Measurement of Popliteal Artery Diameter: A Cadavaric Study

The popliteal artery is the branches off from the femoral artery. It is located in the knee towards the back of the legs. The clinicians and radiologists dealing with the popliteal area use description of branching pattern of the popliteal artery, in which it first gives rise to anterior tibial artery followed by the tibial peroneal trunk, which then terminates by dividing into the posterior tibial and peroneal arteries. As popliteal artery is one of the most common sites for aneurysm formation, the knowledge of the normal popliteal artery diameter is essential to determine the relevance of popliteal dilatations. Objective: Considering the clinical importance of diameter of popliteal artery, this study was undertaken to note the internal diameter of popliteal artery. Subjects and Methods: The present study was conducted on 50 specimen embedded in 10% formalin from the department of Anatomy of tertiary care hospital & medical college. Cadavers which had gross pathological deformities in its lower limbs were excluded from the study. All the cadavers were adult males and females. Results: This study states right popliteal arteries are slightly larger (4.9 ± 0.7 mm) as compare to left popliteal artery (4.8± 0.5 mm). This study also reconfirm popliteal arteries of men are slightly larger than that of female (4.9 ± 0.7 mm), (4.6± 0.9 mm) and left popliteal artery (4.8± 0.5 mm), (4.6± 0.7 mm) respectively. On the other hand terminal part its diameter is slightly larger in male (4.5 ± 0.6 mm) as compare to female (4.3 ± 0.5 mm). This study also shows terminal end of left popliteal arteries (3.8 ± 0.7 mm) are smaller than right popliteal arteries (4.3 ± 0.5 mm). Conclusion: The present study was done in a small cadaveric sample. In our prospective different live and cadaveric study will be helpful for vascular surgeons, radiologists. The variation in the measurement of our study compare to other study may be due to the difference in live and cadaveric spacemen or due to the method of measurement. Therefore, we suggest before making any decision study on much larger sample should be consider

Las Arterias Circunflejas Femorales en el Triángulo Femoral / The Circumflex Femoral Arteries in the Femoral Triangle

Conocer el origen y distribución de las arterias circunflejas femorales (AaCF) en el hombre, es importante en el momento quirúrgico de la reconstrucción vascular. Se disecó el contenido del triángulo femoral en 92 miembros inferiores de cadáveres formolizados, adultos, de sexo masculino y diferentes grupos étnicos, descubriéndose la arteria femoral (AF) y sus ramas originadas a nivel del triángulo femoral. Se localizó el origen de cada una de las AaCF determinándose el tipo y lugar de origen. La arteria circunfleja femoral medial (ACFM) se originó en 43 casos (46,7 por ciento) desde la AF; en 41 casos (44,6 por ciento) desde la arteria femoral profunda (AFP); en 7 casos (7,6 por ciento) en un tronco común formado por la AFP y AaCF y en un caso (1,1 por ciento) desde la arteria circunfleja femoral lateral (ACFL). La ACFM tenía en 75 casos (81,5 por ciento) un origen más proximal que la ACFL y en 9 casos (9,8 por ciento) su origen era al mismo nivel. La ACFL se originó en 68 casos (73,9 por ciento) desde la AFP; en 17 casos (18,5 por ciento) desde la AF; en 7 casos (7,6 por ciento) en un tronco común formado por la AFP y AaCF. El origen de la ACFL fue considerado independientemente si su ramo descendente se originaba desde ella o lo hacía desde la AF. Debido a la presencia de una serie de elementos nobles, conocer el origen preciso de las arterias y sus eventuales variaciones, adquiere especial importancia en los procedimientos realizados en la región.

