the patient's consent, selective left uterine artery embolisation was performed with a mixture of Gelfoam and contrast media, followed by one stainless steel coil insertion.

  6. Posterior auricular artery-middle cerebral artery bypass: a rare superficial temporal artery variant with well-developed posterior auricular artery-case report.

    Science.gov (United States)

    Tokugawa, Joji; Nakao, Yasuaki; Kudo, Kentaro; Iimura, Koji; Esaki, Takanori; Yamamoto, Takuji; Mori, Kentaro

    2014-01-01

    The posterior auricular artery (PAA) is one of the branches of the external carotid artery, but is usually too small for use as a donor artery for middle cerebral artery (MCA) territory revascularization. An extremely unusual case of PAA-MCA anastomosis was performed in a patient requiring MCA territory revascularization because the superficial temporal artery (STA) parietal branch was absent and the PAA was large enough. A 65-year-old man developed mild motor weakness in the right extremities caused by multiple small infarctions. Single photon emission computed tomography (CT) revealed deterioration of the vascular reserve capacity in the left MCA area. Cerebral angiography showed severe stenosis in the C2 portion of the left internal carotid artery, absence of the parietal branch of the left STA, and a well-developed PAA extending to the parietal area. The patient underwent STA (frontal branch)-MCA and PAA-MCA double anastomosis, and has suffered no stroke or transient ischemic attack. The STA with no bifurcation is known as a rare variation. The PAA also occurs with size variations but well-developed PAA is thought to be extremely rare. PAA can be used as a donor artery for MCA territory revascularization if the vessel size is suitable. Preoperative evaluation of the anatomy is mandatory for harvesting the arteries.

  7. Arterial hypoxaemia in cirrhosis: fact or fiction?

    DEFF Research Database (Denmark)

    Møller, S; Hillingsø, J; Christensen, E

    1998-01-01

    BACKGROUND: Although low arterial oxygen tension (Po2) has been claimed to occur in one to two thirds of patients with cirrhosis, hypoxaemia appears to be rare in clinical practice. AIMS: To assess the frequency of arterial hypoxaemia in cirrhosis in relation to clinical and haemodynamic characte...

  8. Increased arterial compliance in decompensated cirrhosis

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Møller, Søren; Schifter, S

    1999-01-01

    of CGRP (r=0.34, pinverse correlation was present to MAP (r= -0.63, pinversely related...... to the level of arterial blood pressure. The altered static and dynamic functions of the arterial wall in cirrhosis may have implications for the circulatory and homoeostatic derangement, and potentially for therapy with vasoactive drugs....

  9. Acute renal artery thrombosis after kidney transplantation

    Directory of Open Access Journals (Sweden)

    Murat Özban

    2014-12-01

    Full Text Available Early kidney transplant loss as a result of acute thrombosis of the renal artery remains a constant and devastating complication, with an incidence of 0.2-7.5%. While uncommon, arterial obstruction in the early postoperative period is a surgical emergency and must be ruled out if previously established diuresis ceases suddenly. Arterial thrombosis may occur as a result of injury to a diseased artery, problems with anastomoses, hypercoagulability or malpositioning of the allograft. In this study, we analyzed data on a group of 105 renal transplant recipients who presented with acute postoperative graft dysfunction between January 2006 and May 2012, to identify cases of acute renal artery thrombosis. We report on our experience of immediate re-transplantation following early kidney transplant thrombosis. Overall, two (1.9% patients suffered early (within 48 hours of surgery allograft renal artery thrombosis. In both patients, transplantation had not been complicated by atherosclerotic lesions or other thrombophilic states and postoperative diuresis had been successfully achieved, but diuresis ceased abruptly during the early postoperative period. Emergent duplex ultrasound scans were performed and acute renal artery thrombosis was detected in both patients. The patients were operated immediately and retransplantation procedures were conducted. We have reported our experience of immediate retransplantation following early primary graft dysfunction due to renal artery thrombosis. In conclusion, close monitoring of postoperative diuresis and, if necessary, immediate retransplantation in this situation can prove to be a successful treatment for preventing graft loss.

  10. Angioplasty and stent placement - carotid artery - discharge

    Science.gov (United States)

    ... E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 60. Read More Carotid artery disease Carotid artery surgery Recovering after stroke Risks of tobacco Smoking - tips on how to quit Stent Stroke ...

  11. Medical treatment in carotid artery intervention

    NARCIS (Netherlands)

    Kolkert, J. L.; Meerwaldt, R.; Lefrandt, Johan; Geelkerken, R. H.; Zeebregts, C. J.

    2011-01-01

    Medical treatment has a pivotal role in the treatment of patients with occlusive carotid artery disease. Large trials have provided the justification for operative treatment besides medical treatment in patients with recent significant carotid artery stenosis two decades ago. Since then, medical

  12. Arterial haptoglobin : expression, regulation and function

    NARCIS (Netherlands)

    Smeets, Mirjam B.

    2003-01-01

    Several studies have demonstrated that collagen turnover is important during arterial restructuring. However, the precise mediators involved in collagen turnover are still not known. In order to develop specific inhibitors to prevent arterial restructuring, it is essential to get a better

  13. Ruptured Retina Artery Macroaneurysm Presenting with Recurrent ...

    African Journals Online (AJOL)

    A 74-year-old hypertensive presented with recurrent vitreous haemorrhage. Examination showed a ruptured retinal arterial macroaneurysm. Control of systemic hypertension was associated with resolution. Risk factors and management are discussed. Ruptured retinal arterial macroaneurysm should be considered in ...

  14. Secondary postpartum haemorrhage with uterine artery ...

    African Journals Online (AJOL)

    Uterine artery pseudoaneurysm (PA) is a rare but serious complication of caesarean section (C/S). If inadequately treated, it can lead to life-threatening postpartum haemorrhage. We report the case of a 28-year-old woman who developed secondary postpartum haemorrhage resulting from uterine artery PA after C/S.

  15. Arterial baroreflex resetting mediates postexercise reductions in arterial pressure and heart rate.

    Science.gov (United States)

    Chandler, M P; Rodenbaugh, D W; DiCarlo, S E

    1998-11-01

    We tested the hypothesis that postexercise reductions in arterial pressure and heart rate (HR) are mediated by a lowering of the operating point and a reduction in the gain of the arterial baroreflex. To test this hypothesis, spontaneous changes in arterial pressure and the reflex responses of HR were examined before and after a single bout of mild to moderate dynamic exercise in 19 spontaneously hypertensive rats (SHR, 10 male and 9 female). Eleven SHR subjected to sinoaortic denervation (SAD) (6 male, 5 female) were also studied. All rats were instrumented with an arterial catheter for the measurement of arterial pressure and HR. After exercise, arterial pressure and HR were reduced below preexercise levels. Furthermore, the operating point and spontaneous gain (G) of the arterial baroreflex were reduced. Specifically, after exercise, the spontaneous range of HR (P1, 50%), the pressure at the midpoint of the pressure range (P3, 13%) and the HR at the midpoint of the HR range (H3, 10%), the spontaneous minimum HR (P4, 8%) and maximum HR (10%), and G (76%) were significantly attenuated. SAD significantly attenuated the relationship between arterial pressure and HR by reducing G (males 94%, females 95%). These results demonstrate that acute exercise resulted in a postexercise resetting of the operating point and a reduction in the gain of the arterial baroreflex. Furthermore, these data suggest that postexercise reductions in arterial pressure and HR are mediated by a lowering of the operating point of the arterial baroreflex.

  16. Radial artery approach for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Seung Hun; Shim, Hyung Jin; Kwak, Byung Kook; Kim, Gi Hyun; Lee, Hwa Yeon; Song, In Sup; Kim, Yang Soo [College of Medicine, Chungang Univ., Seoul (Korea, Republic of)

    2002-03-01

    To evaluate the feasibility and usefulness of the transradial approach for intra-arterial chemoembolization therapy in patients with hepatocellular carcinomas. Twenty-nine patients with hepatocellular carcinoma who underwent intra-arterial chemoembolization via the radial artery approach were involved in this study. All underwent Allen's test to check ulnar arterial patency. In all cases, we used the radial approach hepatic artery (RHA) catheter designed by ourselves, evaluating the selection ability of the hepatic artery using an RHA cathter, the number of punctures, the procedure time, and compression time at the puncture site as well as complications occurring during and after the procedure. Except for three in which puncture failure, brachial artery variation or hepatic artery variation occurred, all procedures were successful. The mean number of punctures was 3.5 and the average duration of the whole procedure was one and half hours. This gradually decreased as the number of procedures increased. The average duration at a compression of puncture site was 12 minutes. There were no major complications. Minor complications included minimal intimal dissection of the radial artery (3.8%), reversible vasospasm of the radial artery (7.7%), hematoma at a puncture site (7.7%) and transient neurologic deficit (3.8%). The transradial approach using an RHA catheter for intra-arterial chemoembolization theraphy in patients with hepatocellular carcinomas was technically feasible, with acceptable levels of safety. It may be a good alternative to absolute bed rest with a sand bag after the femoral approach.

  17. Basilar artery occlusion following yoga exercise: a case report.

    Science.gov (United States)

    Fong, K Y; Cheung, R T; Yu, Y L; Lai, C W; Chang, C M

    1993-01-01

    Basilar artery occlusion developed in a 34 year old woman 2 months after adopting unusual neck postures during yoga practice. On angiography, her basilar artery was filled with intraluminal clot while the vertebral arteries were normal. We postulate that a severe reduction in blood flow and possibly an intimal tear triggered thrombosis of the vertebral artery and that the final stroke mechanism was artery-to-artery embolism.

  18. Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery

    Directory of Open Access Journals (Sweden)

    Venkat Gangadharan MD

    2017-01-01

    Full Text Available A 36-year-old woman was seen with complaints of exertional chest pain and shortness of breath. Her medical history included atrial fibrillation and diabetes. Physical examination was unremarkable except for an irregular cardiac rhythm. Myocardial perfusion imaging revealed the presence of a large area of infarction involving the entire anterior and apical walls and part of the anteroseptal wall with minimal periinfarct ischemia. Computed tomography coronary angiogram revealed an anomalous left main coronary artery arising from the main pulmonary artery. Right and left heart catheterizations demonstrated moderate pulmonary hypertension with a slight step-up in oxygen saturation between the right ventricle and main pulmonary artery. Coronary angiography showed a large tortuous right coronary artery with collaterals to the left anterior descending artery that drained into the main pulmonary artery. She was referred for surgery. This case demonstrates a rare coronary artery anomaly in an adult where survival is dependent on collateral circulation.

  19. Estudo anatomotopográfico do canal arterial em fetos natimortos dirigido para sua abordagem por videotoracoscopia Anatomotopographic study of ductus arteriosus in newborn cadavers directed for its videotoracoscopic approach

    Directory of Open Access Journals (Sweden)

    Josué Viana de Castro Neto

    2001-03-01

    Full Text Available Este trabalho objetiva realizar um estudo anatomotopográfico do Canal Arterial em fetos natimortos enfatizando o seu comprimento e seu diâmetro de acordo com o tamanho de cada feto. Além de que, descrevemos as distâncias entre este e pontos de reparo importantes para sua abordagem por videotoracoscopia. Estudamos dezesseis fetos natimortos, sendo que oito eram do sexo masculino. O tamanho do feto e os perímetros torácico e cefálico variaram de 42-57, 26-35 e 29-35,5 cm, respectivamente. A média de comprimento e diâmetro foram 11,06 e 5,56 cm. Distâncias entre o Canal e as seguintes estruturas: clavícula-22,13mm, segunda costela-20,75mm, esterno-33,88mm e a.subclávia esquerda-5,30mm. Acreditamos que as medidas apresentadas podem facilitar a abordagem do canal por videotoracoscopia.The purpose of this work is to realize an anatomic and topographic study of the ductus arteriosus in newborn cadavers emphasizing its lenght and diameter according to each size of the newborn cadaver. We also describe distances between the ductus and important structures for thoracoscopic approach. We study sixteen newborn cadavers. Eight were male. Size of the cadavers, thoracic and cephalic perimeters ranged from 42-47,26-35 and 29-35,5 cm, respectively. Median lenght and diameter were 11,06 and 5,56 mm. Distances between ductus arteriosus and follow structures were: collarbone-22,13mm, second rib-20,75mm, sternum-33,88mm and left subclavian artery-5,30mm. We belived that these distances described can facilitate thoracoscopic surgical approach to the ductus arteriosus.

  20. Arterial hypertension and chronic liver disease

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Møller, S

    2005-01-01

    , calcitonin gene-related peptide, nitric oxide, and other vasodilators, and is most pronounced in the splanchnic area. This provides an effective (although relative) counterbalance to raised arterial blood pressure. Subjects with arterial hypertension (essential, secondary) may become normotensive during...... the development of chronic liver disease, and arterial hypertension is rarely manifested in patients with cirrhosis, even in those with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial......This review looks at the alterations in the systemic haemodynamics of patients with chronic liver disease (cirrhosis) in relation to essential hypertension and arterial hypertension of renal origin. Characteristic findings in patients with cirrhosis are vasodilatation with low overall systemic...

  1. Pulse Wave Propagation in the Arterial Tree

    Science.gov (United States)

    van de Vosse, Frans N.; Stergiopulos, Nikos

    2011-01-01

    The beating heart creates blood pressure and flow pulsations that propagate as waves through the arterial tree that are reflected at transitions in arterial geometry and elasticity. Waves carry information about the matter in which they propagate. Therefore, modeling of arterial wave propagation extends our knowledge about the functioning of the cardiovascular system and provides a means to diagnose disorders and predict the outcome of medical interventions. In this review we focus on the physical and mathematical modeling of pulse wave propagation, based on general fluid dynamical principles. In addition we present potential applications in cardiovascular research and clinical practice. Models of short- and long-term adaptation of the arterial system and methods that deal with uncertainties in personalized model parameters and boundary conditions are briefly discussed, as they are believed to be major topics for further study and will boost the significance of arterial pulse wave modeling even more.

