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PubMed1989

[A case report of hypoplasia of the root portion and the intermediate portion of the left internal carotid artery associated with an unusual primitive collateral circulation between the left internal carotid artery and the left external carotid artery].

The internal carotid artery is one of the most stable arteries and its absence is very rare. We reported a case of hypoplasia of the root portion and the intermediate portion of the left internal carotid artery associated with an usual primitive collateral circulation between the left internal carotid artery and the left external carotid artery. A 57-year-old male developed right hemiparesis of sudden onset 3 days prior to admission. On admission, right hemiparesis and right minimal facial palsy was observed. The left direct carotid angiogram revealed that the root portion and the intermediate portion of the left internal carotid artery were hypoplastic. There was an unusual primitive collateral circulation between the left internal carotid artery and the left external carotid artery. From an embryological point of view, normally, the internal carotid artery is derived from the third aortic arch and the dorsal aorta when the embryo is attained the 3-mm stage. The root portion of the internal carotid artery is formed from the third aortic arch. The dorsal aorta between the third and the first aortic arch form the intermediate portion. The distal part of the internal carotid artery originates from the dorsal end of the first aortic arch. The common carotid artery begins to form in the 12-mm to 14-mm embryo, following involution of portion of the ventral aortic root between the third and the fourth aortic arch. The external carotid artery arises from the aortic sac and migrate up to the third aortic arch.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta, Thoracic↗
PubMed2002

Randomized comparative study of radial artery and right gastroepiploic artery in composite arterial graft for CABG.

OBJECTIVES: Arterial grafts have been used to achieve better long-term results and improve graft patency in coronary artery bypass grafting. Composite graft was proposed to overcome inconveniences of proximal anastomoses to the aorta and increase the use and surgical options of arterial grafts. However, lack of prospective randomized studies with this kind of grafts is evident. We compare the results of composite Y-grafts of the radial artery (RA) and the right gastroepiploic artery (RGEA) proximally anastomosed to the left internal thoracic artery (LITA) for CABG, evaluated through angiography, in a prospective randomized study. METHODS: Between August 1998 and November 1999, 60 patients were randomly divided into two groups: group I (GI) received RGEA graft and group II (GII), RA graft. LITA was used to graft the left anterior descending artery and RGEA or RA was placed to obtuse marginal or first diagonal branch. The right coronary artery branches was grafted with saphenous vein graft (SVG) when necessary. All coronary arteries receiving arterial grafts had > or =75% proximal stenosis and diameter > or =1.5 mm. RESULTS: GI and GII preoperative data were similar, 63 distal anastomoses were performed with the LITA, 32 with the RA and 32 with the RGEA. There were two perioperative deaths (3.3%), one in each group, none related to cardiac causes. Four (6.6%) q-wave myocardial infarctions were found and two (3.3%) patients showed low cardiac output syndrome. Angiography was performed in all surviving patients from the 8th to 15th postoperative day and showed a patency rate of 96.5% (56/58) for LITA, 89.6% (26/29) for RA and 68.9% (20/29) for RGEA, with a statistically significant difference between RGEA and RA (P=0.025). CONCLUSIONS: Radial artery had better early results than right gastroepiploic artery. Use of the LITA as inflow graft seems not to affect its good patency. Use of the RGEA as composite graft should not be encouraged. Long-term follow-up with objective investigation and randomized trials is required to confirm better results of composite conduits.

Coronary Angiography↗
PubMed1990

Effect of acetylcholine on arterial and venous grafts and coronary arteries in patients with coronary artery disease.

