Clinical value of conventional ultrasound and contrast-enhanced ultrasound in evaluating donor liver quality in liver transplantation / 器官移植

At present, a large quantity of patients with end-stage liver diseases are still waiting for liver transplantation. Evaluation of donor liver quality with rapid, convenient, non-invasive and accurate methods plays a pivotal role in improving the prognosis and quality of life of liver transplant recipients. No standard evaluation criteria of donor liver quality have been established in clinical practice. Comprehensive evaluation methods have been primarily adopted, including clinical parameters of donors, laboratory examination, imaging examination and pathological examination, etc. Conventional ultrasound and contrast-enhanced ultrasound may evaluate the quality of donor liver before liver transplantation and predict the incidence of complications after liver transplantation, which are of significant application prospect in liver transplantation. In this article, the basic methods and research progress on conventional ultrasound and contrast-enhanced ultrasound in evaluating the vascular variation of donor liver, micro-circulatory perfusion of liver parenchyma, degree of steatosis of donor liver, degree of fibrosis of donor liver, volume and quality of donor liver were reviewed, aiming to provide more methods and ideas for clinical evaluation of donor liver quality.

Approaches in the treatment of vascular variation by robot-assisted pancreatic surgery / 中华胰腺病杂志

Da Vinci robot has been widely used in pancreatic surgery nowadays. Pancreatic surgery is known as a difficult procedure in general surgery due to its surgical difficulty, complex anatomy, severe postoperative complications and high perioperative mortality. Vascular variation is another key point in surgical operation, which demands lots of attention and careful management. In physiological state, abdominal blood vessels may vary in different phenotypes, which occasionally cause troubles to surgeons, resulting in increased risk of vascular injuries, perioperative hemorrhage, hepatic or bile duct ischemia and consequent leakage and the like. Based on the previous research and our experience, it is recommended that the vascular variations be treated by specific surgical approaches and techniques in robot-assisted pancreatic surgery.

A Study Of Anatomical Variation In Branching Pattern Of Axillary Artery

Background: The axillary artery is a direct continuation of the subclavian artery. The axillary artery is usuallygives off six branches. Variation in the branching pattern of axillary artery is very commonly seen. The knowledgein variations of axillary artery is helpful in anatomy, radiology and surgery to explain unexpected clinical signsand symptoms.Materials and Methods: The present study undertaken on 30 upper limb (15 cadevers) in department of Anatomyat RKDFMCH&RC, Jatkhedi, Bhopal. None of them had any pathological lesions, traumatic lesions or surgicalprocedures in the axillary region. Bilateral dissection of axilla was conducted and the branching patterns of theaxillary artery was studied.Observations and Results: Unilateral variations were observed in two cadavers. In (6.66%) cases we observed aunique variation of early division of axillary artey. In (3.33%) cases the second part of axillary artery showsthree extra branches (alar artery) In (3.33%) we observed a subscapular artery arises from the second part ofaxillary artery. Up to 36% of it arises from a common trunk with posterior circumflex humeral artery. In (3.33 %),bilaterally a common trunk from II part gave origin to anterior circumflex humeral, post circumflex humeral andsubscapular artery. In 3.33% cases the circumflex scapular artery directly arises from the third part of axillaryartery. In 6.66% cases the anterior circumflex is three in number.In the rest of the cadavers, axillary artery wasnormal in its course and distribution.Conclusion: The detailed knowledge about anatomy of normal as well as variant axillary artery is very helpful forthe surgeons and radiologists performing interventional surgery