  2. Minimally invasive coronary artery bypass grafting versus coronary angioplasty for isolated type C stenosis of the left anterior descending artery

    NARCIS (Netherlands)

    Mariani, MA; Boonstra, PW; Grandjean, JG; Monnink, SHJ; denHeijer, P; Crijns, HJGM

    Background: Isolated stenosis of the left anterior descending coronary artery can be treated with medication, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting. Recently a new treatment has been developed, which is called minimally invasive direct coronary artery

  3. Anatomy of Inferior Mesenteric Artery in Fetuses

    Directory of Open Access Journals (Sweden)

    Ayesha Nuzhat

    2016-01-01

    Full Text Available Aim. To analyze Inferior Mesenteric Artery in fetuses through its site of origin, length, diameter, and variation of its branches. Method. 100 fetuses were collected from various hospitals in Warangal at Kakatiya Medical College in Andhra Pradesh, India, and were divided into two groups, group I (second-trimester fetuses and group II (third-trimester fetuses, followed by dissection. Result. (1 Site of Origin. In group I fetuses, origin of Inferior Mesenteric Artery was at third lumbar vertebra in 33 out of 34 fetuses (97.2%. In one fetus it was at first lumbar vertebra, 2.8%. In all group II fetuses, origin of Inferior Mesenteric Artery was at third lumbar vertebra. (2 Length. In group I fetuses it ranged between 18 and 30 mm, average being 24 mm except in one fetus where it was 48 mm. In group II fetuses the length ranged from 30 to 34 mm, average being 32 mm. (3 Diameter. In group I fetuses it ranged from 0.5 to 1 mm, and in group II fetuses it ranged from 1 to 2 mm, average being 1.5 mm. (4 Branches. Out of 34 fetuses of group I, 4 fetuses showed variation. In one fetus left colic artery was arising from abdominal aorta, 2.9%. In 3 fetuses, Inferior Mesenteric Artery was giving a branch to left kidney, 8.8%. Out of 66 fetuses in group II, 64 had normal branching. In one fetus left renal artery was arising from Inferior Mesenteric Artery, 1.5%, and in another fetus one accessory renal artery was arising from Inferior Mesenteric Artery and entering the lower pole of left kidney. Conclusion. Formation, course, and branching pattern of an artery depend on development and origin of organs to attain the actual adult position.

  4. Minimum training requirement in ultrasound imaging of peripheral arterial disease

    DEFF Research Database (Denmark)

    Eiberg, J P; Hansen, M A; Grønvall Rasmussen, J B

    2008-01-01

    To demonstrate the minimum training requirement when performing ultrasound of peripheral arterial disease.......To demonstrate the minimum training requirement when performing ultrasound of peripheral arterial disease....

  5. [Cerebral artery thrombosis in pregnancy].

    Science.gov (United States)

    Charco Roca, L M; Ortiz Sanchez, V E; Hernandez Gutierrez-Manchon, O; Quesada Villar, J; Bonmatí García, L; Rubio Postigo, G

    2015-11-01

    A 28 year old woman, ASA I, who, in the final stages of her pregnancy presented with signs of neural deficit that consisted of distortion of the oral commissure, dysphagia, dysarthria, and weakness on the left side of the body. She was diagnosed with thrombosis in a segment of the right middle cerebral artery which led to an ischemic area in the right frontal lobe. Termination of pregnancy and conservative treatment was decided, with good resolution of the symptoms. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Popliteal Artery Aneurysm in Women

    DEFF Research Database (Denmark)

    Ravn, Hans; Pansell-Fawcett, Karin; Björck, Martin

    2017-01-01

    OBJECTIVES: Ninety-five per cent of those operated on for popliteal artery aneurysm (PA) are men. Thus, PAs in women are difficult to investigate. The aim was to study the disease in women. METHODS: Women treated for PA in 1987-2012, prospectively registered in the Swedish vascular registry......, Swedvasc, supplemented by case records, were compared with the larger male cohort. Survival was determined through cross linkage with the National Population Registry. RESULTS: 1509 patients (men and women), 1872 legs, were identified; of these 74 patients (4.9%) were women, 81 legs (4.3%). The median age...... was 70 years in women versus 69 in men. Twenty-nine centres operated on women (range 1-7 women/centre). There were no time trends in the proportion of women operated on (p=.5). Bilateral PA occurred in 9.5% of women and 27.0% of men (p=.002). For symptomatic aneurysms, there was a larger proportion...

  7. Differential imaging features of pulmonary artery dissection from other intraluminal diseases of pulmonary artery: Two cases report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Joo Ho; Shin, Hyun Woong; Sohn, Kung Rak; Lee, Yil Gi [Daegu Fatima Hospital, Daegu(Korea, Republic of)

    2015-03-15

    Pulmonary artery dissection is rarer than other intraluminal diseases of pulmonary artery such as pulmonary thromboembolism or pulmonary artery sarcoma. We report two cases of pulmonary artery dissection mimicking pulmonary artery sarcoma. Computed tomography (CT) showed no enhancement of intrapulmonary arterial lesion or expansion of involved pulmonary artery. Magnetic resonance imaging (MRI) showed low-signal intensity intimal flap on T1- and T2-weighted images. There was no fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)-CT. In this case report, we describe the imaging features of pulmonary artery dissection on CT, MRI, and PET-CT.

  8. Total Arterial Minimally Invasive Direct Coronary Artery Bypass Surgery Facilitated by the Trinity Clip Connector.

    Science.gov (United States)

    Stecher, David; Bronkers, Glenn; Hoefer, Imo E; Pasterkamp, Gerard; Buijsrogge, Marc P

    2015-01-01

    This pilot study evaluated the feasibility of total arterial minimally invasive direct coronary artery bypass surgery by using the Trinity Clip anastomotic connector in an acute porcine model. In 3 pigs, the left and right internal thoracic arteries (LITA and RITA) were harvested conventionally and the chest closed subsequently. After a left lateral thoracotomy, the coronary target was positioned and stabilized by an endo-starfish and octopus. A free RITA-to-LITA y-graft, with a LITA-to-left anterior descending coronary artery (LAD) and a free RITA-to-obtuse marginal or posterolateral or posterior descending artery, was constructed using the Trinity Clip. Patency was assessed with angiography (n = 3 anastomoses). The anastomotic procedure was feasible via a small lateral thoracotomy, with a fast construction of the y-graft, and successful application of the mounted complex (ie, graft, connector, and laser, temporarily fixated by a fixation clip) onto the LAD. Access to the obtuse marginal artery, posterolateral artery, and posterior descending artery was possible, with successful construction, resulting in patent anastomoses. This experimental pilot study demonstrates the feasibility of the anastomotic technique in a total arterial minimally invasive direct coronary artery bypass approach. Revascularization of the anterior, lateral, and inferoposterior regions of the heart is possible. However, visibility during the introduction of the connector was limited, and videoscopic assistance is essential to allow for successful construction. The anastomotic technique has potential to facilitate minimally invasive coronary bypass surgery.

  9. Rescue Arterial Revascularization Using Cryopreserved Iliac Artery Allograft in Liver Transplant Patients.

    Science.gov (United States)

    Mohkam, Kayvan; Darnis, Benjamin; Rode, Agnès; Hetsch, Nathalie; Balbo, Gregorio; Bourgeot, Jean-Paul; Mezoughi, Salim; Demian, Hassan; Ducerf, Christian; Mabrut, Jean-Yves

    2017-08-01

    Management of hepatic arterial complications after liver transplant remains challenging. The aim of our study was to assess the efficacy of rescue arterial revascularization using cryopreserved iliac artery allografts in this setting. Medical records of patients with liver transplants who underwent rescue arterial revascularization using cryopreserved iliac artery allografts at a single institution were reviewed. From 1992 to 2015, 7 patients underwent rescue arterial revascularization using cryopreserved iliac artery allografts for hepatic artery pseudoaneurysm (3 patients), thrombosis (2 patients), aneurysm (1 patient), or stenosis (1 patient). Two patients developed severe complications, comprising one biliary leakage treated percutaneously, and one acute necrotizing pancreatitis causing death on postoperative day 29. After a median follow-up of 75 months (range, 1-269 mo), 2 patients had an uneventful long-term course, whereas 4 patients developed graft thrombosis after a median period of 120 days (range, 2-488 d). Among the 4 patients who developed graft thrombosis, 1 patient developed ischemic cholangitis, 1 developed acute ischemic hepatic necrosis and was retransplanted, and 2 patients did not develop any further complications. Despite a high rate of allograft thrombosis, rescue arterial revascularization using cryopreserved iliac artery allografts after liver transplant is an effective and readily available approach, with a limited risk of infection and satisfactory long-term graft and patient survival.

  10. "Ostrich sign" indicates bilateral vertebral artery dissection.

    Science.gov (United States)

    Rose, David Z; Husain, M Rizwan

    2012-11-01

    Vertebral artery dissections (VADs) comprise about 2% of ischemic strokes and can be associated with trauma, chiropractic manipulation, motor vehicle collisions, whiplash, amusement park rides, golfing, and other motion-induced injuries to the neck. We present a case of bilateral extracranial VAD as a complication of conducting an orchestra. To our knowledge, this has not been documented in the literature. Conceivably, vigorous neck twisting in an inexperienced, amateur conductor may place excessive rotational forces upon mobile portions of the verterbral arteries, tear the intima, deposit subintimal blood that extends longitudinally, and cause neck pain and/or posterior fossa ischemic symptoms. Magnetic resonance angiography examinations of axially oriented slices of bilateral VADs resemble the face of an ostrich. This observation is similar to the "puppy sign," in which bilateral internal carotid artery dissections resemble the face of a dog. Craniocervical dissections of either the carotid or vertebral arteries have the potential to form an aneurysm, cause artery-to-artery embolism, or completely occlude the parent artery, resulting in an ischemic stroke. Because bilateral VADs in axial magnetic resonance angiographic sections stand out like the eyes of an ostrich, and because the fast identification of VADs is so critical, we eponymize this image the "ostrich sign." Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. The effect of sumatriptan on cephalic arteries

    DEFF Research Database (Denmark)

    Amin, Faisal Mohammad; Asghar, Mohammad Sohail; Ravneberg, Julie W

    2013-01-01

    AIM: To explore a possible differential effect of sumatriptan on extracerebral versus cerebral arteries, we examined the superficial temporal (STA), middle meningeal (MMA), extracranial internal carotid (ICAextra), intracranial internal carotid (ICAintra), middle cerebral (MCA) and basilar arteries...... (BA). METHODS: The arterial circumferences were recorded blindly using high-resolution magnetic resonance angiography before and after subcutaneous sumatriptan injection (6 mg) in 18 healthy volunteers. RESULTS: We found significant constrictions of MMA (16.5%), STA (16.4%) and ICAextra (15.2%) ( P...

  12. Local thrombolysis in renal artery embolism

    Energy Technology Data Exchange (ETDEWEB)

    Billmann, P.; Hoerl, W.H.; Hohnloser, S.

    1985-02-01

    Thrombo-embolic occlusions of the renal arteries are usually a result of co-existing cardiac disease, in most cases cardiac arrhythmias or ischaemic heart disease. Similar findings have been observed in mesenteric infarction and embolism into the lower extremities. The duration of ischeamia determines the prognosis. Surgical intervention has been the mainstay of previous therapy. However, the application of local thrombolysis, which is an extension of the diagnostic catheter studies, provides an alternative form of treatment. As in the case of peripheral artery disease, the choice of treatment can only be made in consultation with the surgeon. This report presents experience with the use of local thrombolysis of renal artery emboli.

  13. Coronary artery calcium score: current status

    Science.gov (United States)

    Neves, Priscilla Ornellas; Andrade, Joalbo; Monção, Henry

    2017-01-01

    The coronary artery calcium score plays an Important role In cardiovascular risk stratification, showing a significant association with the medium- or long-term occurrence of major cardiovascular events. Here, we discuss the following: protocols for the acquisition and quantification of the coronary artery calcium score by multidetector computed tomography; the role of the coronary artery calcium score in coronary risk stratification and its comparison with other clinical scores; its indications, interpretation, and prognosis in asymptomatic patients; and its use in patients who are symptomatic or have diabetes. PMID:28670030

  14. Thrombophilia And Arterial Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    A.A. Abrishamizadeh

    2017-02-01

    Full Text Available Ischemic stroke (IS is a common cause of morbidity and mortality with significant socioeconomic impact especially when it affects young patients. Compared to the older adults, the incidence, risk factors, and etiology are distinctly different in younger IS. Hypercoagulable states are relatively more commonly detected in younger IS patients. Thrombophilic states are disorders of hemostatic mechanisms that result in a predisposition to thrombosis .Thrombophilia is an established cause of venous thrombosis. Therefore, it is tempting to assume that these disorders might have a similar relationship with arterial thrombosis. Despite this fact that 1-4 % of ischemic strokes are attributed to Thrombophillia, this   alone rarely causes arterial occlusions .Even in individuals with a positive thrombophilia screen and arterial thrombosis, the former might not be the primary etiological factor. Thrombophilic   disorders can be broadly divided into inherited or acquired conditions. Inherited thrombophilic states include deficiencies of natural anticoagulants such as protein C, protein S, and antithrombin III (AT III deficiency, polymorphisms causing resistance to activated protein C(Factor V Leiden mutation, and disturbance in the clotting balance (prothrombin gene 20210G/A variant. Of all the inherited  thrombophilic disorders, Factor V Leiden mutation is perhaps the commonest cause. On the contrary, acquired thrombophilic disorders are more common and include conditions such as the antiphospholipid syndrome, associated with lupus anticoagulant and anticardiolipin antibodies. The more useful and practical approach of ordering various diagnostic tests for the uncommon thrombophilic states tests should be determined by a detailed clinical history, physical examination, imaging studies and evaluating whether an underlying hypercoagulable state appears more likely. The laboratory thrombophilia   screening should be comprehensive and avoid missing the

  15. Total Pancreatectomy with Celiac Axis Resection and Hepatic Artery Restoration Using Splenic Artery Autograft Interposition.

    Science.gov (United States)

    Aosasa, Suefumi; Nishikawa, Makoto; Noro, Takuji; Yamamoto, Junji

    2016-03-01

    Although the indication of locally advanced pancreatic cancer with arterial involvement is controversial, the outcome of the patients with such disease treated by combined resection and reconstruction of the invaded artery has improved recently. For pancreatic body carcinoma invading the celiac axis, distal pancreatectomy with celiac axis resection has been safely performed. However, in case of pancreatic body carcinoma with involvement of the celiac axis, the common hepatic artery and the gastroduodenal artery, margin-negative resection requires total pancreatectomy with celiac axis resection and restoration of hepatic arterial flow. Here, we describe an interposition grafting technique using the splenic artery harvested from the resected specimen. This technique is effective and may widen the resectability of pancreatic cancer in selected patients.

  16. The efficacy of laparosonic coagulating shears for arterial division and hemostasis in porcine arteries.

    Science.gov (United States)

    Ninomiya, K; Kitano, S; Yoshida, T; Bandoh, T; Baatar, D; Matsumoto, T; Tsuboi, S

    2000-02-01

    Recently, the laparosonic coagulating shears (LCS) have been used widely in laparoscopic surgery. In the current study, the usefulness of LCS for arterial division and hemostasis was examined in porcine arteries. Porcine arteries of several diameters (1, 3, and 5 mm) were removed and divided using LCS with different blade modes: shear, blunt, and flat. The division time and bursting pressure were registered. Additionally, divided sections stained by the Azan-Mallory method were observed microscopically. The division time was dependent on the blade modes used. With the flat mode, the bursting pressure of 5-mm arteries was significantly higher than the bursting pressure with shear and blunt modes. Histologically, cavitation and mild degeneration of the vessel walls occurred adjacent to the cutting edge. The LCS is a safe and useful device for arterial division and hemostasis for 5-mm arteries if an adequate blade mode is used.