Endothelium-dependent vasomotor responses differ in arteries and veins. The transfer of a given vessel from a different vascular bed into the coronary circulation by grafting may affect its endothelial function. In order to evaluate the differences in endothelial function of the internal mammary artery and aortocoronary venous grafts in patients with coronary artery disease, the response to acetylcholine (ach) was examined and compared with that of native coronary arteries. Eighteen patients were examined, including eight with internal mammary artery grafts (9 days to 48 months after surgery), and 10 with saphenous vein grafts (12-96 months after surgery). Ach (70-700 nmol min-1) was infused selectively into a graft on the left anterior descending coronary artery, and the effect on vessel diameters was assessed by quantitative arteriography. In both groups 84% and 83%, respectively, of the arterial segments distal to the bypass anastomosis were contracted by ach (greater than or equal to 70 nmol min-1). The segments of both groups did not show angiographic evidence of local atherosclerosis. A complete occlusion occurred in four cases. In contrast, internal mammary artery grafts were not contracted by ach; in four of 12 segments a dilatation was observed, whereas five of 20 aortocoronary venous graft segments showed a slight reduction in lumen diameter after the highest ach dose applied. The vasoconstricting effect of ach was reversed by intracoronary nitroglycerin. By using ach as an indicator of endothelial dysfunction it is concluded that the internal mammary artery grafts maintained an intact endothelial function after surgery, whereas the coronary artery segments showed an impaired endothelium-dependent vasodilatation. Some of the venous graft segments reacted as coronary arteries did with a less pronounced cholinergic vasoconstriction. This in vivo study supports the observation of a functional superiority of internal mammary artery over saphenous vein coronary grafts.

Acetylcholine↗
PubMedDate not supplied

Unilateral hepatic artery reconstruction is unnecessary in biliary tract carcinomas involving lobar hepatic artery: implications of interlobar hepatic artery and its preservation.

BACKGROUND/AIMS: The interruption of hepatic arterial flow when performing a bilioenteric anastomosis has been reported to usually bring about serious postoperative complications, such as anastomotic leakage, hepatic abscess and infarction. We aimed to evaluate the surgical implications of the interlobar hepatic artery when patients with advanced biliary tract carcinomas undergo surgical resection with a bilioenteric anastomosis. METHODOLOGY: In 7 patients with advanced biliary tract carcinomas, the combined resection of the liver (greater than hemihepatectomy in 2 and less than hemihepatectomy in 5), extrahepatic bile duct, hepatic artery (right hepatic artery in 5, right and left hepatic artery in 1, left hepatic artery in 1), and the portal vein was performed in 4 patients. The portal vein was reconstructed in all 4 patients. The hepatic artery was reconstructed in only one patient, with combined resection of both right and left hepatic arteries, but was not reconstructed in 2 other patients, even though they underwent resection greater than hemihepatectomy. RESULTS: The interlobar hepatic artery running into the Glissonian sheath around the hepatic duct confluence could be preserved in 5 patients, as shown by angiography, but could not be preserved in 2 patients who underwent greater than hemihepatectomy. Moderate and transient ischemic liver damage occurred, but no serious postoperative complications were induced in any of the 5 patients in the unilateral hepatic artery preserved group. However, both cases without preservation of the hepatic artery encountered liver failure, liver abscess and leakage of bilioenteric anastomosis, and one patient died of multiple organ failure. CONCLUSIONS: One major lobar branch of the hepatic artery involved by cancer invasion could be safely resected without reconstruction in patients with advanced biliary tract carcinomas when the interlobar hepatic artery running into the Glissonian sheath around the hepatic duct confluence is preserved.

Adult↗
PubMed2001

High bifurcation of common carotid artery, anomalous origin of ascending pharyngeal artery and anomalous branching pattern of external carotid artery.

We present a rare case of combined high bifurcation of the common carotid artery, anomalous origin of the ascending pharyngeal artery and unusual branching pattern of the external carotid artery. The right common carotid artery bifurcated at the level between the second and the third cervical vertebrae, giving rise to the ascending pharyngeal artery just below the bifurcation. The right external carotid artery branched directly at its origin into the superior thyroid, lingual and occipital arteries and the distal part of the external carotid artery. The latter gave rise to the right facial artery and finally bifurcated into the maxillary and superficial temporal arteries. The right posterior auricular artery arose from the right occipital artery. The finding was unilateral and other vascular anomalies were not observed. The embryogenesis of such a combination of anomalies is not clear, but the anatomic consequences may have important clinical implications.

Aged↗
PubMed1995

[Evaluation of new style of drug delivery system for primary lung cancer: intermittent intra-arterial injection therapy with subcutaneous infusible port I.--Temporary changes in feeding arteries of lung cancer in processes of intra-arterial injection therapy].

