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Objective To discuss the incidence and clinical predictor factors of anatomical variation of radial arteries among patients in the XingJing province of China. Methods A total of 1731 patients who underwent transradial coronary intervention for the first time during the period of Jan.2016-June.2016 in the People‵s Hospital of Xin jiang Uyghur Autonomous Region were enrolled in this study. All relevant basic information and related medical history were recorded in detail.Right radial artery angiography was performed in all patients, According to the definition of radial artery variation, the patients were decided into the radial artery variation group and the normal radial artery group. Single factor and multiple factors logistic regression analysis were performed to evaluate the predictive value of variables factors in radial artery variations. Results The incidence of radial artery variation was 4.97%(86/1731).The incidence of radial artery spasm in the radial artery variation group33.72%(29/86),and 2.74% (45/1645) in the normal radial artery group (P<0.001).The failure rate of coronary intervanton by right radial artery in the radial artery variation group was 26.74%(23/86)and 1.51%(25/1645)in the normal radial artery group(P<0.001).The overall success rate of coronary intervention through right radial artery approach was 97.23%(1683/1731).Female gender,short statue、low body weight,history hyperlipidemia,smoking,drinking rabbit,occupation as farmer were found to be associated with the existence of radial artery variation (all P < 0.05).Diabetes,body mass index,hyperlipidemia and ethnicity were not associated with the existence of radial artery variation (all P >0.05). Multivariate logistic regression analysis showed age, gender, farmer occupation, hyperlipidemia were associated with the occurrence of radial artery variation. Increased in age by every 10 years would bring a 0.264 fold increase in risk of radial artery variation(OR 1.264,95%CI 1.006-1.587, P=0.044)and the risk of radial artery variation in females was 3.999 times to males(OR 3.999, 95%CI 2.241-7.136,P<0.001).The risk of radial artery variation in patients with hyperlipidemia was 1.776 times to patients without hyperlipidemia(OR 1.776,95%CI 1.011-3.122,P=0.046)and the risk of radial artery variation in farmers was 2.188 times higher than others(OR 2.188,95%CI 1.238-3.867, P=0.007). Conclusions For people in Xinjiang in China,anatomical variation of radial artery was uncommon. Advanced age, female gender, short states, low body weight, hyperlipidemia, smoking, drinking and farmer occupation were associated with the occurrence of radial artery variation. Multivariates logistic regression analysis showed advanced age, female gender, hyperlipidemia, farmers were associated whit the presence of radial artery variation. These factors have predictive value for the existence of radial artery variation.
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Objective To study the preoperative diagnosis and treatment strategy of laparoscopic pancreatoduodenectomy (LPD) in patients with arterial anomalies.Methods The clinical data of 16 patients with arterial anomalies who underwent counterclockwise LPD at the Hunan People's Hospital from January 2016 to December 2017 were analyzed.Results The operation time was 370.0±109.0 min.The blood loss was 92.0±45.0 ml.In 14 patients,arterial anomalies were found preoperatively and were confirmed intraoperatively.The number of patients with a replaced right hepatic artery (rRHA),common hepatic artery (CHA) which originated from superior mesenteric artery (SMA),right hepatic artery (RHA) crossing in front of common bile duct (CBD),celiac artery (CA) and SMA with a common origin,right renal artery (RRA) anomaly were 5,3,3,2,and 1,respectively.In 2 patients,the anomalies were not found before operation:a dorsal pancreatic artery (DPA) originating from CHA,and a cystic artery and a right gastric artery (RGA) originating from left hepatic artery (LHA).Operative complications included biochemical fistula in 3 patients;peritoneal local effusion in 2 patients;pleural effusion in 2 patients;gastrointestinal anastomosis bleeding in 1 patient;delayed gastric emptying in 1 patient;a proper hepatic artery (PHA) pseudoaneurysm in 1 patient;and a subumbilical incision infection in 1 patient.The pathological results showed all the 16 patients had malignant tumors of the pancreas or ampulla.All the tumors were resected by R0 resection.Conclusion Arterial anomaly was common in LPD.Preoperative targeted radiological reading of X-rays,regional anatomical division combined with counterclockwise resection could result in early detection,identification and help to protect the arterial anomaly from injury and reduce the risk of serious postoperative complications.