  17. Transposition of the great arteries

    Directory of Open Access Journals (Sweden)

    Castela Eduardo

    2008-10-01

    Full Text Available Abstract Transposition of the great arteries (TGA, also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial (VA discordance. The incidence is estimated at 1 in 3,500–5,000 live births, with a male-to-female ratio 1.5 to 3.2:1. In 50% of cases, the VA discordance is an isolated finding. In 10% of cases, TGA is associated with noncardiac malformations. The association with other cardiac malformations such as ventricular septal defect (VSD and left ventricular outflow tract obstruction is frequent and dictates timing and clinical presentation, which consists of cyanosis with or without congestive heart failure. The onset and severity depend on anatomical and functional variants that influence the degree of mixing between the two circulations. If no obstructive lesions are present and there is a large VSD, cyanosis may go undetected and only be perceived during episodes of crying or agitation. In these cases, signs of congestive heart failure prevail. The exact aetiology remains unknown. Some associated risk factors (gestational diabetes mellitus, maternal exposure to rodenticides and herbicides, maternal use of antiepileptic drugs have been postulated. Mutations in growth differentiation factor-1 gene, the thyroid hormone receptor-associated protein-2 gene and the gene encoding the cryptic protein have been shown implicated in discordant VA connections, but they explain only a small minority of TGA cases. The diagnosis is confirmed by echocardiography, which also provides the morphological details required for future surgical management. Prenatal diagnosis by foetal echocardiography is possible and desirable, as it may improve the early neonatal management and reduce morbidity and mortality. Differential diagnosis includes other causes of central neonatal cyanosis. Palliative treatment with prostaglandin E1 and balloon atrial septostomy are usually

  18. Case report of hepatic artery dissection secondary to hepatic artery pseudoaneurysm after living donor liver transplantation

    OpenAIRE

    Ma, Lin; Chen, Kefei; Lu, Qiang; Ling, Wenwu; Luo, Yan

    2016-01-01

    Background Hepatic artery pseudoaneurysm (HAP) and Hepatic artery dissection are rare vascular complications after living donor liver transplantation (LDLT), which may lead to graft loss and death of the recipients. Conventional gray-scale and Doppler ultrasound, as well as contrast-enhanced ultrasound (CEUS), play important roles in identifying vascular complications in the early postoperative period and during follow-up. We report a case of hepatic artery dissection secondary to HAP after L...

  19. Transcatheter arterial embolization of a pseudoaneurysm of gastroduodenal artery: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Han, Young Min; Kang, Sung Soo; Lee, Jeong Min; Chung, Jin Young; Lee, Sang Yong; Chung, Gyung Ho; Kim, Chong Soo; Sohn, Myung Hee; Choi, Ki Chul [Chonbuk National University School of Medicine, Chonju (Korea, Republic of)

    1997-01-01

    Gastroduodenal artery pseudoaneurysm is a relatively rare and potentionally life-threatening complication of chronic pancreatitis, which is thought to occur because of autodigestion of arterial walls by pancreatic enzymes. Embolotherapy should probably be the first method of treatment, since surgical treatment carries a high risk of mortality and morbidity. We report the case of 30-year-old male with gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis which was successfully treated by transcatheter embolization using Gianturco spring coils.

  20. Idiopathic pulmonary artery aneurysm treated with surgical correction and concomitant coronary artery bypass grafting.

    Science.gov (United States)

    Arnaoutakis, George; Nwakanma, Lois; Conte, John

    2009-07-01

    Idiopathic pulmonary artery aneurysm is a rare clinical entity, and therefore the natural course and clinical management are not well established. We present the case of an elderly woman with a symptomatic idiopathic pulmonary artery aneurysm who underwent surgical repair along with simultaneous coronary artery bypass grafting. With long-term follow-up presented in this report, we describe the safety and durability of surgical repair.

  1. Superior epigastric artery pseudoaneurysm- a rare complication of chest drain insertion in coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Ward Nick

    2007-04-01

    Full Text Available Abstract Background Although chest drain insertion during coronary artery bypass grafting is a fairly standard procedure, however it may result in extremely rare complications. Case presentation This is the first case being reported that demonstrates a pseudoaneurysm of superior epigastric artery resulting from chest drain insertion following coronary artery bypass grafting. Conclusion Adequate caution should be used along with good understanding of the anatomical landmarks during apparently simple and standard operative procedures.

  2. Variant termination of the common carotid artery: Cases of ...

    African Journals Online (AJOL)

    In all cases of trifurcation, superior thyroid artery was the third branch. The common carotid artery quadrifurcated into external, internal carotid, superior thyroid and ascending pharyngeal arteries. The pentafurcations comprised internal carotid, external carotid, superior thyroid, occipital and posterior auricular arteries.

  3. Origin of thyroid arteries in a Kenyan population | Magoma | Annals ...

    African Journals Online (AJOL)

    Introduction: The thyroid gland receives blood supply predominantly from paired superior and inferior thyroid arteries. The superior thyroid artery originates from external carotid while the inferior thyroid artery is a branch of thyrocervical trunk. Unusual origins of superior thyroid artery include common carotid and cervical part ...

  4. Studies on diagnosis and treatment of renal artery stenosis

    NARCIS (Netherlands)

    P. Krijnen (Pieta)

    2004-01-01

    textabstractThis thesis describes studies on ~onosis and treatment of renal artery stenosis in patients with drug-resistant hypertension. In Chapter 1, the clinical problem of renal artery stenosis is discussed. Renal artery stenosis, a narrowing of the renal artery, is a potential cause of

  5. 21 CFR 882.5175 - Carotid artery clamp.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Carotid artery clamp. 882.5175 Section 882.5175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5175 Carotid artery clamp. (a) Identification. A carotid artery clamp is a device that is surgically placed around a patient's carotid artery...

  6. Anatomical variation of arterial supply to the rabbit stomach.

    Science.gov (United States)

    Ikegami, Reona; Tanimoto, Yoshimasa; Kishimoto, Miori; Shibata, Hideshi

    2016-05-03

    Gastric stasis is common in rabbits, and gastrotomy may be performed to cure this pathological condition. Detailed descriptions of the arterial supply to the stomach are essential for this surgical operation, but published descriptions are limited. Here, we investigated anatomical variations of the arterial supply to the stomach in 43 New Zealand White rabbits by injecting colored latex into arteries. We observed that the left gastric artery that arose as the second branch from the celiac artery provided 1-3 parietal and 1-3 visceral branches to the stomach, with various branching patterns depending on the case. In 34 of 43 cases, the left gastric artery ended upon entering the gastric wall at the lesser curvature, whereas in the remaining cases, the artery continued as the hepatic artery without entering the gastric wall. The right gastric artery that branched off from the gastroduodenal artery also supplied the lesser curvature sinistrally but did not anastomose with the left gastric artery. In 40 cases, the hepatic artery provided 1-4 pyloric branches. In the fundic region, the short gastric arteries arose from the splenic artery and varied in number from 2 to 6. The right and left gastroepiploic arteries anastomosed to give 2-7 branches to the greater curvature. The results showed that many variations occurred in the arteries supplying the rabbit stomach, suggesting that such variations should be considered when performing veterinary surgical treatments in rabbits.

  7. Anomalous Gonadal Arteries in Relation to the Renal Vein: A ...

    African Journals Online (AJOL)

    ... in ovarian arteries on the right side; 37 (64%) of testicular arteries and 3 (27%) of ovarian arteries on the left side. Partial occlusion or compression of the renal vein due to the arching gonadal arteries could result in varicocele and hypertension. The knowledge of such anomalous is useful in surgery and human anatomy

  8. Cervical artery dissection following a turbulent flight.

    LENUS (Irish Health Repository)

    Quinn, Colin

    2012-01-31

    BACKGROUND: Cervical artery dissection is a common cause of stroke in young patients without vascular risk factors and may affect the carotid or vertebral arteries. The risk of spontaneous dissection is higher in those with genetic predisposing factors while other cases may be precipitated by an event involving head or neck movement or associated with direct neck trauma. CASE REPORT: We present the case of a previously well young woman with a history of migraine who developed internal carotid artery dissection following a turbulent short-haul commercial flight while restrained using a seatbelt. DISCUSSION: We propose that repetitive flexion-hyperextension neck movements encountered during the flight were the most likely precipitant of carotid artery dissection in this case and review the therapeutic options available.

  9. Unusual migration of pulmonary artery catheter

    Directory of Open Access Journals (Sweden)

    Sanjay Kuravinakop

    2007-01-01

    Full Text Available Pulmonary artery catheter is widely used in intensive care. Distal migration of the catheter is a know complication. Diagnosis of such a migration is made by both clinical criteria and radiographs. A 55 year old septic lady was admitted to the intensive care unit. Pulmonary artery catheter introduced for cardiac output monitoring migrated from right lung to left lung. Diagnosis was made following a chest radiograph the following day of insertion with the clinical criteria remaining unaltered. Migration of pulmonary artery catheter can occur not only distally but from one lung to another. Clinical criteria alone cannot rule out migration. Chest radiographs form an important part in monitoring the position of the pulmonary artery catheter.

  10. Arterial and Peripheral Sympathectomy for Vasospastic Disease

    Medline Plus

    Full Text Available Arterial and Peripheral Sympathectomy for Vasospastic Disease Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2017 BroadcastMed, Inc. All rights reserved.

  11. How Is Carotid Artery Disease Diagnosed?

    Science.gov (United States)

    ... arteries and highlights them on x-ray pictures. Magnetic Resonance Angiography Magnetic resonance angiography (MRA) uses a large magnet and ... symptoms start (do not drive yourself to the hospital). For more detailed information about the warning signs ...

  12. How Is Carotid Artery Disease Treated?

    Science.gov (United States)

    ... arteries and highlights them on x-ray pictures. Magnetic Resonance Angiography Magnetic resonance angiography (MRA) uses a large magnet and ... symptoms start (do not drive yourself to the hospital). For more detailed information about the warning signs ...

  13. How Can Carotid Artery Disease Be Prevented?

    Science.gov (United States)

    ... arteries and highlights them on x-ray pictures. Magnetic Resonance Angiography Magnetic resonance angiography (MRA) uses a large magnet and ... symptoms start (do not drive yourself to the hospital). For more detailed information about the warning signs ...

  14. Ischemic stroke: carotid and vertebral artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Vilela, P.; Goulao, A. [Hospital Garcia de Orta, Servico de Neurorradiologia, Almada (Portugal)

    2005-03-01

    Ischemic strokes may have distinct aetiologies, including several different intrinsic arterial pathological disorders. The diagnosis and understanding of these arterial diseases is critical for the correct management of stroke as different treatment approaches are undertaken according to the aetiology. Atherosclerosis is by far the most common arterial disease among adults, and other pathological processes include arterial dissection, small vessel disease, inflammatory and non-inflammatory vasculopathy and vasomotor disorders. In children, there are several vasculopathies responsible for vaso-occlusive disease such as sickle-cell anemia, acute regressive angiopathy and Moya-Moya disease, neurofibromatosis, dissections, vasculitis associated with intracranial and systemic infections. An overview of the major carotid and vertebral pathological diseases responsible for ischemic stroke in adults and children, highlighting the accuracy of the different imaging modalities for its diagnosis and the imaging appearance of these diseases, is given. (orig.)

  15. Increased arterial compliance in decompensated cirrhosis

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren; Schifter, S

    1999-01-01

    BACKGROUND/AIMS: In patients with cirrhosis, the systemic circulation is hyperdynamic with low arterial blood pressure and reduced systemic vascular resistance. The present study was undertaken to estimate the compliance of the arterial tree in relation to severity of cirrhosis, circulating level...... of the vasodilator, calcitonin gene-related peptide (CGRP) and mean arterial blood pressure (MAP). METHODS: Arterial compliance (COMPart=deltaV/deltaP) was determined as the stroke volume relative to pulse pressure (i.e. systolic minus diastolic blood pressure) during a haemodynamic evaluation of portal hypertension...... of CGRP (r=0.34, pcompliance in cirrhosis is directly related to the severity of the disease and to the elevated level of circulating vasodilator peptide CGRP, and inversely related...

  16. Evaluation of Peripheral Arterial Disease in Prediabetes

    Directory of Open Access Journals (Sweden)

    Elham Faghihimani

    2014-01-01

    Conclusions: Peripheral arterial disease is common in asymptomatic diabetes and prediabetes patients. Management of hypertensive prediabetes patients and early detection of PAD in this group as well as in asymptomatic patients is important.

  17. Spontaneous coronary artery dissection during cabergoline therapy.

    Science.gov (United States)

    Mehta, Nishaki Kiran; Malkani, Samir; Ockene, Ira

    2012-01-01

    Although spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, it should be considered during the evaluation of patients who have chest pain. Coronary vasospasm can lead to spontaneous dissection. The dopamine agonist cabergoline is known to cause digital vasospasm. Herein, we report a case of spontaneous right coronary artery dissection in a 43-year-old woman who was taking cabergoline as therapy for prolactinoma. To our knowledge, this is the first report of an apparent relationship between cabergoline therapy and spontaneous coronary artery dissection. The possible association of cabergoline with coronary artery spasm and dissection should be considered in patients who present with chest pain while taking this medication.

  18. Pressure Change in an Arterial Constriction

    Science.gov (United States)

    Mungan, Carl E.

    2015-01-01

    Consider the following ConcepTest. A platelet is drifting with the blood flowing through a horizontal artery. As the platelet enters a constriction, does the blood pressure increase, decrease, or stay the same?

  19. Angioplasty and stent placement - peripheral arteries

    Science.gov (United States)

    ... blood flow. A stent is a small, metal mesh tube that keeps the artery open. Angioplasty and ... 1570. PMID: 23473760 www.ncbi.nlm.nih.gov/pubmed/23473760 . Society for Vascular Surgery Lower Extremity Guidelines ...

  20. Successful management of uterine arteriovenous malformation by ligation of feeding artery after unsuccessful uterine artery embolization.

    Science.gov (United States)

    Yokomine, Daisaku; Yoshinaga, Mitsuhiro; Baba, Yasutaka; Matsuo, Takashi; Iguro, Yoshifumi; Nakajo, Masayuki; Douchi, Tsutomu

    2009-02-01

    Uterine arteriovenous malformation (AVM) is a rare and potentially life-threatening disease. The present report describes a postmenopausal patient with uterine AVM manifesting recurrent, massive genital bleeding. Uterine artery embolization (UAE) was scheduled before hysterectomy, but UAE was unsuccessful due to the dilated, tortuous internal iliac arteries, and extremely rapid arterial blood flow. Hysterectomy appeared to carry a potential risk of massive blood loss due to multiple dilated vessels around the uterine corpus and cervix. Therefore, six arteries feeding the uterus were surgically ligated. At 10 months after the operation there have been no episodes of atypical genital bleeding.