Arterial injection therapy for lung cancers is concentrated on the bronchial arteries, because they are reported by the main feeders of lung cancers. In the present study, we attempted intermittent arterial injection therapy with implantable port system. In the cases of lung cancers, in the present study, tumors were mainly fed by bronchial arteries originating from intercostal-bronchial arteries in right lungs, and those directly originating from aorta in the left lungs. However, in the processes of BAI (Bronchial Arterial Injection Therapy), main feeders often were obstructed and the new feeders originated from branches of subclavian arteries, such as thyro-cervical truncks, internal mammary arteries, thoraco-acromial arteries and intercostal arteries. They formed networks surrounding the lungs. Adequate study of the feeding arteries should be performed in the course of arterial injection therapy of lung cancers.

Adenocarcinoma↗
PubMed1993

Vasoreactivity of the radial artery. Comparison with the internal mammary and gastroepiploic arteries with implications for coronary artery surgery.

BACKGROUND: Recently, satisfactory results were obtained in a series of patients in whom the radial artery was used as a conduit for coronary artery bypass. However, spasm of this conduit was observed in 4% of patients. The aim of this study was to analyze the vasoreactive properties of the radial artery and to compare them with those of the internal mammary and the gastroepiploic arteries. METHODS AND RESULTS: Human radial (56 from 15 patients), internal mammary (77 from 20 patients), and gastroepiploic (41 from 12 patients) artery ring segments were mounted on a strain gauge in oxygenated, normothermic Krebs' solution at optimal resting tension. With KCl (100 mM) serving as the control, the dose-response curves to norepinephrine, serotonin, and thromboxane A2 mimetic were obtained, permitting assessment of force of contraction and sensitivity. Functional endothelium was assessed with acetylcholine. Smooth muscle-dependent relaxation was assessed with sodium nitroprusside. The radial artery had stronger contractions to KCl than the other vessels. The radial and the gastroepiploic arteries with endothelium presented a higher contraction force than the internal mammary artery in response to norepinephrine and serotonin. The three vessels had equal sensitivities to norepinephrine and serotonin. The gastroepiploic artery had a lower sensitivity to thromboxane A2 mimetic than the two other vessels. CONCLUSIONS: This increased reactivity of the radial artery explains its propensity to spasm and emphasizes the need for antispastic drugs and platelet inhibitors when the radial artery is used for coronary artery bypass.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
PubMed2000

The anastomotic artery connecting the axillary or brachial artery to one of the forearm arteries.

A vessel connecting the axillary or brachial artery to one of the forearm arteries was found in a 65 year old male cadaver, during the gross anatomy dissection of the upper extremity of 20 adult cadavers at the Department of Cellular Biology and Anatomy, Louisiana State University Medical Center. The right radial artery originated from the brachial artery nearly at the usual level and was connected to the axillary or brachial artery by a long slender anastomotic artery (vasa aberrantia). The anastomotic artery coursed under the medial side of the biceps muscle between the median and musculocutaneous nerves, and gave off two muscular branches to the biceps muscle. The anastomotic artery coursed between the median and musculocutaneous nerves in the arm, it passed to the forearm under the bicipital aponeurosis and connected the main radial artery on the radial side of the forearm. The anastomotic artery can be explained on the basis of its embryologic development and also ought to be distinguished from the other common arterial variations in the upper extremity.

Aged↗
PubMed2005

Evaluation of relation among aneurysmal neck, parent artery, and daughter arteries in middle cerebral artery aneurysms, by three-dimensional digital subtraction angiography.

Intracranial aneurysms usually occur at arterial bifurcations. However, in middle cerebral artery (MCA) aneurysms, we often find that the aneurysmal neck does not necessarily exist just on the arterial bifurcation. In this study, we have evaluated the relation among aneurysmal neck, parent artery, and daughter arteries in middle cerebral artery aneurysms, by three-dimensional digital subtraction angiography. Twenty consecutive patients (9 men and 11 women) with MCA aneurysms were examined. The total number of aneurysms was 22, of which 10 aneurysms were unruptured and 12 were ruptured. Aneurysmal sizes and angles between the parent artery and each of the two daughter arteries were measured. Furthermore, aneurysms were classified into two types based on neck location. Thus, when the neck was located on the extension of the midline of the parent artery, it was defined as a classical neck type aneurysm, and when it was not, it was defined as a deviating neck type aneurysm. There were 15 cases of deviating and 7 cases of classical neck type. Interestingly, in the deviating neck type, all the aneurysms existed on the side of the daughter arteries of which the angles between parent arteries were narrower, and in 93%, the sizes of the daughter arteries in which the neck existed were smaller compared with other daughter arteries.