VASCULAR RECONSTRUCTION DURING KIDNEY TRANSPLANTATION FOR PREVENTING COMPLICATIONS / Мэс засал

Introduction: This article provides areview about techniques and pitfalls of arterialand venous reconstruction during kidneytransplantation. Main reasons of our clinicalstudy are to evaluate vascular variationsof kidney, posttransplantation vascularcomplication incidence and present status ofsurgery outcome.This retrospective researchbased on cross-sectional assessmentofconsecutive 102 kidney transplantation cases,which performed from 2006 to 2015 at theFirst Central Hospital of Mongolia.Materials and methods: Statisticalprocessing andanalysis on posttransplantionpatient history data are made byMicrosoftExcel, SPSS19.0software.Results: Despite rising technicaldifficulties caused by vascular variations,pelvic and inguinal morphology of recipientand the existence of multiple renal arterieskidney transplantation is a safe and highlyefficient procedure.On this article wereexplained 44 kidney transplantation caseswith reconstruction using microvasculartechniques to reconstruct renal arteriesand veins. About 10 different kinds ofreconstructions were done in our practice.Due to investigation of consecutive 102kidney transplanted recipients, 24,51% had avascular anatomical variations. And describedabout 44 vascular reconstructions used inour hospital in case of vascular variations.According to the lit., vascular complicationsranges from 1 to 16%. In our hospital,vascularcomplication of kidney transplantation withmultiple vessels is 4,0-12,0%. Also, incidenceof vascular complication in group with singlevessels from 1.3 to 2.6% and in group withmultiple vessel 4 to 12%.Even it is highcomparing with other international articles;it’s almost in same results. But lymphaticcomplication is higher than others; it showsneeds of careful and accurate dissection ofrecipient site anastomosing vessels.Conclusion: Multiple renal graft’sveselshave been associated with a higher rateof vascular complications, including arterialstenosis and lymphorrhea. It shows needs ofcareful and accurate dissection of recipientsite anastomosing vessels.

Management of vascular variation in free transplantation of posterior interosseous perforator flap / 中华显微外科杂志

Objective To discuss the method and treatment outcome of vascular variation in repairing skin defect of the hand by free transplantation of posterior interosseous perforator flap.Methods Eight cases with vascular variation were adjusted flap position,two cases were repaired by single perforator flap,three cases were repaired by cutting perforator and anastomosing perforator after changing the path,three cases were repaired by designing composition leaves flap.Results Seven flaps survived,one flap partly necrosis and healed by skin-grafting,and all of the patients were followed-up 3 to 18 months.The color,texture and thickness of the flaps were satisfactory.The movements of the fingers were satisfactory.According to the hand function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association,outcomes were rated excellent in 1 case,good in 5 cases,fair in 2 cases.The excellent and good rate was 75％.Conclusion When finding vascular variation in repairing skin defect of the hand by free transplantation of posterior interosseous perforator flap,adjust flap position,repair by single perforator flap,cutting perforator and anastomosing perforator after changing the path,or designing composition leaves flap is a good treatment option.

The classification of complex vessels and the catheterization technique in hepatic artery endovascular therapy / 介入放射学杂志

For interventional therapy of hepatic carcinoma, the anatomical pathway and the variation of complex vessels often cause difficulties in performing super-selective catheterization, or even result in catheterization failure. Understanding of the vascular variations and finding out the effective technique of catheterization can surely reduce the radiation exposure dose to both the operators and patients, and in the same time, can increase the successful rate of super-selective catheterization, which will undoubtedly improve the curative effect. More than 30 thousand times of interventional managements for hepatic carcinoma have been performed in our hospital, from which the author has selected some successful cases as well as some unsuccessful cases to make a technical analysis in order to sum up the experience of super-selective catheterization for clinical physicians' reference.

Abnormal branching pattern of the axillary artery and its clinical significance / Patrón de ramificación anormal de la arteria axilar y su significado clínico

The increasing use of invasive diagnostic and interventional procedures in cardiovascular diseases makes it important that the type and frequency of vascular variations are well documented and understood. Sound knowledge of neurovascular variations is important for surgeons who remove axillary lymph nodes, to anesthesiologists, and orthopedic surgeons, considering the frequency of procedures done in this region. An unusual variation in the branching pattern of axillary artery was observed on the left side of a 60 year old female cadaver. In the present case the course and distribution of the first and second part of the axillary artery were normal. But a rare case of unusual origin of subscapular, anterior and posterior circumflex humeral, profunda brachii artery and ulnar collateral arteries from a common trunk were found on the left side during routine dissection. This common trunk was found arising from the third part of the axillary artery and at its commencement it was found passing between the two roots of the median nerve. Cases with this kind of variations should be examined or operated carefully during surgical or electrophysiological procedures.