It is important to identify the origin and distribution of the circumflex femoral arteries (CFA) at the time of vascular reconstructive surgery. The femoral triangle contents in 92 lower extremities of formolized adult male cadavers of different ethnic groups, were dissected uncovering the femoral artery (FA) and its branches originating at the level of the femoral triangle. The origin of each CFA was identified determining the origin type and location. The medial circumflex femoral artery (MCFA) originated from the FA in 43 cases (46.7 percent); from the profunda femoris artery (PFA) in 41 cases (44.6 percent); from a common trunk formed by the PFA and CFA in 7 cases (7.6 percent), and in one case (1.1 percent) from the lateral circumflex femoral artery (LCFA). In 75 cases (81.5 percent) the MCFA was most proximal than the LCFA, and in 9 cases (9.8 percent) it originated at the same level. The LCFA originated at the PFA in 68 cases (73.9 percent); from the FA in 17 cases (18.5 percent); from a common trunk formed by the PFA and CFA in 7 cases (7.6 percent). The origin of the LCFA was considered regardless, whether the descending branch originated therein or from the FA. Considering the presence of a number of important elements it is essential to identify the precise origin of the arteries and its eventual variations in procedures carried out in that area.

Intermediate Results of Infrainguinal Percutaneous Transluminal Angioplasty

PURPOSE: Percutaneous transluminal angioplasty (PTA) is being increasingly used as a primary treatment for critical limb ischemia (CLI). The aim of this study was to evaluate the results of performing PTA for the superficial femoral arteries (SFA) for treating CLI or claudication. METHOD: From April 2003 to February 2007, PTA of the SFA was performed on 44 limbs in 39 patients. The mean follow-up was 10.1 months. RESULT: The demographic features included a mean age of 67.6 years; the patients were 89.7% males, and CLI was present in 56.8% of the subjects. The lesions were classified according to the TransAtlantic Inter-Society Consensus (TASC) as A (6.8%), B (40.9%), C (31.8%) and D (20.5%). PTA was confined to the SFA in 29 limbs (65.9%), and 15 patients (34.1%) underwent concurrent interventions in other anatomic locations. The SFA interventions included angioplasty only in 9 limbs (20.5%) and at least one stent in 35 limbs (79.5%). Clinical success was obtained in 33 limbs (75.0%) and limb salvage for CLI was achieved in 80% limbs (20/25 limbs). The complications included two access site hematomas and six intimal dissections. Interval conversion to bypass surgery was done in 5 limbs and major amputation was performed in 4 limbs. One patient died perioperatively after bypass surgery. The primary patency rates were 83.0% at 3 months, 78.9% at 6months and 72.3% at 12 months. The variables associated with the inferior primary patency rate by univariate analysis included CLI, the type of lesions (TASC A/B vs C/D), and the length of the treated lesions (P=0.01, P=0.008 and P=0.007, respectively). The modified runoff scoring system was predictive of PTA failure (P=0.003). CONCLUSION: PTA of the SFA for treating CLI or claudication is feasible and safe, and it provides acceptable clinical results. It would be appropriate to use PTA as the initial treatment option for chronic superficial femoral occlusive disease.

Intermediate Results of Infrainguinal Percutaneous Transluminal Angioplasty

PURPOSE: Percutaneous transluminal angioplasty (PTA) is being increasingly used as a primary treatment for critical limb ischemia (CLI). The aim of this study was to evaluate the results of performing PTA for the superficial femoral arteries (SFA) for treating CLI or claudication. METHOD: From April 2003 to February 2007, PTA of the SFA was performed on 44 limbs in 39 patients. The mean follow-up was 10.1 months. RESULT: The demographic features included a mean age of 67.6 years; the patients were 89.7% males, and CLI was present in 56.8% of the subjects. The lesions were classified according to the TransAtlantic Inter-Society Consensus (TASC) as A (6.8%), B (40.9%), C (31.8%) and D (20.5%). PTA was confined to the SFA in 29 limbs (65.9%), and 15 patients (34.1%) underwent concurrent interventions in other anatomic locations. The SFA interventions included angioplasty only in 9 limbs (20.5%) and at least one stent in 35 limbs (79.5%). Clinical success was obtained in 33 limbs (75.0%) and limb salvage for CLI was achieved in 80% limbs (20/25 limbs). The complications included two access site hematomas and six intimal dissections. Interval conversion to bypass surgery was done in 5 limbs and major amputation was performed in 4 limbs. One patient died perioperatively after bypass surgery. The primary patency rates were 83.0% at 3 months, 78.9% at 6months and 72.3% at 12 months. The variables associated with the inferior primary patency rate by univariate analysis included CLI, the type of lesions (TASC A/B vs C/D), and the length of the treated lesions (P=0.01, P=0.008 and P=0.007, respectively). The modified runoff scoring system was predictive of PTA failure (P=0.003). CONCLUSION: PTA of the SFA for treating CLI or claudication is feasible and safe, and it provides acceptable clinical results. It would be appropriate to use PTA as the initial treatment option for chronic superficial femoral occlusive disease.