Adolescent↗
PubMed2001

Myocardial revascularization with multiple arterial grafts: comparison between the radial artery and the right internal thoracic artery.

BACKGROUND: Bilateral internal thoracic artery (ITA) harvesting is significantly underused, whereas the radial artery is being used with increasing frequency. We have retrospectively analyzed perioperative and short-term outcomes of patients receiving a radial artery versus those receiving a right ITA as a second arterial graft. METHODS: Between February 1999 and May 2000, 250 patients underwent coronary artery bypass grafting using the radial artery (156 patients) or the right ITA (94 patients) in combination with the left ITA and, when required, the saphenous vein. RESULTS: There was a higher prevalence of risk factors in the radial artery group. More coronary artery bypass graftings (p < 0.001) were performed with the radial artery. Operative mortality was not different (p = not significant). In the right ITA group there was more bleeding (p < 0.001) and a longer hospital stay (p < 0.001). Mean follow-up was 8.1 +/- 3.9 months. The probability of survival was similar (p = not significant). CONCLUSIONS: The radial artery can extend the benefits of multiple arterial grafting to those patients who are usually excluded from bilateral ITA harvesting because of multiple risk factors. Perioperative and short-term results are good.

Adult↗
PubMed1999

Transverse cervical artery bypass pedicle for treatment of common carotid artery occlusion: new adjunct for revascularization of the internal carotid artery domain.

OBJECTIVE: We present two cases of common carotid artery occlusion that were treated by vascular reconstruction using the transverse cervical artery. METHODS: Two patients with common carotid artery occlusion presented with transient ischemic attacks resulting from decreased cerebral blood flow on the affected side. Both patients underwent vascular reconstruction using the transverse cervical artery. The transverse cervical artery was anastomosed to the ipsilateral external carotid artery at its origin, as a pedicle graft. A superficial temporal artery-middle cerebral artery anastomosis was then performed. RESULTS: The postoperative courses were uneventful. The transverse cervical artery bypass grafts were patent, and cerebral blood flow increased to normal levels. CONCLUSION: Transverse cervical artery grafting provides a less tedious alternative to saphenous vein interposition grafting for revascularization of the internal carotid artery domain.

Aged↗
PubMed2003

"Bay window" technique for the arterial switch operation of the transposition of the great arteries with complex coronary arteries.

BACKGROUND: The success of arterial switch operations for transposition of the great arteries largely depends on faultless coronary translocation and subsequent sufficient myocardial perfusion. However, in patients with complex coronary artery anatomy, coronary translocation is often difficult to perform by conventional surgical techniques alone. Therefore we developed the "bay window" technique as a useful adjunct in patients with complex coronary arteries undergoing concomitant coronary translocation and arterial switch operation. Early and midterm results of this technique are described. METHODS: Between September 2001 and February 2002, 4 patients with transposition of the great arteries with complex coronary arteries underwent arterial switch operation. The ages of the patients at the time of operation ranged from 8 to 52 days. Great arterial relationships were anteroposterior in 2 patients, right-oblique in 1, and side-by-side in 1. One patient also had ventricular septal defect. Coronary arterial patterns were as follows: absent left main trunk in 1 patient, short left main trunk in 1, and short right main trunk in 1. Both coronary arterial orifices were resected as a tall U-shaped cuff. The inferior half of the coronary cuff was sewn into a J-shaped incision on the pulmonary stump. The superior half of the coronary cuff was folded down inside to form a bay window channel. RESULTS: No coronary events occurred (ie, inclusive of coronary stenosis, myocardial infarction, and coronary death). Postoperative echocardiogram demonstrated normal ventricular wall motions in all 4 patients. CONCLUSIONS: The bay window technique is an innovative and simple surgical adjunct for translocating complex coronary arteries.