  1. Feasibility and Safety of Routine Transpedal Arterial Access for Treatment of Peripheral Artery Disease.

    Science.gov (United States)

    Kwan, Tak W; Shah, Sooraj; Amoroso, Nicholas; Diwan, Ravi; Makker, Parth; Ratcliffe, Justin A; Lala, Moinakhtar; Huang, Yili; Nanjundappa, Aravinda; Daggubati, Ramesh; Pancholy, Samir; Patel, Tejas

    2015-07-01

    To demonstrate the feasibility and safety of transpedal arterial access for lower-extremity angiography and intervention. Traditionally, the femoral artery is chosen for the initial access site in symptomatic peripheral artery disease (PAD), but this approach carries a substantial portion of the entire procedural complication risk. 80 patients were prospectively evaluated for the treatment of PAD between May and July 2014. All patients underwent peripheral angiography, and intervention if necessary. A pedal artery was the initial access site for all patients. Under ultrasound guidance, one of the pedal arteries was visualized and accessed, and a 4 Fr Glidesheath was inserted. Retrograde orbital atherectomy and balloon angioplasty were performed with a 4 Fr sheath or upsizing to a 6 Fr Glidesheath Slender (Terumo) for stenting as needed. Clinical and ultrasound assessment of the pedal arteries were performed before the procedure and at 1-month follow-up. Diagnostic transpedal peripheral angiography was performed in all 80 patients. 43 out of 51 patients (84%) who required intervention were successful using a pedal artery as the sole access site. No immediate or delayed access-site complications were detected. Clinical follow-up was achieved in 77 patients (96%) and access artery patency was demonstrated by ultrasound at 1 month in 100% of patients. The routine use of a transpedal approach for the treatment of PAD may be feasible and safe. Pedal artery access may also avoid many of the complications associated with the traditional femoral approach, but further study is needed.

  2. Left bronchial artery arising from a replaced left hepatic artery in a patient with massive hemoptysis

    Energy Technology Data Exchange (ETDEWEB)

    Khil, Eun Kyung; Lee, Jae Myung [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon (Korea, Republic of)

    2015-09-15

    A 70-year-old man with a 3-year history of bronchiectasis presented with massive hemoptysis that had lasted for 3 days. In our attempt to perform bronchial artery embolization, upper abdominal angiography was required to locate the left bronchial artery, which in this case was of anomalous origin, arising from a replaced left hepatic artery, which arose from the left gastric artery-a very unusual anatomical variant. We performed embolization with polyvinyl alcohol particles, and the patient's symptoms resolved completely, with no additional complications after conservative treatment.

  3. Atypical presentation of popliteal artery entrapment syndrome: involvement of the anterior tibial artery.

    Science.gov (United States)

    Bou, Steven; Day, Carly

    2014-11-01

    Popliteal artery entrapment syndrome (PAES) is a rare condition that should be suspected in a young patient with exertional lower extremity pain. We report the case of an 18-year-old female volleyball player with bilateral exertional lower extremity pain who had been previously diagnosed with tendinitis and periostitis. Diagnostic studies showed entrapment of the left popliteal artery and the left anterior tibial artery. To our knowledge, there has only been 1 previous report of anterior tibial artery involvement in PAES. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  4. Renal Artery Stenting in Patients With Documented Resistant Hypertension and Atherosclerotic Renal Artery Stenosis (ANDORRA)

    Science.gov (United States)

    2018-01-24

    Hypertension; Hypertension Resistant to Conventional Therapy; Angiographically Proven Grade III Unilateral or Bilateral Atherosclerotic Renal Artery Stenosis (ARAS) Greater Than or Equal to 60 Percent

  5. Is local intra-arterial fibrinolysis contraindicated in elderly patients with cerebral artery occlusion?

    Energy Technology Data Exchange (ETDEWEB)

    Schumacher, M.; Kraft, S.; Siekmann, R. [Freiburg Univ. (Germany). Abt. Radiologie

    1998-12-01

    Local intra-arterial fibrinolysis (LIF) is an effective treatment for selected patients in acute thromboembolic occlusion of the middle cerebral artery, vertebrobasilar system or ophthalmic artery. However, the risk/benefit ratio of thrombolysis in patient subgroups requires classification. Advanced age has been regarded as a prognostic factor for poor clinical outcome. We report our experience with LIF in seven patients with a mean age of 79 years (range 76-83 years) who represented thromboembolic occlusion of the basilar, middle cerebral or pericallosal arteries. We discuss why advanced age need not contraindicate LIF. (orig.) With 3 figs., 20 refs.

  6. The contribution of arterial calcification to peripheral arterial disease in pseudoxanthoma elasticum.

    Directory of Open Access Journals (Sweden)

    Georges Leftheriotis

    Full Text Available The contribution of arterial calcification (AC in peripheral arterial disease (PAD and arterial wall compressibility is a matter of debate. Pseudoxanthoma elasticum (PXE, an inherited metabolic disease due to ABCC6 gene mutations, combines elastic fiber fragmentation and calcification in various soft tissues including the arterial wall. Since AC is associated with PAD, a frequent complication of PXE, we sought to determine the role of AC in PAD and arterial wall compressibility in this group of patients.Arterial compressibility and patency were determined by ankle-brachial pressure index (ABI in a cohort of 71 PXE patients (mean age 48 ± SD 14 yrs, 45 women and compared to 30 controls without PAD. Lower limb arterial calcification (LLAC was determined by non-contrast enhanced helicoidal CT-scan. A calcification score (Ca-score was computed for the femoral, popliteal and sub-popliteal artery segments of both legs. Forty patients with PXE had an ABI1.40. LLAC increased with age, significantly more in PXE subjects than controls. A negative association was found between LLAC and ABI (r = -0.363, p = 0.002. The LLAC was independently associated with PXE and age, and ABI was not linked to cardiovascular risk factors.The presence of AC was associated with PAD and PXE without affecting arterial compressibility. PAD in PXE patients is probably due to proximal obstructive lesions developing independently from cardiovascular risk factors.

  7. The contribution of arterial calcification to peripheral arterial disease in pseudoxanthoma elasticum.

    Science.gov (United States)

    Leftheriotis, Georges; Kauffenstein, Gilles; Hamel, Jean François; Abraham, Pierre; Le Saux, Olivier; Willoteaux, Serge; Henrion, Daniel; Martin, Ludovic

    2014-01-01

    The contribution of arterial calcification (AC) in peripheral arterial disease (PAD) and arterial wall compressibility is a matter of debate. Pseudoxanthoma elasticum (PXE), an inherited metabolic disease due to ABCC6 gene mutations, combines elastic fiber fragmentation and calcification in various soft tissues including the arterial wall. Since AC is associated with PAD, a frequent complication of PXE, we sought to determine the role of AC in PAD and arterial wall compressibility in this group of patients. Arterial compressibility and patency were determined by ankle-brachial pressure index (ABI) in a cohort of 71 PXE patients (mean age 48 ± SD 14 yrs, 45 women) and compared to 30 controls without PAD. Lower limb arterial calcification (LLAC) was determined by non-contrast enhanced helicoidal CT-scan. A calcification score (Ca-score) was computed for the femoral, popliteal and sub-popliteal artery segments of both legs. Forty patients with PXE had an ABI1.40. LLAC increased with age, significantly more in PXE subjects than controls. A negative association was found between LLAC and ABI (r = -0.363, p = 0.002). The LLAC was independently associated with PXE and age, and ABI was not linked to cardiovascular risk factors. The presence of AC was associated with PAD and PXE without affecting arterial compressibility. PAD in PXE patients is probably due to proximal obstructive lesions developing independently from cardiovascular risk factors.

  8. Arterial prehabilitation: can exercise induce changes in artery size and function that decrease complications of catheterization?

    Science.gov (United States)

    Alkarmi, Amr; Thijssen, Dick H J; Albouaini, Khalled; Cable, N Timothy; Wright, D Jay; Green, Daniel J; Dawson, Ellen A

    2010-06-01

    Coronary angiography and angioplasty are common invasive procedures in cardiovascular medicine, which involve placement of a sheath inside peripheral conduit arteries. Sheath placement and catheterization can be associated with arterial thrombosis, spasm and occlusion. In this paper we review the literature pertaining to the possible benefits of arterial 'prehabilitation'--the concept that interventions aimed at enhancing arterial function and size (i.e. remodelling) should be undertaken prior to cardiac catheterization or artery harvest during bypass graft surgery. The incidence of artery spasm, occlusion and damage is lower in larger arteries with preserved endothelial function. We conclude that the beneficial effects of exercise training on both artery size and function, which are particularly evident in individuals who possess cardiovascular diseases or risk factors, infer that exercise training may reduce complication rates following catheterization and enhance the success of arteries harvested as bypass grafts. Future research efforts should focus directly on examination of the 'prehabilitation' hypothesis and the efficacy of different interventions aimed at reducing clinical complications of common interventional procedures.

  9. Bilateral internal carotid artery agenesis with artery compression of the brain parenchyma.

    Science.gov (United States)

    Sun, Jihong; Jiang, Dingyao; Zhang, Shizheng

    2008-09-15

    Bilateral internal carotid artery (ICA) agenesis is an extremely rare congenital anomaly. The most common type of collateral circulation is developed through the circle of Willis via the basilar and posterior communicating arteries. Both anterior circulations are usually supplied by enlarged posterior communicating arteries (PCOMs). We present an unusual case of bilateral ICA agenesis, which is associated with dolichoectatic left PCOM and left posterior cerebral artery (PCA) compression of left basal ganglia and thalamus. These complex cerebral and vascular anomalies can be noninvasively revealed and evaluated by CT and MR.

  10. Radial artery access for peripheral endovascular procedures.

    Science.gov (United States)

    Kumar, Avnee J; Jones, Lauren E; Kollmeyer, Kenneth R; Feldtman, Robert W; Ferrara, Craig A; Moe, Michelle N; Chen, Julia F; Richmond, Jasmine L; Ahn, Sam S

    2017-09-01

    The radial artery is often used for coronary angiography, with a demonstrated decrease in local complications and an increase in postoperative mobility of the patient. Data on radial artery access for peripheral endovascular procedures, however, are limited. We describe our experience with radial artery access for diagnostic and endovascular interventions. Between February 2012 and March 2015, there were 95 endovascular procedures performed using radial artery access in 80 unique patients. Demographic and clinical data were recorded. Perioperative, postoperative, and 30-day follow-up data were evaluated retrospectively for major and minor complications. Major adverse events included any immediate hospitalization admission, stroke, hand amputation, bleeding requiring transfusion, hematoma requiring surgery, and death. Minor complications included superficial bleeding and hematoma. The patients (52.6% male, 47.4% female) had a mean age of 72.1 ± 9.4 years. Radial artery access was used for diagnostic purposes in 15.8% of all procedures and for therapeutic intervention, including angioplasty and stenting, in 84.2%. The radial artery was the only access point in 80% of patients and was accessed in conjunction with other sites in 20%. Percutaneous access was achieved in 100% of patients with a 100% technical success rate. Hemostasis after catheterization was achieved by manual compression (22.1%) and TR band (Terumo Medical, Tokyo, Japan; 77.9%). Major adverse events occurred in three cases (3.2%) and were unrelated to radial artery access. Radial artery access site-related complications occurred in three cases (3.2%), all of which were minor hematomas that required no treatment. The risk of radial artery complication was not associated with procedure type, vessels treated, or use of heparin. The incidence of stroke, hand ischemia, and upper extremity limb or finger loss was 0%. Radial artery access for peripheral endovascular procedures appears to be safe and

  11. Idiopathic aneurysm of pulmonary artery

    Energy Technology Data Exchange (ETDEWEB)

    Pacheco, Julio B. Cota; Pimentel, Patricia N.; Knust, Beatriz S., E-mail: jcota@uol.com.br [Clinica de Cardiologia Cota Pacheco, Mogi das Cruzes, SP (Brazil)

    2015-07-15

    Because it is a very rare isolated lesion, we decided to present this case of idiopathic pulmonary artery aneurysm (IPAA) and review the cases published in the literature in order to correlate our clinical and imaging findings, as well as management based on patient data. IPAA was first described in a case of autopsy by Bristowe in 1860 and later in 1947 by Deterling and Claggett, whose prevalence was lower than eight to one hundred thousand. Although the use of diagnostic imaging methods has been applied in a very large population in recent decades, this lesion has been most often described in postmortem examinations. Therefore, it is important to be aware of possible clinical symptoms, at times non-specific, as well as the signs on imaging studies. In this study, therefore, the report of a case of an asymptomatic patient whose diagnosis was done through color Doppler echocardiography in a routine test in 2012, later confirmed by simple chest computed tomography (chest CT) and cardiac catheterization as IPAA and its branches. We discussed the literature available and the possibilities for treatment and the use of color Doppler echocardiography as an initial diagnostic tool for such a rare and intriguing disease. (author)

  12. Innervated digital artery perforator flap.

    Science.gov (United States)

    Ozcanli, Haluk; Coskunfirat, Osman Koray; Bektas, Gamze; Cavit, Ali

    2013-02-01

    To describe a technique for covering defects of the fingertips: the innervated digital artery perforator (IDAP) flap. A total of 17 patients were treated with an IDAP flap. The size of the flaps varied between 2 ×1 cm and 3.5 × 2 cm. Postoperative evaluation of the patients consisted of the Semmes-Weinstein Monofilament test, static 2-point discrimination, patient satisfaction, extension loss, and an investigation into complications. All IDAP flaps survived completely, and no patients required secondary interventions. The mean follow-up period was 7 months (range, 6-10 mo). The Semmes-Weinstein monofilament test results ranged from 3.22 to 3.84. The static 2-point discrimination in the flaps ranged from 2 mm to 4 mm (mean, 3.4 mm) compared with a range of 2 mm to 3 mm (mean, 2.7 mm) on the contralateral hand. There were no joint contractures in the reconstructed fingertips, although 2 patients developed mild hook nail deformity. One patient experienced mild cold intolerance, and 1 patient exhibited mild postoperative hypersensitivity. The advantages of the IDAP flap include minimally invasive surgery; a reliable, versatile flap; and the ease of the technique for different-sized fingertip defect reconstructions with few complications. The IDAP flap may be useful in fingertip amputations when the amputated part is not suitable for replantation. Therapeutic IV. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  13. Hepatic artery pseudoaneurysm following laparoscopic cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    Chigot, Valerie; Dubois, Josee [Department of Medical Imaging, Hopital Sainte-Justine, 3175 Cote Sainte-Catherine, Montreal, Quebec (Canada); Lallier, Michel [Department of Pediatric Surgery, Hopital Sainte-Justine, 3175 Cote Sainte-Catherine, Montreal, Quebec (Canada); Alvarez, Fernando [Department of Gastroenterology, Hopital Sainte-Justine, 3175 Cote Sainte-Catherine, Montreal, Quebec (Canada)

    2003-01-01

    The authors describe a hepatic pseudoaneurysm following laparoscopic cholecystectomy in a child. It arose from a hepatic artery that was ligated during surgery and was supplied by collaterals from the superior right branch. Because of the risk of hepatic infarction and recanalization of the pseudoaneurysm by new collaterals, the authors decided not to occlude the superior right branch, but to embolize the aneurysm itself with cyanoacrylate. Since the intra-arterial approach was not feasible, a transhepatic puncture was successfully performed. (orig.)