Evaluation of the clinical application and curative effect of femoral arterial closure devices / 介入放射学杂志

Along with the advances in interventional therapy, compression methods for arterial closure require prolonged compression or long arterial sheath dwelling period, which in turn would increase the procedural time, complication rates, and patients' discomfort. Under this circumstance, a variety of percutaneous arterial closure devices was invented offering rapid and reliable hemostasis but there are still some controversies concerning, whether it can reduce the incidence of postoperative complications or not. This paper reviewed and comprehended many researches and literatures to assess the efficacy and complication rates of device-mediated closure versus the gold standard of manual compression. (J Intervent Radiol, 2006, 15: 564-567)

17/β-Estradiol modulates effects of insulin-induced changes in vascular contractility / El 17/β-estradiol modula los efectos de los cambios de la contractilidad vascular producidos por la insulina

The protective role of estrogens against peripheral vascular and coronary disease in women is well documented; however, it is not present in diabetic women. Estrogens reduce tension development through non-genomic mechanisms that include changes in calcium concentrations in endothelial and smooth muscle cells, and regulation of nitric oxide synthase (NOS) in endothelial cells. Insulin increases endothelin-1 (ET-1) release from endothelial cells modulating smooth muscle calcium levels and elevating force generated by femoral and coronary arteries. This paper examines whether 17/β-estradiol (E2β) modulates changes in femoral and coronary artery contractility induced by insulin. Femoral and coronary arteries were obtained from male Wistar rats, placed in isolated tissue baths for in vitro studies, perfused with different solutions, and the contractile response to KCl 40 mmol/L was measured. Insulin increased arterial contraction induced by KCl. This increase was not present when the endothelium was removed. In the presence of E2β, we observed a dose dependent reduction in the tension developed and this effect disappeared when the endothelium was removed. The insulin-induced contraction was significantly reduced in presence of E2β. These data indicate that the effect of insulin on femoral and coronary vascular contractility is modulated by E2β.

Los estrógenos protegen a la mujer contra enfermedades vasculares periféricas y centrales; sin embargo, su papel se pierde con la diabetes. Los estrógenos reducen la tensión en las arterias mediante cambios en el calcio intracelular en células endoteliales y musculares lisas y la regulación de la óxido nítrico sintasa en células endoteliales. La insulina incrementa la liberación de endotelina-1 (ET-1) en células endoteliales aumentando la fuerza generada por las arterias. En este estudio se examina si el 17/β-estradiol (E2β) modula los cambios en la contractilidad inducidos por insulina en las arterias femorales y coronarias. Las arterias se obtuvieron de ratas Wistar macho y se colocaron en cámaras para tejido aislado para perfundirse in vitro con distintas concentraciones de insulina y estrógenos estimulando la contracción con KCl 40 mmol/L. La insulina elevó la fuerza de la contracción inducida por KCl. Este incremento desapareció cuando se eliminó el endotelio. El E2β disminuyó la tensión desarrollada por las arterias conforme se aumentó la dosis y el efecto desapareció al quitar el endotelio. El incremento en la tensión por insulina disminuyó con E2β. En conclusión el efecto de la insulina sobre las arterias femorales y coronarias se encuentra modulado por el E2β.(Arch Cardiol Mex 2003; 73:254-260).