Anastomosis, Surgical↗
PubMed1992

Systemic multiple aneurysms of the extracranial internal carotid artery, intracranial vertebral artery, and visceral arteries: case report.

A rare case of systemic multiple aneurysms located in the extracranial internal carotid artery, intracranial vertebral artery, and intraperitonial arteries is described. A 56-year-old woman was referred to our hospital with suspected rupture of an aneurysm of the right extracranial internal carotid artery. Digital subtraction angiography demonstrated a giant aneurysm in the right extracranial internal carotid artery and an aneurysm of fusiform type of the left intracranial vertebral artery. The extracranial carotid artery aneurysm was successfully resected, with end-to-end anastomosis of the internal carotid artery, preserving the cranial nerves. Five days later, an aneurysm of the left hepatic artery ruptured unexpectedly and was treated with emergency surgery. Other aneurysms in the liver and spleen were identified on postoperative celiac angiography. The patient subsequently underwent an operation for a left intracranial vertebral artery aneurysm by proximal clipping.

Abdomen, Acute↗
PubMed1990

Coronary artery pattern and outcome of arterial switch operation for transposition of the great arteries.

A successful outcome of an arterial switch operation (ASO) for dextro-transposition of the great arteries (D-TGA) depends in large part on the transfer of the coronary arteries to the neoaorta without distortion or narrowing. However, the origins and distribution of the coronary arteries are quite variable in D-TGA; therefore, the entire experience with ASO at the Children's Hospital in Boston was reviewed. From 1983 through November 1989, 314 patients underwent surgery for D-TGA with the intent to perform an ASO. An ASO was actually performed in 290 patients, and 20 patients died, with 12 deaths (4.2%) clearly related to problems with the coronary arteries (CA deaths). The ASO was aborted to a Senning operation in 24 patients (7.6%), primarily due to coronary anatomy. Eight coronary patterns were identified and related to the outcome of the ASO. In 182 patients with the "usual" coronary pattern for D-TGA (i.e., anterior descending and circumflex arteries from the left sinus and right coronary artery from the right sinus), five CA deaths occurred, and two patients had Senning operations. Sixty-seven patients had right coronary and circumflex arteries from the right sinus and anterior descending arteries from the left sinus. Three CA deaths occurred, and one patient had a Senning operation. Single right coronary artery was found in 14; 12 had ASOs with three CA deaths (25%); and two had Senning operations. One late death was due to diffuse narrowing of the single right coronary artery. Single left coronary artery occurred in 11 patients, and seven had ASO with no early but one late "sudden" death, whereas four had Senning operations.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1995

Which is the graft of choice for the right coronary and posterior descending arteries? Comparison of the right internal mammary artery and the right gastroepiploic artery.

BACKGROUND: The graft of choice for the left anterior descending coronary artery is the left internal mammary artery because of superior long-term patency. However, controversy exists regarding the graft of choice for the right coronary artery and for the posterior descending branch. METHODS AND RESULTS: Two types of pedicled arterial grafts were used for the right coronary and the posterior descending arteries in patients undergoing coronary bypass surgery between January 1991 and September 1994. Group A comprised 114 patients with a right internal mammary artery (RIMA) graft, and group B consisted of 127 patients with an in situ right gastroepiploic artery (R-GEA) graft. Mean age was 56.9 years in group A and 63.3 years in group B; 7.9% (9 of 114) and 33.9% (43 of 127) were diabetics in groups A and B, respectively. Overall mortality was 2.6% (3 deaths) for group A and 3.9% (5 deaths) for group B (P = NS). However, the prevalence of perioperative myocardial infarction in the right coronary artery distribution was significantly higher for group A (5.3%, or 6 of 114) than for group B (0.8%, or 1 of 127; P < .05), and the reoperation rate for graft failure (from 0 to 12 months after surgery) was significantly higher for the RIMA (4.4%, or 5 of 114) than for the R-GEA (0%; P < .05). Also, the prevalence of deep sternal wound infection in diabetics was significantly higher in group A (22.2%, or 2 of 9) than in group B (4.6%, or 2 of 43; P < .05). CONCLUSIONS: Our preliminary results suggest that the failure rate of the RIMA graft is significantly higher, especially if used as a pedicled graft to the posterior descending artery. The risk of sternal wound complications is greater in diabetics if both internal mammary arteries are used for grafting. Therefore, the R-GEA graft is preferred in diabetics and whenever the posterior descending artery is the target vessel.