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Abstract In this article we present a rare variant in which the large intestine was vascularized by the inferior mesenteric artery. It was encountered during macro and microscopic dissection of the cadaver of a 63-year-old woman at a university department of human anatomy. In this case, the ascending, transverse, descending, and sigmoid colon and rectum were vascularized by the inferior mesenteric artery, whereas the small intestine, cecum and appendix were supplied by the superior mesenteric artery.
Resumo Neste artigo apresentamos uma variação rara em que o intestino grosso era vascularizado pela artéria mesentérica inferior. A variação foi descoberta durante a dissecção macro e microscópia de um cadáver do sexo feminino, 63 anos de idade, em um departamento universitário de anatomia humana. Neste caso, o cólon ascendente, transverso, descendente e sigmoide e também o reto eram vascularizados pela artéria mesentérica inferior, ao passo que o intestino delgado, ceco e apêndice eram vascularizados pela artéria mesentéria superior.
Subject(s)
Humans , Female , Middle Aged , Intestine, Large/anatomy & histology , Mesenteric Artery, Inferior/anatomy & histology , Anatomy , Colon, Ascending/anatomy & histology , Dissection/methods , Intestine, Small/anatomy & histology , Mesenteric Artery, Superior/anatomy & histologyABSTRACT
Objective To study the anatomic data of the first metatarsal dorsal artery and to provide anatomical basis for clinical tissue transplantation based on the first metatarsal dorsal artery.Methods The 16 adult cadaver specimens with 32 feet were dissected and meas-ured by vernier caliper.Then the anatomic data of the first metatarsal dorsal artery were analyzed.Results Through the examinations of 32 feet sample,the first metatarsal dorsal artery were classified into 5 types.Type Ⅰ:the first metatarsal dorsal artery runs at the surface of the first dorsal interosseous muscle (13 sides,40.6%).Type Ⅱ:the first metatarsal dorsal artery runs in the interior of the first dorsal interosse-ous muscle (11sides,34.4%).Type Ⅲ:the first metatarsal dorsal artery runs underneath the first dorsal interosseous muscle (6 sides, 18.8%).Type Ⅳ:the first metatarsal dorsal artery is slender (1 side,3.1%).TypeⅤ:the first metatarsal dorsal artery is absent (1 side, 3.1%).Distance relationship was measured between the first metatarsal bone and the first metatarsal dorsal artery:the vertical distance be-tween the origin of the posterior branch of the first metatarsal dorsal artery and base of the first metatarsal bone was (2.4 ±0.3)mm,the ver-tical distance between the origin of the posterior branch of the first metatarsal dorsal artery and head of the first metatarsal bone was (10.1 ±1.0)mm;the vertical distance between the origin of the anterior branch of the first metatarsal dorsal artery and the first metatarso-phalangeal joint was (7.6 ±2.7)mm.Conclusion The first metatarsal dorsal artery has clinical reference significance for the hands and feet’s trauma and skin flap transplantation such as thumb reconstruction.
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Having up-to-date knowledge of the variability in facial artery topography is an essential starting point in performing certain surgical and radiological procedures on the head and neck (e.g. oromucosal reconstruction flaps, transarterial embolization). We report a unique case with: (1) the left facial artery truncating as an atypical inferior labial artery, (2) the left anterolateral face being perfused by unusual arterial collaterals derived from the right superior labial, left infraorbital and left dorsal nasal arteries, (3) the transverse facial artery not being one of the perfusing collaterals, and (4) the right submental artery piercing the mylohyoid muscle and entering the oral cavity. The embryologic basis of this atypical vascular pattern is discussed. Discovery of a highly atypical facial artery highlights the importance of performing a thorough pre-operative vascular evaluation to prevent iatrogenic injuries and complications before any surgical or therapeutic procedure.