  14. Imaging of a Cilioretinal Artery Embolisation

    Directory of Open Access Journals (Sweden)

    Marion R. Munk

    2014-09-01

    Full Text Available Retinal artery occlusion can be the first indicator of a significant cardiovascular disorder and the need for treatment. We present the case of a 69-year-old man with a cilioretinal artery occlusion and retinal ischemia. Retinal imaging, in particular fundus autofluorescence, highlighted an intraluminal hyperautofluorescent lesion which led to the diagnosis of retinal emboli. Subsequently a severe, previously undiagnosed carotid occlusive disease was discovered. The patient underwent prompt endarterectomy.

  15. Biaxial vasoactivity of porcine coronary artery

    OpenAIRE

    Huo, Yunlong; Cheng, Yana; Zhao, Xuefeng; Lu, Xiao; Ghassan S. Kassab

    2012-01-01

    The passive mechanical properties of blood vessel mainly stem from the interaction of collagen and elastin fibers, but vessel constriction is attributed to smooth muscle cell (SMC) contraction. Although the passive properties of coronary arteries have been well characterized, the active biaxial stress-strain relationship is not known. Here, we carry out biaxial (inflation and axial extension) mechanical tests in right coronary arteries that provide the active coronary stress-strain relationsh...

  16. Heritability and intrafamilial aggregation of arterial characteristics

    Science.gov (United States)

    Seidlerová, Jitka; Bochud, Murielle; Staessen, Jan A.; Cwynar, Marcin; Dolejšová, Milena; Kuznetsova, Tatiana; Nawrot, Tim; Olszanecka, Agnieszka; Stolarz, Katarzyna; Thijs, Lutgarde; Wojciechowska, Wiktoria; Struijker-Boudier, Harry A.; Kawecka-Jaszcz, Kalina; Elston, Robert C.; Fagard, Robert; Filipovský, Jan

    2013-01-01

    Background We investigated the heritability and familial aggregation of various indexes of arterial stiffness and wave reflection and we partitioned the phenotypic correlation between these traits into shared genetic and environmental components. Methods Using a family-based population sample, we recruited 204 parents (mean age, 51.7 years) and 290 offspring (29.4 years) from the population in Cracow, Poland (62 families), Hechtel-Eksel, Belgium (36), and Pilsen, the Czech Republic (50). We measured peripheral pulse pressure (PPp) sphygmomanometrically at the brachial artery; central pulse pressure (PPc), the peripheral augmentation indexes (PAIxs) and central augmentation indexes (CAIxs) by applanation tonometry at the radial artery; and aortic pulse wave velocity (PWV) by tonometry or ultrasound. In multivariate-adjusted analyses, we used the ASSOC and PROC GENMOD procedures as implemented in SAGE and SAS, respectively. Results We found significant heritability for PAIx, CAIx, PPc and mean arterial pressure ranging from 0.37 to 0.41; P ≤ 0.0001. The method of intrafamilial concordance confirmed these results; intrafamilial correlation coefficients were significant for all arterial indexes (r > ≥ 0.12; P < ≤ 0.02) with the exception of PPc (r = −0.007; P = 0.90) in parent–offspring pairs. The sib–sib correlations were also significant for CAIx (r = 0.22; P = 0.001). The genetic correlation between PWV and the other arterial indexes were significant (ρG ≥ 0.29; P < 0.0001). The corresponding environmental correlations were only significantly positive for PPp (ρE = 0.10, P = 0.03). Conclusion The observation of significant intrafamilial concordance and heritability of various indexes of arterial stiffness as well as the genetic correlations among arterial phenotypes strongly support the search for shared genetic determinants underlying these traits. PMID:18327082

  17. Vertebral artery dissection associated with sildenafil abuse.

    Science.gov (United States)

    Dersch, Rick; Anastasopoulos, Constantin; Hader, Claudia; Stich, Oliver

    2013-05-01

    We present a 49-year-old male who suffered a cerebellar infarction due to a vertebral artery dissection. The patient had taken sildenafil daily for at least 2 years for sexual enhancement. There was no sexual intercourse or traumatic event prior to symptom onset. Sildenafil intake has been associated with aortic dissection and, in the light of this report, we suggest that chronic sildenafil intake could be a risk factor for arterial dissection. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Branch retinal artery occlusion in Susac's syndrome

    Directory of Open Access Journals (Sweden)

    Ricardo Evangelista Marrocos de Aragão

    2015-02-01

    Full Text Available Susac's syndrome is a rare disease attribuited to a microangiopathy involving the arterioles of the cochlea, retina and brain. Encefalopathy, hearing loss, and visual deficits are the hallmarks of the disease. Visual loss is due to multiple, recurrent branch arterial retinal occlusions. We report a case of a 20-year-old women with Susac syndrome presented with peripheral vestibular syndrome, hearing loss, ataxia, vertigo, and vision loss due occlusion of the retinal branch artery.

  19. Effect of arterial puncture on ventilation.

    Science.gov (United States)

    Sahni, Ashima Synghal; Gonzalez, Hemil; Tulaimat, Aiman

    Clinicians frequently assume that during arterial puncture for measuring arterial blood gases patients hyperventilate from pain and anxiety. This assumption leads clinicians to falsely interpret a PaCO2 and pH near the upper limit of normal as a chronic respiratory acidosis corrected by an acute respiratory alkalosis. Determine if participants hyperventilate during arterial puncture from pain and anxiety. We recruited participants from a pulmonary function laboratory referred for arterial blood gas measurement. We excluded those with heart failure and included those with any respiratory condition (COPD, asthma, sleep apnea). We measured end tidal PCO2 (PETCO2), respiratory rate, and heart rate 15 min before topical anesthesia, during anesthesia, during arterial puncture, and 15 min later. We assessed generalized anxiety before and measured pain during and after arterial puncture. 24 participants were recruited (age: 54 ± 12 years; men: 54%). PaCO2 was 41 ± 5 mmHg. One had acute respiratory alkalosis. Respiratory rate increased from (19 ± 6 breaths per minute (bpm)) before to a maximum (21 ± 6 bpm) during arterial puncture (p = 0.001). Heart rate was stable throughout. The lowest PETCO2 during the procedure (35 ± 5) was similar to PETCO2 before the procedure (p = 0.1). The change in PETCO2 and respiratory rate did not correlate with pain, anxiety, or lung function. Respiratory rate increased slightly during arterial puncture without any change in PETCO2. Hence, acid-base status must be interpreted without the assumption of procedure induced hyperventilation. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Metabolic syndrome and arterial elasticity in youth.

    Science.gov (United States)

    Gardner, Andrew W; Parker, Donald E; Krishnan, Sowmya; Chalmers, Laura J

    2013-03-01

    To compare arterial elasticity in children, adolescents, and young adults with and without metabolic syndrome (MetS), and to assess which MetS components, demographic measures, and body composition measures are associated with arterial elasticity. Two-hundred six subjects (107 females and 99 males) between the ages of 10 and 20years were recruited by local newspaper advertisements, university email advertisements, and informational flyers. Subjects were assessed on MetS components, demographic measures, body composition measures, and arterial elasticity via radial tonometry. Forty-five subjects (22%) had MetS, as defined by the International Diabetes Federation, and 161 subjects (78%) did not. The primary novel finding was that group differences were not observed for large artery elasticity index (LAEI) (MetS=16.1±4.4 (ml×mmHg(-1))×10 (mean±SD), control=15.4±4.9, (ml×mmHg(-1))×10, p=0.349), and small artery elasticity index (SAEI) (MetS=9.2±2.7 (ml×mmHg(-1))×100, control=8.4±2.9, (ml×mmHg(-1))×100, p=0.063). In the MetS group, fat free mass was positively associated with arterial elasticity, and was the strongest multivariate predictor of LAEI (partial R(2)=0.41) and SAEI (partial R(2)=0.29). Youth with MetS did not exhibit differences in LAEI and SAEI compared to controls. Furthermore, fat free mass of youth with MetS was positively associated with arterial elasticity, and was the strongest predictor of both LAEI and SAEI. The clinical implication is that exercise intervention designed to increase fat free mass might increase arterial elasticity in youth, particularly in youth with MetS. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. [Arterial obliterative disease and physical activity].

    Science.gov (United States)

    Landi, Anna; Jassó, István

    2007-06-10

    Regular physical exercise represents an essential element in treating patients with second-stage peripheral arterial occlusive disease. Peripheral arterial occlusive disease is a characteristic clinical manifestation of atherothrombotic processes. Its prevalence is 2-3%, consequently, it is estimated to be 200,000-300,000 patients in Hungary. Coronary artery disease and atherothrombosis of the carotid artery system may frequently coexist with peripheral arterial obliterative disease. Treatment of peripheral arterial obliterative disease influences their prevalence and prognosis as well. The main aim of regular physical exercise is to improve the quality of life of patients by increasing the functional capacity of the lower limbs. During exercise beneficial vascular changes occur like haemodynamic changes consisting of increasing pressure-gradient of stenotic artery and opening of collateral vessels, as well as improvement of the endothelial dysfunction. It favourably influences lipid profile by decreasing LDL cholesterol and increasing HDL cholesterol. Physical exercise beneficially affects blood rheology as well. It also brings about structural changes in the skeletal muscles, increases the enzyme levels in the oxidative metabolic processes and enhances the density of capillaries in the skeletal muscle fibres. According to the data published so far, patients with peripheral arterial obliterative disease are recommended to take part in supervised treadmill walking at least 3 days per week for 30-60 minutes each session containing 5-5 minute warm-up and cool-down periods. The training should be of intermittent intensity at the pain-free threshold. The physiological benefits are optimised at 3-6 months. The home-based training programme is also remarkably useful.

  2. Porcine radial artery decellularization by high hydrostatic pressure.

    Science.gov (United States)

    Negishi, Jun; Funamoto, Seiichi; Kimura, Tsuyoshi; Nam, Kwangoo; Higami, Tetsuya; Kishida, Akio

    2015-11-01

    Many types of decellularized tissues have been studied and some have been commercially used in clinics. In this study, small-diameter vascular grafts were made using HHP to decellularize porcine radial arteries. One decellularization method, high hydrostatic pressure (HHP), has been used to prepare the decellularized porcine tissues. Low-temperature treatment was effective in preserving collagen and collagen structures in decellularized porcine carotid arteries. The collagen and elastin structures and mechanical properties of HHP-decellularized radial arteries were similar to those of untreated radial arteries. Xenogeneic transplantation (into rats) was performed using HHP-decellularized radial arteries and an untreated porcine radial artery. Two weeks after transplantation into rat carotid arteries, the HHP-decellularized radial arteries were patent and without thrombosis. In addition, the luminal surface of each decellularized artery was covered by recipient endothelial cells and the arterial medium was fully infiltrated with recipient cells. Copyright © 2012 John Wiley & Sons, Ltd.

  3. Hepatocellular carcinoma with extensive hepatic artery injury: transcatheter arterial chemoembolization through collaterals after coil embolizatoin of gastric arteries

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Gab Choul; Yoon, Hyun Ki; Hwang, Jae Cheol; Lee, Duck Hee; Song, Ho Young; Suh, Dong Jin; Lee, Yung Sang; Chung, Young Hwa; Sung, Gyu Bo [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of); Ko, Ki Young [Catholic Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-09-01

    To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE) after coil embolization of the gastroduodenal artery in hepatocellular carcinoma cases with multiple collateral arteries caused by proper hepatic artery injury. Between March 1997 and November 1998, a prospective trial of transcatheter arterial chemoembolization (TACE) was performed through collaterals from the gastroduodenal artery of 31 hepatocellular carcinoma patients with extensive proper hepatic artery injury due to repeated TACE. Among this number, 16 (group A) underwent TACE after coil embolization of the right gastric and gastroduodenal artery. The other 15 patients (group B) underwent TACE without coil embolization. The two groups had the same TNM stage and Clild-Pugh status. During the follow-up period, group A underwent additional TACE 3.3 times, and group B 2.8 times. The therapeutic effect of TACE was evaluated with computed tomography and by measuring alpha-fetoprotein levels. Complications were evaluated by means of gastrofibroscopy, laboratory data, and evaluation of the patients' clinical symptoms. The results obtained after six months and one year were compared within and between each group. At six months follow-up, CT findings had improved or were unchanged in 11 patients(69 %) in group A, and four patients(27 %) in group B(p = 0.032). In ten patients in each group, the level of alpha-fetoprotein was above 200 ng/ml. Its level was decreased in five patients(50 %) and three patients(30 %), respectively. The six-month survival rate was 81 % (13/16) in group A and 67% (10/15) in group B (p 0.43), while the one-year survival figures for these two groups were 50 % (8/16) and 20 % (3/15), respectively(p = 0.135). In group A, the CT findings were steady in five out of eight patients(63 %), while in groupB, CT findings showed that tumors with increased alpha-fetoprotein levels had increased in size and/or number. In group A, it was found that in two (33 %) of six

  4. Analysis, reconstruction and manipulation using arterial snakes

    KAUST Repository

    Li, Guo

    2010-01-01

    Man-made objects often consist of detailed and interleaving structures, which are created using cane, coils, metal wires, rods, etc. The delicate structures, although manufactured using simple procedures, are challenging to scan and reconstruct. We observe that such structures are inherently 1D, and hence are naturally represented using an arrangement of generating curves. We refer to the resultant surfaces as arterial surfaces. In this paper we approach for analyzing, reconstructing, and manipulating such arterial surfaces. The core of the algorithm is a novel deformable model, called arterial snake, that simultaneously captures the topology and geometry of the arterial objects. The recovered snakes produce a natural decomposition of the raw scans, with the decomposed parts often capturing meaningful object sections. We demonstrate the robustness of our algorithm on a variety of arterial objects corrupted with noise, outliers, and with large parts missing. We present a range of applications including reconstruction, topology repairing, and manipulation of arterial surfaces by directly controlling the underlying curve network and the associated sectional profiles, which are otherwise challenging to perform. © 2010 ACM.

