[Morphology of the communicating veins of the leg, and its meaning in the genesis and surgical treatment of primary varicose veins].
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Biomedical subjects
Publications and source records attributed to L Corcos.
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Increasing interest on the short saphenous vein has been induced by its employment as autologus graft in arterial surgery and for being held responsible for the onset and development of varicose veins of the lower limbs and postoperative recurrence. These two clinical conditions require a more precise assessment of the short saphenous anatomy and its variables previously described in literature. A verify of the anatomical variations of the sapheno-popliteal junction and of the short saphenous outlet in 528 not randomized limbs was performed in separate groups by the following methods: High Resolution Echography, preoperative ascending Phlebography, preoperative Digital Phlebography, intraoperative Selective Phlebography. A high number of anatomical variations was found (29.8%) and the conclusion was that modest differences between published data by other Authors and the results of this study were found. The ideal diagnostic approach for these anatomical variations is the intraoperative Selective Phlebography in cases systematically selected by preoperative High Resolution Echography.
In 50 healthy subjects the internal diameter of the intracranial vertebral artery were measured by echocolor doppler method. The diameter of left vertebral a. was greater than that of the right in most subjects (58%); the mean left/right difference was statistically significant (p < 0.05). Analyzing men and women separately, the difference remained significant only in women (p < 0.05). A significant correlation was found between vertebral a. diameter and sex (p < 0.01). The vertebral a. diameter had a tendency to increase with age, that reached significance only for the left vertebral one. No significant correlation was found between body surface area and vertebral a. diameter.
The collateral circles formed following lower limbs arterial occlusion and their hemodynamic function have been described; 35 subjects (23 men and 12 women; age range 65 to 80), with symptomatic lower limbs obstructive arteriopathy (Fontaine's stage II) following occlusion of vessels downstream the subrenal aorta have been studied by means of Contrast Angiography and Color Doppler Echography of the vascular district including the terminal aorta and the lower limbs arteries. The hemodynamic significance of the collateral circles was assessed by calculating the Windsor index. In this population, the collateral circles for each level of obstruction were explored. Occlusion of the terminal abdominal aorta: the collateral circle was mainly established through the inferior mesenteric and ischiatic arteries and through the lumbar, ilio-lumbar and gluteal arteries; occlusion of the iliac tract: the collateral circulation was established through the spermatic or ovaric artery and through the funicular, external pudendal and middle sacral arteries; occlusion of the ilio-femoral tract: the collateral circulation was formed by the internal and external pudendal arteries and by the ilio-lumbar, obturating, gluteal and circumflex iliac arteries; occlusion of first tract of the superficial femoral artery: collateral circulation was established through the deep femoral artery and through the perforating arteries; occlusion of the terminal tract of the superficial femoral artery: collateral circulation was formed by the articular branches of the same artery originating proximal to the occlusion and through branches of the deep femoral artery; occlusion of the superficial and deep femoral arteries at their origin: collateral circulation was established through the ischiatic artery (directly and, indirectly, through the perforating arteries), and through the tegumental arteries. The hemodynamic significance, as measured by Windsor index was higher the more proximal was the occlusion, in accord with the lower caliber and/or number of vessels involved in the collateral circles.
50 healthy subjects (25 men and 25 women; age range: 18 to 80 years) have been examined. The internal calibers of the common femoral artery, of the superficial femoral artery, of the common femoral vein, and of the superficial femoral vein have been measured in selected locations using Color Doppler Ultrasonography. The difference in vessel caliber between men and women was statistically significant (p < 0.01). There was no significant difference in left versus right vessel calibers for all the four vessels studied. In the same subject, vessel caliber was directly proportional in the left compared to the right side (p < 0.01). Both in the left and in the right side, arterial and venous calibers of the same subject in the same side were directly proportional (p < 0.01). The relationship between the calibers of the four vessels under study and age, height, and body surface area were not statistically significant.
The Circle of Willis was studied by Magnetic Resonance Angiography in 100 healthy subjects. In 41% of these cases, the arteries were arranged in the classically described way. In 21%, hypoplasia of the posterior communicating as. was noted, while in 13% the posterior cerebral as were found to originate from the internal carotid a.. In 9% of these cases, three anterior cerebral as. were present. In 3% the anterior communicating artery could not be identified, while the left posterior communicating artery was hypoplastic. In 2% the absence of a posterior communicating artery was associated with the origin of a posterior cerebral a. from the internal carotid. In another 2% the anterior cerebral as. were partially fused, and in yet another 2%, hypoplasia of both an anterior and a posterior cerebral a. was present. The remaining seven cases (7%), all different from each other, represented combinations of the above described variations. Statistical analysis indicated that anomalies occurred more commonly on the left than on the right side. The morphology of the Circle of Willis could not be correlated with either sex or Body Index.
The collateral circles and their hemodynamic significance in distal lower limb arterial occlusion have been described in an elderly population. Overall 40 subjects (20 men and 20 women; age range 66-83) with symptomatic lower limb arteriopathy (Fontaine's stage II) have been studied combing Contrast Angiography and Color Doppler Echography of the lower limb arterial district. In our population, the results showed that the tibialis arteries were the vessels most often involved in arterial occlusion (posterior tibialis a., 15 cases = 37.5%, posterior tibialis a., 12 cases = 30%), followed by the peroneal a. (8 cases = 20%) and by the popliteal a. (5 cases, 12.5%). In the occlusion of the popliteal artery the collateral circle was mainly established through the deep femoral a., the great anastomotic a., the recurrent posterior tibialis a., and from the articular supero-lateral a. In the occlusion of the anterior tibialis artery the collateral circulation was ensured through the collateral posterior tibialis as. and through the collateral perineal as. In the occlusion of the posterior tibialis a., the collateral circle was established through the great anastomotic a., through the branchers of the arterial circle of the ankle and from the perforating plantar as. (anterior tibial a.). Finally, in the occlusion of the peroneal a., the collateral circulation was only represented by branches of the arterial circle of the ankle. The hemodynamic compromission, measured by the Windsor Index, was the highest for popliteal occlusions (mean IW = 34.3%). Occlusions of the anterior tibialis a. (mean IW. = 35.48%), of the peroneal a. (mean IW = 44.71%), and of the posterior tibialis a. (mean IW = 55.44%) showed progressively lower hemodynamic compromission. Gender differences in hemodynamic significance at each level of occlusion were not significant.