El incremento del uso de diagnósticos invasivos y procedimientos de intervención en las enfermedades cardiovasculares hace que sea importante que el tipo y la frecuencia de las variaciones vasculares estén bien documentados y entendidos. Un buen conocimiento de las variaciones neurovasculares es importante para los cirujanos que extirpan linfonodos axilares, para anestesiólogos y cirujanos ortopédicos, considerando la frecuencia de los procedimientos realizados en esta región. Una inusual variación en el patrón de ramificación de la arteria axilar se observó en el lado izquierdo de un cadáver de sexo femenino de 60 años de edad. En el presente caso, el curso y la distribución de la primera y segunda parte de la arteria axilar fueron normales. Sin embargo, fue encontrado en el lado izquierdo, durante la disección de rutina, un caso raro, de origen inusual, de las arterias subescapular cirunflejas humerales anterior y posterior, braquial profunda y arterias colaterales ulnares desde un tronco común. Este tronco común se encontró derivado de la tercera parte de la arteria axilar y en su comienzo se comprobó que pasaba entre las dos raíces del nervio mediano. Los casos con este tipo de variaciones deben ser examinados u operados cuidadosamente durante procedimientos quirúrgicos o electro fisiológicos.

Ectopic Thyroid Tissue With a Rare Vascular Variation / Tejido Tiroideo Ectópico con una Rara Variación Vascular

Awareness of the variations and anomalous existence of some structures serve as useful guide for both in studies of human anatomy and in clinical practice today. Identification of ectopic thyroid tissue and variations in origin, number and course of the branches of the superior thyroid artery are of significant practical importance for the general, vascular surgeons and radiologist. Angiographic images with such vascular patterns may lead to confusion in interpretation. The relations of these vessels with the other structures are important for accurate diagnostic and invasive techniques and to prevent further complications during surgical interventions. In our routine dissections with the purpose of preparation of the teaching and museum specimens, it was observed that in one of the elderly male cadaver showed median thyroid tissue at a site other than in its usual pretracheal region. It was situated in the median plane extending from the hyoid bone to the front of cricoid cartilage. Normal thyroid gland in the pretracheal region was absent. Added to this rare anomaly a vascular anomaly was found in the same ectopic thyroid tissue. Solely the superior thyroid arteries supplied this median thyroid tissue. The inferior thyroid arteries were found to be absent on both sides supplying this median thyroid tissue.

Conocer la existencia de variaciones y anomalías de algunas estructuras, sirve usualmente como guía para estudios de anatomía humana y práctica clínica. La identificación de tejido tiroideo ectópico y variaciones en origen, número y curso de ramas de la arteria tiroidea superior son, por lo general, de importancia práctica significativa para cirujanos vasculares y radiólogos. Imágenes angiográficas con tales patrones vasculares pueden llevar a confusión en su interpretación. La relación de estos vasos con otras estructuras son importantes en un diagnóstico acucioso, en técnicas invasivas y para prevenir complicaciones durante intervenciones quirúrgicas. En una disección de rutina, con el propósito de preparar piezas anatómicas de museo para la enseñanza, se observó en un cadáver de sexo masculino, tejido tiroideo mediano en un sitio diferente a la región pretraqueal. Estaba situado en el plano mediano extendiéndose desde el hueso hiodes a la parte anterior del cartflago cricoides. La glándula tiroides normal en la región pretraqueal estuvo ausente. Agregada a estainusual variación, una rara anomalía vascular fue encontrada en el mismo tejido tiroideo ectópico, sólo las arterias tiroideas superiores irrigaban este tejido tiroideo mediano. No se encontraron arterias tiroideas inferiores irrigando este tejido.