  5. Preventive aspects in peripheral artery disease.

    Science.gov (United States)

    Aggarwal, Saurabh; Loomba, Rohit Seth; Arora, Rohit

    2012-04-01

    The prevalence of peripheral artery disease is steadily increasing and is associated with significant morbidity, including a significant percentage of amputations. Peripheral artery disease often goes undiagnosed, making its prevention increasingly important. Patients with peripheral arterial disease are at increased risk of adverse cardiovascular outcomes which makes prevention even more important. Several risk factors have been identified in the pathophysiology of peripheral artery disease which should be modified to decrease risk. Smoking, hyperlipidemia, hypertension, and diabetes are among proven risk factors for the development of peripheral artery disease, thus smoking cessation, lipid control, blood pressure control, and glucose control have been tried and shown to be effective in preventing the morbidity associated with this disease. Pharmacologic agents such as aspirin and clopidogrel alone or in combination have been shown to be effective, though risk of bleeding might be increased with the combination. Anticoagulation use is recommended only for acute embolic cases. Other treatment modalities that have been tried or are under investigation are estrogen replacement, naftidrofuryl, pentoxifylline, hyperbaric oxygen, therapeutic angiogenesis, and advanced glycation inhibitors. The treatment for concomitant vascular diseases does not change in the presence of peripheral artery disease, but aggressive management of risk factors should be undertaken in such cases.

  6. Anomalous origin of the left coronary artery from the pulmonary artery in children: diagnostic use of multidetector computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Shen, Quanli; Yao, Qiong; Hu, Xihong [Children' s Hospital of Fudan University, Department of Radiology, Shanghai (China)

    2016-09-15

    Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly. It is important to demonstrate the anomalous origin of the left coronary artery and its course before surgery. To explore the clinical diagnostic use of multidetector CT coronary angiography in detecting anomalous origin of the left coronary artery from the pulmonary artery in children. Nine children (2 boys, 7 girls) ages 2 months to 9 years with surgically confirmed anomalous origin of the left coronary artery from the pulmonary artery were studied. Clinical data, transthoracic echocardiography and CT coronary angiography images were retrospectively analyzed. Transthoracic echocardiography correctly diagnosed anomalous origin of the left coronary artery from the pulmonary artery in 7 of 9 patients (95% CI: 40-97%). CT coronary angiography revealed the anomalous origin of the left coronary artery in all children (95% CI: 66-100%). In a 4-year-old girl and a 9-year-old girl, CT coronary angiography showed dilation of the right coronary artery and collateral circulation between the right and the left coronary arteries. CT coronary angiography is a useful method to show the anomalous origin of the coronary artery in children with anomalous origin of the left coronary artery from the pulmonary artery, especially for patients in whom origin of the left coronary artery cannot be detected by transthoracic echocardiography. (orig.)

  7. Echocardiographic evaluation of coronary arteries in congenital heart disease.

    Science.gov (United States)

    Freire, Grace; Miller, Michelle S

    2015-12-01

    Among populations of patients with the congenital heart disease, there is considerable diversity in the anatomy of the coronary arteries. Understanding these anatomical differences is vitally important in directing interventions and surgical repair. In this report, the authors describe the echocardiographic evaluation of the variants of coronary artery anatomy in the following lesions: transposition of the great arteries, congenitally corrected transposition of the great arteries, double-inlet left ventricle, common arterial trunk, tetralogy of Fallot, and double-outlet right ventricle.

  8. Rarefaction and blood pressure in systemic and pulmonary arteries

    OpenAIRE

    Mette S Olufsen; N. A. Hill; VAUGHAN, GARETH D. A.; Sainsbury, Christopher; Johnson, Martin

    2012-01-01

    The effects of vascular rarefaction (the loss of small arteries) on the circulation of blood are studied using a multiscale mathematical model that can predict blood flow and pressure in the systemic and pulmonary arteries. We augmented a model originally developed for the systemic arteries (Olufsen et al. 1998, 1999, 2000, 2004) to (a) predict flow and pressure in the pulmonary arteries, and (b) predict pressure propagation along the small arteries in the vascular beds. The systemic and pulm...

  9. Distal vertebral artery reconstruction when managing vertebrobasilar insufficiency

    OpenAIRE

    D. M. Galaktionov; A. V. Dubovoy; K. S. Ovsyannikov

    2017-01-01

    This article presents a literature review devoted to the reconstruction of the distal vertebral artery and a clinical case of successful surgical treatment of a patient suffering from vertebrobasilar insufficiency caused by occlusion of the vertebral artery in a proximal segment. The external carotid artery-distal vertebral artery bypass was performed by using the radial artery.Received 27 February 2017. Revised 25 July 2017. Accepted 3 August 2017.Funding: The study did not have sponsorship....

  10. Calculation of arterial wall temperature in atherosclerotic arteries: effect of pulsatile flow, arterial geometry, and plaque structure

    Directory of Open Access Journals (Sweden)

    Kim Taehong

    2007-03-01

    Full Text Available Abstract Background This paper presents calculations of the temperature distribution in an atherosclerotic plaque experiencing an inflammatory process; it analyzes the presence of hot spots in the plaque region and their relationship to blood flow, arterial geometry, and inflammatory cell distribution. Determination of the plaque temperature has become an important topic because plaques showing a temperature inhomogeneity have a higher likelihood of rupture. As a result, monitoring plaque temperature and knowing the factors affecting it can help in the prevention of sudden rupture. Methods The transient temperature profile in inflamed atherosclerotic plaques is calculated by solving an energy equation and the Navier-Stokes equations in 2D idealized arterial models of a bending artery and an arterial bifurcation. For obtaining the numerical solution, the commercial package COMSOL 3.2 was used. The calculations correspond to a parametric study where arterial type and size, as well as plaque geometry and composition, are varied. These calculations are used to analyze the contribution of different factors affecting arterial wall temperature measurements. The main factors considered are the metabolic heat production of inflammatory cells, atherosclerotic plaque length lp, inflammatory cell layer length lmp, and inflammatory cell layer thickness dmp. Results The calculations indicate that the best location to perform the temperature measurement is at the back region of the plaque (0.5 ≤ l/lp ≤ 0.7. The location of the maximum temperature, or hot spot, at the plaque surface can move during the cardiac cycle depending on the arterial geometry and is a direct result of the blood flow pattern. For the bending artery, the hot spot moves 0.6 millimeters along the longitudinal direction; for the arterial bifurcation, the hot spot is concentrated at a single location due to the flow recirculation observed at both ends of the plaque. Focusing on the

  11. Intra-arterial high signals on arterial spin labeling perfusion images predict the occluded internal carotid artery segment

    Energy Technology Data Exchange (ETDEWEB)

    Sogabe, Shu; Satomi, Junichiro; Tada, Yoshiteru; Kanematsu, Yasuhisa; Kuwayama, Kazuyuki; Yagi, Kenji; Yoshioka, Shotaro; Mizobuchi, Yoshifumi; Mure, Hideo; Yamaguchi, Izumi; Kitazato, Keiko T.; Nagahiro, Shinji [Tokushima University Graduate School, Department of Neurosurgery, Tokushima (Japan); Abe, Takashi; Harada, Masafumi [Tokushima University Graduate School, Department of Radiology, Tokushima (Japan); Yamamoto, Nobuaki; Kaji, Ryuji [Tokushima University Graduate School, Department of Clinical Neurosciences, Institute of Biomedical Biosciences, Tokushima (Japan)

    2017-06-15

    Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment. Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4). Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1-C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3-C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1-C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion. High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site. (orig.)

  12. Dynamic contrast-enhanced ultrasound and transient arterial occlusion for quantification of arterial perfusion reserve in peripheral arterial disease

    Energy Technology Data Exchange (ETDEWEB)

    Amarteifio, E., E-mail: erick.amarteifio@med.uni-heidelberg.de [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Wormsbecher, S. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Krix, M. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Bracco Imaging Germany, Konstanz (Germany); Demirel, S. [University Hospital of Heidelberg, Department of Vascular Surgery, Heidelberg (Germany); Braun, S. [Department of Biostatistics, German Cancer Research Center, Heidelberg (Germany); Delorme, S. [Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Boeckler, D. [University Hospital of Heidelberg, Department of Vascular Surgery, Heidelberg (Germany); Kauczor, H.-U. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Weber, M.-A. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany)

    2012-11-15

    Objective: To quantify muscular micro-perfusion and arterial perfusion reserve in peripheral arterial disease (PAD) with dynamic contrast-enhanced ultrasound (CEUS) and transient arterial occlusion. Materials and methods: This study had local institutional review board approval and written informed consent was obtained from all subjects. We examined the dominant lower leg of 40 PAD Fontaine stage IIb patients (mean age, 65 years) and 40 healthy volunteers (mean age, 54 years) with CEUS (7 MHz; MI, 0.28) during continuous intravenous infusion of 4.8 mL microbubbles. Transient arterial occlusion at mid-thigh level simulated physical exercise. With time-CEUS-intensity curves obtained from regions of interest within calf muscles, we derived the maximum CEUS signal after occlusion (max) and its time (t{sub max}), slope to maximum (m), vascular response after occlusion (AUC{sub post}), and analysed accuracy, receiver operating characteristic (ROC) curves, and correlations with ankle-brachial index (ABI) and walking distance. Results: All parameters differed in PAD and volunteers (p < 0.014). In PAD, t{sub max} was delayed (31.2 {+-} 13.6 vs. 16.7 {+-} 8.5 s, p < 0.0001) and negatively correlated with ankle-brachial-index (r = -0.65). m was decreased in PAD (4.3 {+-} 4.6 mL/s vs. 13.1 {+-} 8.4 mL/s, p < 0.0001) and had highest diagnostic accuracy (sensitivity/specificity, 75%/93%) for detection of diminished muscular micro-perfusion in PAD (cut-off value, m < 5{approx}mL/s). Discriminant analysis and ROC curves revealed m, and AUC{sub post} as optimal parameter combination for diagnosing PAD and therefore impaired arterial perfusion reserve. Conclusions: Dynamic CEUS with transient arterial occlusion quantifies muscular micro-perfusion and arterial perfusion reserve. The technique is accurate to diagnose PAD.

  13. The use of the inferior epigastric artery for accessory lower polar artery revascularization in live donor renal transplantation.

    Science.gov (United States)

    El-Sherbiny, M; Abou-Elela, A; Morsy, A; Salah, M; Foda, A

    2008-01-01

    This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after declamping. Between 1988 and 2004, 477 consecutive live donor renal transplants were performed, including 429 with single and 48 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 15 grafts with multiple arteries. Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning +/- MRA in some patients. In live donor renal transplantation with multiple arteries, the anastomosis of the lower polar artery to the inferior epigastric artery after declamping avoids prolongation of the ischemia time that occurs with other surgical and microsurgical techniques of intracorporeal and ex vivo surgeries.

  14. Feeding Arteries of Primary Tongue Cancers on Intra-arterial Infusion Chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kamitani, Takeshi, E-mail: kamitani@radiol.med.kyushu-u.ac.jp [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences (Japan); Kawanami, Satoshi, E-mail: kawanami-01@mac.com [Kyushu University, Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences (Japan); Asayama, Yoshiki, E-mail: asayama@radiol.med.kyushu-u.ac.jp; Matsuo, Yoshio, E-mail: yymatsuo@radiol.med.kyushu-u.ac.jp; Yonezawa, Masato, E-mail: ymasato@radiol.med.kyushu-u.ac.jp; Yamasaki, Yuzo, E-mail: yyama@radiol.med.kyushu-u.ac.jp [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences (Japan); Nagao, Michinobu, E-mail: minagao@radiol.med.kyushu-u.ac.jp [Kyushu University, Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences (Japan); Yamanouchi, Torahiko, E-mail: tora0228@radiol.med.kyushu-u.ac.jp [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences (Japan); Yabuuchi, Hidetake, E-mail: h-yabu@med.kyushu-u.ac.jp [Kyushu University, Department of Health Sciences, Graduate School of Medical Sciences (Japan); Nakamura, Katsumasa, E-mail: nakam@radiol.med.kyushu-u.ac.jp [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences (Japan); Nakashima, Torahiko, E-mail: nakatora@qent.med.kyushu-u.ac.jp [Kyushu University, Department of Otorhinolaryngology, Graduate School of Medical Sciences (Japan); Honda, Hiroshi, E-mail: honda@radiol.med.kyushu-u.ac.jp [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences (Japan)

    2016-02-15

    PurposeTo evaluate the frequency and the predictive factor of each feeding artery on intra-arterial infusion chemotherapy (IAIC) in primary tongue cancer.Materials and MethodsWe retrospectively evaluated 20 patients who received IAIC for primary tongue cancer. The main and accompanying feeding arteries were identified on super-selective angiography of the branches of the external carotid artery. Tumor diameter, and extension to the contralateral side, tongue extrinsic muscles (TEMs), and lateral mesopharyngeal wall were determined based on magnetic resonance imaging or computed tomography findings.ResultsThe main feeding artery was the ipsilateral lingual artery (LA) in 15 of the 20 examined tumors and the contralateral LA in the other 5. Ten cancers had only one feeding artery, and multiple feeding arteries were detected in the remaining 10. Tumors >4 cm (n = 9), those with extension to the contralateral side (n = 13), and those with extension to TEMs (n = 15) were supplied by significantly larger numbers of feeding arteries compared to tumors without these features (P = 0.01, 0.049, and 0.02, respectively). The frequency of feeding from the contralateral LA was 64 % (9/14) and 17 % (1/6) in tumors with and without extension to the contralateral side, respectively. Feeding from a facial artery (FA) was not detected in tumors ≤4 cm, while 5 of the 9 (56 %) tumors >4 cm were supplied by a FA (P = 0.01).ConclusionA careful search for feeding arteries is required, especially in large tumors with extension to the contralateral side or to TEMs.

  15. Peripheral Endothelial Function After Arterial Switch Operation for D-looped Transposition of the Great Arteries.

    Science.gov (United States)

    Sun, Heather Y; Stauffer, Katie Jo; Nourse, Susan E; Vu, Chau; Selamet Tierney, Elif Seda

    2017-06-01

    Coronary artery re-implantation during arterial switch operation in patients with D-looped transposition of the great arteries (D-TGA) can alter coronary arterial flow and increase shear stress, leading to local endothelial dysfunction, although prior studies have conflicting results. Endothelial pulse amplitude testing can predict coronary endothelial dysfunction by peripheral arterial testing. This study tested if, compared to healthy controls, patients with D-TGA after arterial switch operation had peripheral endothelial dysfunction. Patient inclusion criteria were (1) D-TGA after neonatal arterial switch operation; (2) age 9-29 years; (3) absence of known cardiovascular risk factors such as hypertension, diabetes, hypercholesterolemia, vascular disease, recurrent vasovagal syncope, and coronary artery disease; and (4) ability to comply with overnight fasting. Exclusion criteria included (1) body mass index ≥85th percentile, (2) use of medications affecting vascular tone, or (3) acute illness. We assessed endothelial function by endothelial pulse amplitude testing and compared the results to our previously published data in healthy controls (n = 57). We tested 20 D-TGA patients (16.4 ± 4.8 years old) who have undergone arterial switch operation at a median age of 5 days (0-61 days). Endothelial pulse amplitude testing indices were similar between patients with D-TGA and controls (1.78 ± 0.61 vs. 1.73 ± 0.54, p = 0.73).In our study population of children and young adults, there was no evidence of peripheral endothelial dysfunction in patients with D-TGA who have undergone arterial switch operation. Our results support the theory that coronary arterial wall thickening and abnormal vasodilation reported in these patients is a localized phenomenon and not reflective of overall atherosclerotic burden.