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Objective:To investigate the recognition and injury prevention strategies of hepatic artery variations during hepatic portal lymphadenectomy. Methods:A retrospective analysis was performed, and 12 patients of hepatic arterial variation among 62 pa-tients with hepatic portal lymphadenectomy were the subjects. The study was conducted in the First Affiliated Hospital of Bengbu Medi-cal College between January 2013 and July 2014. The intraoperative treatment and postoperative complications were recorded. Results:Among 12 cases of hepatic artery variation, we found the following cases:3 cases (25.0%) of Michels' Type III, 2 cases (16.7%) of Mi-chels' Type VI, 1 case (8.3%) of Michels' Type IX, 1 case (8.3%) of Hiatt's Type 6, 2 cases (16.7%) of spatial location variation between right hepatic artery and hepatic duct, 2 cases (16.7%) of left and right hepatic artery originating from a common hepatic artery, and 1 case (8.3%) of right hepatic artery originating from the gastroduodenal artery. No injury of hepatic artery occurred. Two cases had post-operative complications, including 1 case of pancreatic leakage and 1 case of incision infection;postoperative hemorrhage, bile leakage, hepatic abscess did not occur in these two cases. Patients recovered well in general. Conclusion:Hepatic arterial injury can be signifi-cantly reduced by the following:increased familiarity with the various types of hepatic artery variations;complete imaging examina-tions for inspection and evaluation before surgery;and careful and meticulous operations in surgery.
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ObjectiveTo share the experience of arterial plasty and reconstruction of variant arteries in living donor liver transplantation. MethodsFrom September 2006 to May 2010, 73 living donor liver grafts (64 cases using the right lobe,9 cases using left lobe) were used in patients with end-stage liver disease. The hepatic arteries were evaluated preoperatively with computed tomography and magnetic resonance angiography. Back-table arterial plasty was performed under a microscope or a loupe according to arterial variation. We described technical points based on anatomic variations. There were 13 (17. 8 ％) liver grafts with anatomic hepatic arterial variations and all of these cases were subjected to back-table reconstruction with interrupted 8-0 or 9-0 nonabsorbable nylon monofilament sutures according to the diameter of artery. ResultsIn 3 cases, the associate right hepatic arteries that were arisen from superior esenteric arteris (SMA) were reconstructed to cystic arteries. In 2 cases with the associate right hepatic arteries arisen from the abdominal trunk, the right hepatic arteries and associate right hepatic arteries of donors were anastomosed with right hepatic arteries and left hepatic arteries in recipients respectively. In 2 donors, hepatic arteries had branches, which were reconstructed. All of the arterial plasty were conducted on a back table. No arterial thrombosis was found during a postoperative follow-up period of 6 months. ConclusionLive donor liver transplantation using the right lobe with hepatic artery variation can be performed safely, but there is a potential operative risk of severe complication after transplantation. Tominimize operative difficulties and complications, back-table reconstruction should be applied and proper treatment is given according to individual situations to ensure a safe and satisfactory outcome
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PURPOSE: The latissimus dorsi flap and the serratus anterior flap have been used as combined flaps to reconstruct extensive defects. Because these two muscles are usually supplied by the subscapular- thoracodorsal vessels, the two flaps can be based on vascular pedicle that is long and anatomically reliable. In this case, we reported that serratus anterior possessed an anomalous arterial supply totally independent from the subscapular pedicle while raising combined latissimus dorsi and serratus anterior flap. METHODS: A 35-year-old male with extensive soft tissue defect in the left perineum and thigh visited. Muscle defects of the medial thigh were observed, and femoral nerve and vessels were exposed. Combined latissimus dorsi and serratus anterior free flap was raised to reconstruct defect. On raising flaps, artery supplying the serratus anterior muscle originated from the axillary artery directly, was lying on the undersurface of the serratus anterior muscle. RESULTS: Because two flap pedicles had no communication and latissimus dorsi muscle was large enough to cover soft tissue defect, we transferred only latissimus dorsi free flap with 1:3 meshed skin graft. Patient had limb salvage and satisfactory functional outcome. CONCLUSION: There are many variations of arterial pedicles of flaps. However, most of these variations remain within known anatomical consistence, thus is an indicator in planning the dissection of the vessels. According to documents, arterial pedicle to the serratus muscle not originated from the thoracodorsal artery is rarely reported, and in most of these cases, the arteries are originated from the subscapular artery. Thus pedicle directly originated from the axillary artery to serratus muscle is a very rare variation in its vascular anatomy.