Adult↗
PubMed2002

[Modification of repeat lateral minimally invasive direct coronary artery bypass; left axillary artery to circumflex artery bypass].

A 69-year-old man underwent triple coronary artery bypass graftings [LITA (left internal thoracic artery)-LAD (left anterior descending artery), SVG (saphenous vein graft)-PD (postac-descending artery), SVG-PL (postero-lateral artery)] 11 years previously. Recently, angina pectoris occurred due to the graft disease of SVG-PL. A repeat modified lateral minimally invasive direct coronary artery bypass (MIDCAB) [left axillary artery-PL using SVG] was performed. The left axillary artery was chosen as inflow vessel for coronary artery bypass graft because of the difficult descending aorta and patent LITA-LAD. Postoperative course was uneventful. The left axillary artery to circumflex artery bypass could be one of the option of the lateral MIDCAB.

Aged↗
PubMed1986

Anatomical bases for surgical approach to the initial segment of the anterior cerebral artery. Microanatomy of Heubner's artery and perforating branches of the anterior cerebral artery.

Both the Heubner's artery and the perforating branches of the anterior cerebral artery (ACA) were present in all thirty-three examined brains. Heubner's arteries varied in number from 1 to 3. They originated from the distal (A2) segment of the ACA in 34% of the cases, from the proximal (A1) segment of the ACA in 17%, at the level of the anterior communicating artery in 21%, from the fenestration of the ACA in 8%, and in all the other cases (20%) from the azygous anterior cerebral artery, accessory middle cerebral artery, frontopolar artery and, finally, by the common stem with the medial orbitofrontal artery. Heubner's artery most commonly terminated dorsal and lateral to the carotid bifurcation, at an average distance of 4.8 mm. The mean diameter of Heubner's artery was 662 microns, that of its extracerebral collateral branches 205 microns, of the terminal branches 462 microns, and of the intracerebral segments 354 microns. Perforating branches varied in number from 1 to 12 with an average of 6.6. The majority of the branches originated from the initial 6.1 mm of the A1 segment. These vessels terminated close to the carotid bifurcation, at an average distance of 3.8 mm. All the perforating branches were divided into small (average 122 microns in diameter) and large (average 325 microns). The mean diameter of intracerebral segments was 276 microns, and that of terminal branches 259 microns. It was concluded that the anatomical characteristics of both the recurrent artery and the perforating branches can be of a great significance in cerebrovascular diseases.

Adult↗
PubMed1996

Ketone body ratios of the superior and inferior vena cava and of pulmonary arterial blood compared to that of arterial blood: central venous ketone body ratio as a substitute for the arterial ketone body ratio.

To investigate the ketone body ratio (acetoacetate/3-hydroxybutyrate) of central venous blood compared to that of peripheral arterial blood, the acetoacetate and 3-hydroxybutyrate concentrations in paired peripheral arterial and central venous or pulmonary arterial blood were measured. The ketone body concentrations in superior and inferior vena cava blood were significantly (P < 0.0001) lower than those in peripheral arterial blood, whereas those in pulmonary arterial blood were almost the same as those in peripheral arterial blood. These results indicate that ketone bodies were metabolized in the muscles, which reduced their levels in vena cava blood, but ketone bodies newly produced by the liver were transported to the right side of the heart via the hepatic vein, giving concentrations in pulmonary arterial blood that were almost the same as those in peripheral arterial blood. On the other hand, the correlation coefficients (r2) of the arterial blood ketone body ratio to the ratio of superior and inferior vena cava and pulmonary arterial blood were 0.897, 0.767 and 0.882, respectively. The ratios of central venous ketone body ratio/arterial blood ketone body ratio were 0.89 +/- 0.15 in the superior vena cava, 0.64 +/- 0.18 in the inferior vena cava and 1.01 +/- 0.15 in the pulmonary artery.

3-Hydroxybutyric Acid↗