  16. Feasibility Study of Ex Ovo Chick Chorioallantoic Artery Model for Investigating Pulsatile Variation of Arterial Geometry.

    Directory of Open Access Journals (Sweden)

    Kweon-Ho Nam

    Full Text Available Despite considerable research efforts on the relationship between arterial geometry and cardiovascular pathology, information is lacking on the pulsatile geometrical variation caused by arterial distensibility and cardiomotility because of the lack of suitable in vivo experimental models and the methodological difficulties in examining the arterial dynamics. We aimed to investigate the feasibility of using a chick embryo system as an experimental model for basic research on the pulsatile variation of arterial geometry. Optical microscope video images of various arterial shapes in chick chorioallantoic circulation were recorded from different locations and different embryo samples. The high optical transparency of the chorioallantoic membrane (CAM allowed clear observation of tiny vessels and their movements. Systolic and diastolic changes in arterial geometry were visualized by detecting the wall boundaries from binary images. Several to hundreds of microns of wall displacement variations were recognized during a pulsatile cycle. The spatial maps of the wall motion harmonics and magnitude ratio of harmonic components were obtained by analyzing the temporal brightness variation at each pixel in sequential grayscale images using spectral analysis techniques. The local variations in the spectral characteristics of the arterial wall motion were reflected well in the analysis results. In addition, mapping the phase angle of the fundamental frequency identified the regional variations in the wall motion directivity and phase shift. Regional variations in wall motion phase angle and fundamental-to-second harmonic ratio were remarkable near the bifurcation area. In summary, wall motion in various arterial geometry including straight, curved and bifurcated shapes was well observed in the CAM artery model, and their local and cyclic variations could be characterized by Fourier and wavelet transforms of the acquired video images. The CAM artery model with

  17. Relationship between carotid artery stenosis and ischemic ocular diseases

    Directory of Open Access Journals (Sweden)

    Qian Chen

    2015-01-01

    Full Text Available AIM: To investigate the relationship between carotid artery stenosis and ischemic ocular diseases.METHODS: The clinical data of 30 cases(37 eyesof patients with ischemic eye diseases were collected from November 2010 to May 2014, and they were accepted the fundus fluorescein angiography(FFA, transcranial Doppler(TCDultrasonic blood vessels of the eye, neck vascular color Doppler flow imaging(CDFI, the neck CT angiography(CTAand carotid artery digital subtraction angiography(DSAexamination, and then the ischemic eye disease patients with ocular symptoms were analyzed. The peak systolic velocity(PSVand resistance index(RIof ophthalmic artery and central retinal artery were compared. Correlation between the internal carotid artery intima-media thickness(IMTand ophthalmic artery, central retinal artery PSV and RI correlation risk; ipsilateral internal carotid artery plaque and ophthalmic artery PSV and RI; PSV and RI associated ipsilateral internal carotid artery plaque and central retinal artery were analyzed. RESULTS: Eye symptoms: a black dim, reduced vision, the eyes flash, and around the eye pain were 75.7%, 83.8%, 51.4% and 32.4%; The eye signs: the dilatation of retinal vein, retinal hemorrhage, arterial stenosis and cotton spot and the contralateral side were regarded as main signs. Ophthalmic artery PSV and RI value of the differences were statistically significant(PPP>0.05; The ipsilateral internal carotid artery plaque and ophthalmic artery PSV had no correlation with RI values(P>0.05; PSV and RI and the ipsilateral internal carotid artery plaque and central retinal artery had no correlation(P>0.05.CONCLUSION: The incidence of ischemic eye diseases and internal carotid artery stenosis is associated with very close, the clinical can regard the degree of internal carotid artery stenosis as an important basis for diagnosis and treatment of eye diseases.

  18. Peripheral Arteries May Be Reliable Indicators of Coronary Vascular Disease.

    Science.gov (United States)

    Hoehmann, Christopher L; Futterman, Bennett; Beatty, Brian Lee

    2017-07-01

    Atherosclerosis is a stronger predictor for ischemic cardiovascular events than traditional risk factors such as race, age, sex, history, and metabolic profile. Previous research had primarily used ultrasound; however, we performed a study using histopathology to more accurately grade atherosclerosis development using the American Heart Association's grading scale. We cross-sectioned 13 different arteries from 48 cadavers and placed them into three separate groups based on anatomic location: central arteries, peripheral arteries, and carotid arteries. The central artery group included arteries that are non-palpable and commonly lead to ischemic diseases when occluded. The peripheral artery group included arteries that are accessible to palpation. The carotid artery group included branches of the carotid artery. We investigated whether a centrally located atherosclerotic vessel was associated with atherosclerosis of a specific peripheral artery. We hypothesized a correlation between carotid, peripheral and central arteries that may point to specific arteries that are more effective to analyze clinically when assessing cardiovascular risk. We observed a correlation between pathology in the left coronary artery and bifurcation of the carotid artery (r = 0.37 P ≤ 0.016), two arteries known to be implicated in ischemic stroke and ischemic heart disease. Importantly, our study demonstrates that the radial artery, a peripheral vessel, exhibited a positive correlation between both the pathologic left coronary (r = 0.33 P ≤ 0.041) and bifurcation of the carotid arteries (r = 0.34 P ≤ 0.025). Therefore, we propose investigating the radial artery as a clinically accessible location to monitor with ultrasound when assessing a patient's risk for ischemic cardiovascular disease. Anat Rec, 300:1230-1239, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  19. Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass

    Directory of Open Access Journals (Sweden)

    Wasmuth Hermann E

    2011-06-01

    Full Text Available Abstract Background Upper gastrointestinal haemorrhage is mainly caused by ulcers. Gastric varicosis due to portal hypertension can also be held responsible for upper gastrointestinal bleeding. Portal hypertension causes the development of a collateral circulation from the portal to the caval venous system resulting in development of oesophageal and gastric fundus varices. Those may also be held responsible for upper gastrointestinal haemorrhage. Case presentation In this study, we describe the case of a 69-year-old male with recurrent severe upper gastrointestinal bleeding caused by arterial submucosal collaterals due to idiopathic splenic artery thrombosis. The diagnosis was secured using endoscopic duplex ultrasound and angiography. The patient was successfully treated with a laparoscopic splenectomy and complete dissection of the short gastric arteries, resulting in the collapse of the submucosal arteries in the gastric wall. Follow-up gastroscopy was performed on the 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall. Subsequent follow-up after 6 months also showed no further gastrointestinal bleeding as well as subjective good quality of life for the patient. Conclusion Submucosal arterial collaterals must be excluded by endosonography via endoscopy in case of recurrent upper gastrointestinal bleeding. Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.

  20. Percutaneous transluminal angioplasty of the superficial femoral artery by retrograde catheterization via the popliteal artery

    DEFF Research Database (Denmark)

    Tønnesen, K H; Sager, P; Karle, A

    1988-01-01

    We report the results of 50 angioplasty procedures via the popliteal artery. A 3-year follow-up including control of blood pressures at ankle and toe levels show results comparable to reports in the literature. This new approach for angioplasty of the superficial femoral artery and eventually of ...

  1. Local intra-arterial thrombolysis in a 4-year-old male with vertebrobasilar artery thrombosis

    NARCIS (Netherlands)

    Janmaat, Mirjam; Gravendeel, Joost P; Uyttenboogaart, Maarten; Vroomen, Patrick C; Brouwer, Oebele F; Luijckx, Gert-Jan

    We report the case of a 4-year-old male with vertebrobasilar artery thrombosis for which he was treated with local intra-arterial urokinase 60 hours after onset of symptoms. Initially the patient had dysarthria and dysphagia. Brain magnetic resonance imaging (MRI) in a community hospital showed

  2. Congenital arteriovenous fistula between the internal mammary artery and the pulmonary artery

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); H. van Meurs-van Woezik

    1984-01-01

    textabstractThis is the fourth reported case of congenital arteriovenous fistula between the internal mammary artery and pulmonary artery. Precise and complete diagnostic evaluation is required to localize, delineate and appreciate the haemodynamic significance of this type of arteriovenous shunt. A

  3. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M-C. Morice (Marie-Claude); A.P. Kappetein (Arie Pieter); A. Colombo (Antonio); D.R. Holmes Jr (David); M.J. Mack (Michael); E. Stahle (Elisabeth); T.E. Feldman (Ted); M.J.B.M. van den Brand (Marcel); E.J. Bass (Eric); N. van Dyck (Nic); K. Leadly (Katrin); K.D. Dawkins (Keith); F.W. Mohr (Friedrich)

    2009-01-01

    textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating

  4. [Pediatric case of congenital coronary artery fistula; surgical result and late changes in coronary artery aneurysm].

    Science.gov (United States)

    Sugawara, Masaaki; Oguma, Fumiaki; Hirahara, Hiroyuki

    2014-07-01

    Congenital coronary artery fistula is an uncommon heart anomaly involving the coronary arteries. We report here a case of a 4-year-old boy who had a coronary fistula from the right coronary artery to the right ventricle, with a coronary aneurysm. He was asymptomatic, but the calculated ratio of pulmonary blood flow to systemic blood flow was shown to be high [pulmonary flow (Qp)/systemic flow(Qs)=1.78]. The coronary angiography showed that the right coronary artery was dilated beginning at the ostium and had an aneurysm at the acute marginal portion. A large spherical aneurysm approximately 20 mm in diameter was found to have been connected with coronary fistula opening into the right ventricle. Surgical repair by closure of the fistula under direct vision, partial resection and suture closure of the aneurysm was performed. Plication of the proximal portion of the right coronary artery was not performed, and the diffusely dilated artery was left untouched. After this operation, he recovered well under anticoagulant treatment with warfarin and aspirin. Postoperative angiography was performed 17 months after the surgery to evaluate morphological changes in the coronary artery. The angiography confirmed the closure of the fistula and the regression of coronary artery dilatation.

  5. Constitutive description of human femoropopliteal artery aging.

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    Kamenskiy, Alexey; Seas, Andreas; Deegan, Paul; Poulson, William; Anttila, Eric; Sim, Sylvie; Desyatova, Anastasia; MacTaggart, Jason

    2017-04-01

    Femoropopliteal artery (FPA) mechanics play a paramount role in pathophysiology and the artery's response to therapeutic interventions, but data on FPA mechanical properties are scarce. Our goal was to characterize human FPAs over a wide population to derive a constitutive description of FPA aging to be used for computational modeling. Fresh human FPA specimens ([Formula: see text]) were obtained from [Formula: see text] predominantly male (80 %) donors 54±15 years old (range 13-82 years). Morphometric characteristics including radius, wall thickness, opening angle, and longitudinal pre-stretch were recorded. Arteries were subjected to multi-ratio planar biaxial extension to determine constitutive parameters for an invariant-based model accounting for the passive contributions of ground substance, elastin, collagen, and smooth muscle. Nonparametric bootstrapping was used to determine unique sets of material parameters that were used to derive age-group-specific characteristics. Physiologic stress-stretch state was calculated to capture changes with aging. Morphometric and constitutive parameters were derived for seven age groups. Vessel radius, wall thickness, and circumferential opening angle increased with aging, while longitudinal pre-stretch decreased ([Formula: see text]). Age-group-specific constitutive parameters portrayed orthotropic FPA stiffening, especially in the longitudinal direction. Structural changes in artery wall elastin were associated with reduction of physiologic longitudinal and circumferential stretches and stresses with age. These data and the constitutive description of FPA aging shed new light on our understanding of peripheral arterial disease pathophysiology and arterial aging. Application of this knowledge might improve patient selection for specific treatment modalities in personalized, precision medicine algorithms and could assist in device development for treatment of peripheral artery disease.

  6. Energetic and spatial constraints of arterial networks

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    Sandro Rossitti

    1995-06-01

    Full Text Available The principle of minimum work (PMW is a parametric optimization model for the growth and adaptation of arterial trees. A balance between energy dissipation due to frictional resistance of laminar flow (shear stress and the minimum volume of the blood and vessel wall tissue is achieved when the vessel radii are adjusted to the cube root of the volumetric flow. The PMW is known to apply over several magnitudes of vessel calibers, and in many different organs, including the brain, in humans and in animals. Animal studies suggest that blood flow in arteries is approximately proportional to the cube of the vessel radius, and that arteries alter their caliber in response to sustained changes of blood flow according to PMW. Remodelling of the retinal arteriolar network to long-term changes in blood flow was observed in humans. Remodelling of whole arterial networks occurs in the form of increase or diminishing of vessel calibers. Shear stress induced endothelial mediation seems to be the regulating mechanism for the maintenance of this optimum blood flow/vessel diameter relation. Arterial trees are also expected to be nearly space filing. The vascular system is constructed in such a way that, while blood vessels occupy only a small percentage of the body volume leaving the bulk to tissue, they also crisscross organs so tightly that every point in the tissue lies on the boundary between an artery and a vein. This review describes how the energetic optimum principle for least energy cost for blood flow is also compatible with the spatial constraints of arterial networks according to concepts derived from fractal geometry.

  7. [Intra-arterial fibrinolysis in vertebrobasilar system].

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    Castaño-Duque, C H; de Juan-Delago, M; Muñoz-Casadevall, J; Martí-Fábregas, J; Franquet, E; Ruscalleda-Nadal, J; Guardia-Mas, E

    The acute vertebrobasilar occlussion is usually a life-treatening disease leading to death or major disability. The treatment with heparin and the selective fibrinolysis no show good results, for this reason the local intra-arterial fibrinolysis appear as the choice treatment in patients with stroke and a agiography with basilar artery occlussion or intracranial vertebral artery occlusion. This tecnique has been proved to be effective treatment for selected patients with acute thromboembolic occlusion of the middle cerebral artery, ophthalmic artery and vertebrobasilar system, reducing the mortality in the vertebrobasilar system from 90% to 40%. We present a 63 years-old man with a vertebrobasilar thrombosis of a probable cardioembolic origen. He was treated with r-TPA local intra-arterial fibrinolysis, to get a recanalization of vertebrobasilar system. In the control TC we see a haemorragic sufusion in the brain stem. The follow-up see a patient with tetraparesis and palsy of the low cranial nerves and normal superior cerebral functions. The local intra-arterial fibrinolysis is the choise treatment in the vertebrobasilar thrombosis because the high morbimortality of this patology and the inefficacy of the others therapeutics. The result depend of many factors as the thrombo location, the neurologic state, the evolution time, the start of treatment, the colateral circulation, the nervous tissue reserve, etc, that have dificult predict the result, but it is best of the natural history of the disease. Is necesary, change the concept of emergency and the attitude front the isquemic cerebral disease at the sanitary leaders, the doctors, and the general population, for dispose of more means to cofront this pathology, which permit diminish the morbimortality and reduce the grade of incapacity.

  8. Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease

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    Ghabili K

    2011-10-01

    Full Text Available Abolhassan Shakeri Bavil1, Kamyar Ghabili2, Seyed Ebrahim Daneshmand3, Masoud Nemati3, Moslem Shakeri Bavil4, Hossein Namdar5, Sheyda Shaafi61Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 3Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran; 4Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran; 5Department of Cardiology, Tabriz University of Medical Sciences, Tabriz, Iran; 6Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Generalized screening for carotid artery stenosis with carotid duplex ultrasonography in patients with peripheral arterial disease is controversial.Objectives: The aim of the present study was to determine the prevalence of significant internal carotid artery (ICA stenosis in a group of Iranian patients with peripheral arterial disease.Methods: We prospectively screened 120 patients with a known diagnosis of peripheral vascular disease for carotid artery stenosis. Based on the angiographic assessment of abdominal aorta and arteries of the lower extremities, patients with stenosis greater than 70% in the lower extremity arteries were included. A group of healthy individuals aged ≥50 years was recruited as a control. Risk factors for atherosclerosis including smoking, diabetes mellitus, hyperlipidemia, ischemic heart disease, and cerebrovascular disease were recorded. Common carotid arteries (CCAs and the origins of the internal and external arteries were scanned with B-mode ultrasonogaphy. Significant ICA stenosis, >70% ICA stenosis but less than near occlusion of the ICA, was diagnosed when the ICA/CCA peak systolic velocity ratio was ≥3.5.Results: Ninety-five patients, with a mean age of 58.52 ± 11.04 years, were studied. Twenty-five patients had a history of smoking, six

  9. Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Diagnosis with CT Angiography

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    Guray Oncel

    2013-01-01

    Full Text Available Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA is a rare congenital anomaly. It is associated with early infant mortality and sudden death in adults. Traditionally, ALCAPA has been diagnosed by angiography or autopsy; however, the development of cardiac computed tomography (CT and magnetic resonance imaging (MRI has allowed noninvasive evaluation of the coronary anatomy by direct visualization of the origin of the left coronary artery (LCA from the pulmonary artery. We report a case of 10-year-old girl who has been on follow up for dilated cardiomyopathy for 4 years. The definitive diagnosis of ALCAPA is reached by multislice computed tomography (MSCT. The MSCT scan showed an anomalous origin of LCA from the pulmonary trunk, with a tortuous and dilated right coronary artery and right-to-left collateralization. Consequently, the patient was successfully treated with surgery.

  10. Relationship of daily arterial blood pressure monitoring readings and arterial stiffness profile in male patients with chronic obstructive pulmonary disease combined with arterial hypertension

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    Karoli N.A.

    2013-06-01

    Full Text Available The aim of the study was to determine correlation between arterial blood pressure daily rhythm and daily profile of arterial stiffness in male patients with chronic obstructive pulmonary disease (COPD and arterial hypertension. Materials et methods: Prospective investigation comprised 45 male patients with COPD and arterial hypertension. Individuals of 40 years younger and 80 years elder, patients with diabetes, stroke, angina pectoris, or heart infarction, vascular diseases, and exacerbation of chronic disease, bronchial and pulmonary diseases of other etiology were excluded from the analyses. Comparison group included 47 patients with essential arterial hypertension and without chronic respiratory diseases closely similar on general parameters with patients from main clinical series. Twenty-four-hour arterial blood pressure monitoring (ABPM and daily arterial stiffness monitoring were performed using BPLab® MnSDP-2 apparatus (Petr Telegin, Russian Federation. Results: Patients with COPD combined with arterial hypertension with raised arterial stiffness measures prevail over individuals in essential hypertension group. There is pathological alteration of the ABPM circadian rhythm and raised «Pressure load» values in raised arterial stiffness group. Conclusion: We found ABPM raised parameters in patients with COPD and arterial hypertension. It confirms necessity of ABPM in daily arterial stiffness assessment in patients with COPD.

  11. Tentorial artery embolization in tentorial dural arteriovenous fistulas

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    Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N. [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

    2006-10-15

    The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

  12. [Alterations in arterial compliance of dyslipidemic patients].

    Science.gov (United States)

    Clara, Fernando Mario; Corral, Pablo; Blanco, Gustavo Hector; Scandurra, Adriana Graciela; Meschino, Gustavo Javier

    2015-01-01

    We studied the alteration on the distensibility of the arterial walls caused by dyslipidemia LDLc dependent, along the decades of life, by means of a study of the radial artery pulse wave. We made an analysis of the radial artery pulse wave records acquired by means a movement displacement sensor, placed on radial palpation area. We recruited 100 dyslipidemic men without other cardiovascular risk factors, between the 3rd and the 6th decade. We identified the reflected wave in the records and we computed the augmentation index in order to quantify its amplitude and position. This index is useful to assess the endothelial dysfunction. Besides, we defined a velocity coefficient as the ratio between the size of the individuals and the delay time between the peak of the systolic wave and the arrival of the reflected wave. Results were compared against those obtained in a group of 161 healthy volunteers. We found that dyslipidemic patients presented augmentation index values similar to controls until the fourth decade, increasing thereafter with significant differences only in the 6th decade. No significant differences were found in the velocity index in any of the ages studied. We conclude that alterations produced by dyslipidemia take decades to manifest, and they begin affecting the mechanism of vasodilation of distal arteries with highest proportion of smooth muscle, without altering the proximal conduit arteries with more elastin content. Copyright © 2013 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  13. Pulmonary Artery Leiomyosarcoma Diagnosed without Delay

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    Motohisa Yamasaki

    2011-05-01

    Full Text Available A 63-year-old female presented with abnormal lung shadows but had, apart from this, few symptoms. Computed tomography (CT revealed multiple nodules and blockage of the pulmonary artery. She was immediately diagnosed with pulmonary artery sarcoma based on a careful differential diagnosis and underwent surgery. Her tumor was pathologically diagnosed as leiomyosarcoma (i.e. intimal sarcoma. Pulmonary artery sarcoma can be easily confounded with thromboembolism in a clinical setting and some cases are diagnosed post mortem only. In our case, clinical prediction scores (Wells score, Geneva score, and revised Geneva score for the pulmonary embolism showed low probability. Moreover, chest CT showed uncommon findings for pulmonary thromboembolism, as the nodules were too big for thrombi. Because surgical resection can provide the only hope of long-term survival in cases of pulmonary artery sarcoma, clinicians should consider this possibility in the differential diagnosis of pulmonary embolism. Clinical prediction scores and CT findings might help to reach the correct diagnosis of pulmonary artery sarcoma.

  14. Fiber Bragg grating based arterial localization device

    Science.gov (United States)

    Ho, Siu Chun Michael; Li, Weijie; Razavi, Mehdi; Song, Gangbing

    2017-06-01

    A critical first step to many surgical procedures is locating and gaining access to a patients vascular system. Vascular access allows the deployment of other surgical instruments and also the monitoring of many physiological parameters. Current methods to locate blood vessels are predominantly based on the landmark technique coupled with ultrasound, fluoroscopy, or Doppler. However, even with experience and technological assistance, locating the required blood vessel is not always an easy task, especially with patients that present atypical anatomy or suffer from conditions such as weak pulsation or obesity that make vascular localization difficult. With recent advances in fiber optic sensors, there is an opportunity to develop a new tool that can make vascular localization safer and easier. In this work, the authors present a new fiber Bragg grating (FBG) based vascular access device that specializes in arterial localization. The device estimates the location towards a local artery based on the bending of a needle inserted near the tissue surrounding the artery. Experimental results obtained from an artificial circulatory loop and a mock artery show the device works best for lower angles of needle insertion and can provide an approximately 40° range of estimation towards the location of a pulsating source (e.g. an artery).

  15. Acute effect of hemodialysis on arterial elasticity.

    Science.gov (United States)

    Sağ, Saim; Yeşilbursa, Dilek; Yildiz, Abdulmecit; Dilek, Kamil; Şentürk, Tunay; Serdar, Osman Akın; Aydinlar, Ali

    2015-01-01

    Reduced arterial elasticity is an independent predictor of cardiovascular mortality in patients with end-stage renal disease (ESRD). Hemodialysis (HD) treatment per se can bring additional risk factors for vascular disease. Our study was designed to determine whether a single hemodialysis session leads to an acute alteration in parameters of arterial elasticity in ESRD. In this study, 58 patients undergoing chronic hemodialysis and 29 healthy controls were enrolled. Large artery elasticity index (LAEI) and the small artery elasticity index (SAEI) were measured by applanation tonometry. The acute effect of a hemodialysis session on arterial elasticity indices was assessed by comparison of prehemodialysis and posthemodialysis determinations. At baseline, LAEI did not differ significantly in patients compared with controls. In contrast, the SAEI was significantly lower in patients (4.1 ± 2.6 mL/mmHg x 100) than in healthy individuals (8.9 ± 3.4 mL/mmHg x 100, P < 0.05). In patients with ESRD, no significant changes in LAEI was observed after HD, but SAEI deteriorated significantly (from 4.1 ± 2.6 mL/mmHg x 100 to 3.4 ± 2.3, P < 0.05). We conclude that ESRD patients face a significant reduction in SAEI, which is exacerbated by a dialysis procedure.

  16. Effect of internal carotid artery stenting on superior thyroid artery Doppler flow.

    Science.gov (United States)

    Gunduz, Yasemin; Akdemir, Ramazan; Varim, Perihan; Ayhan, Lacin Tatli; Cakar, Mehmet Akif; Vatan, Mehmet Bulent; Kilic, Harun

    2014-10-01

    Patients with carotid disease are frequently referred for carotid artery stenting based on the results of carotid duplex studies. During carotid artery stenting, the stent is usually extended into the common carotid artery, thereby crossing the external carotid artery. Previous studies have shown conflicting results regarding internal carotid stenting and external carotid artery flow velocities, but the effect of stenting on ipsilateral superior thyroid artery velocities has not been defined. This study examined the effect of internal carotid angioplasty and stenting on the ipsilateral superior thyroid artery Doppler-derived flow parameters. We prospectively studied preinterventional and postinterventional duplex scans obtained from 41 patients (mean age ± SD, 64 ± 10 years) who underwent carotid artery stenting. The Doppler-defined preprocedural peak systolic velocity (PSV) end-diastolic velocity (EDV), resistive index (RI), and pulsatility index (PI) in the ipsilateral external carotid and superior thyroid arteries were compared with postprocedural values. Among patients with stenting, the preprocedural PSV, EDV, RI, and PI in the ipsilateral superior thyroid artery were 30 ± 11 cm/s, 13 ± 6 cm/s, 0.62 ± 0.11, and 1.04 ± 0.28,respectively; after stenting, they were 36 ± 8 cm/s, 14 ± 9 cm/s, 0.71 ± 0.07, and 1.11 ± 0.19. The preprocedural PSV, EDV, RI, and PI in the ipsilateral external carotid artery were 79 ± 24 cm/s, 17 ± 7 cm/s, 0.77 ± 0.26, and 1.27 ± 0.22; after stenting, they were 94 ± 31 cm/s, 20 ± 6 cm/s, 0.80 ± 0.4, and 1.25 ± 0.31. Despite a slight increase in superior thyroid and external carotid artery flow, there was no statistically significant change from before to after stenting. This study showed no differences in blood velocity profiles in the ipsilateral superior thyroid and external carotid arteries after stenting. © 2014 by the American Institute of Ultrasound in Medicine.

  17. The resonance theory of coronary arterial wall stress as an explanation for the distribution of coronary artery disease.

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    John, Lindsay C H

    2010-05-01

    The coronary arteries are unique within the arterial system in being subject to a continuous oscillatory displacement. It is hypothesised that oscillatory resonance of the coronary arteries occurs when the heart rate is the same as the arteries' Natural Frequency of oscillation. If resonance were to occur then standing waves would exist along the coronary arteries. The sites of the anti-nodes of such standing waves would be the sites of increased wall stress and therefore be expected to be predisposed to disease. Coronary artery resonance would explain the observed increased incidence of disease in the proximal segments of the arteries. It is proposed that coronary artery resonance is a previously unrecognised aetiological factor for coronary artery disease that contributes to its location. If the hypothesis is true then there are potential important consequences for the diagnosis and treatment of the disease.

  18. Plurivascular Lesions in Patients with Peripheral Arterial Disease

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    Kelemen Piroska

    2016-09-01

    Full Text Available Introduction: Occlusive arterial disease, regardless of etiology, is a progressive chronic disease with multiple vessel involvement. The importance of obstructive arterial disease is that it leads to an increased mortality and morbidity of other cardiovascular disorders. Therefore, the presence of a lesion on a certain artery should lead to the identification of other lesions on the carotid and coronary arteries. The aim of the study was to assess the frequency and severity of lesions in peripheral arterial disease of different etiologies, and also to study its association with multivessel lesions at the level of the coronary tree and the carotid arteries.

  19. Dextrocardia with situs inversus totalis: coronary artery bypass grafting.

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    Hashmi, Salila; Anis, Mariam; Darr, Umer

    2012-01-01

    Dextrocardia with situs inversus is a rare congenital abnormality involving a left-handed mal rotation of the visceral organs. The incidence of coronary artery disease is the same as that in the general population. Performing coronary artery bypass surgery on patients with dextrocardia poses a more challenging task. It is recommended that the right internal mammary artery be the first choice of graft for the anterior descending artery for a "situs inversus" situation. We report 2 cases of patients with Dextrocardia who developed coronary artery disease and underwent coronary artery bypass grafting. Also mentioned is the slight difference in our technique.

  20. Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess

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    Jacek Brzost

    2015-01-01

    Full Text Available The extracranial internal carotid artery aneurysm (EICAA is an uncommon arterial lesion. Patients typically present with neurologic symptoms resulting from impaired cerebral perfusion and compression symptoms of cranial nerves. Often EICAA presents as a pulsatile neck mass, which is otherwise asymptomatic. We present a case of an 84-year-old female, who was initially referred to the Emergency Department for Otolaryngology with suspected peritonsillar abscess. The patient had a history of recent upper airway infection and cardiovascular comorbidities, including hypertension and ischaemic stroke complicated by extensive neurologic deficits. Physical examination revealed a compact, nonpulsatile mass in the lateral parapharyngeal space and local erythema of the mucosa. Duplex Doppler Ultrasonography and Computed Tomography revealed an atherosclerotic aneurysm of the right internal carotid artery, measuring 63×55×88 mm, stretching from the skull base to the angle of the mandible.