Comparative descriptive anatomy of the femoral artery in crab-eating fox, hoary fox and maned wolf / Anatomia descritiva comparativa da artéria femoral de cachorro-do-mato, raposa-do-campo e lobo-guará

The goal of this study was to describe the anatomy of the femoral artery in wild canids such as the crab-eating fox (Cerdocyon thous), the hoary fox (Lycalopex vetulus), and the maned wolf (Chrysocyon brachyurus). Two specimens from each canid group were used. Red dyed latex was injected in the arterial system of the animals, which were then fixed in 10% formaldehyde aqueous solution and dissected following the routine techniques in macroscopic anatomy. In the three canid groups, the arterial pattern was similar to that described for domestic canids, in which the deep femoral artery rises from the external iliac artery, still in the abdominal cavity, and sends its first branch, the lateral circumflex femoral artery. A few muscular branches, one or two caudal femoral arteries, and the terminal branches ­ the descending genicular artery, the saphenous artery, and the popliteal artery ­ are all originated from the femoral artery. The origin pattern of these vessels also shows similarities with those from domestic canids, sometimes forming trunks and occasionally rising individually. Thus, it can be concluded that the anatomical pattern of the femoral artery and its branches in wild canids shows similarities with that from domestic canids, but inherent variations in each species are also present.(AU)

O objetivo deste estudo foi descrever a anatomia da artéria femoral em canídeos selvagens, como o cachorro do mato (Cerdocyon thous), a raposa do campo (Lycalopex vetulus) e o lobo-guará (Chrysocyon brachyurus). Foram utilizados dois espécimes de cada grupo canídeo. Solução de látex vermelha foi injetada no sistema arterial dos animais, que foram então fixados em solução aquosa de formaldeído a 10% e dissecados seguindo as técnicas rotineiras da anatomia macroscópica. Nos três grupos canídeos, o padrão arterial foi semelhante ao descrito para canídeos domésticos, em que a artéria femoral profunda origina da artéria ilíaca externa, ainda na cavidade abdominal, e envia seu primeiro ramo, a artéria femoral circunflexa lateral. Alguns ramos musculares, uma ou duas artérias femorais caudais e os ramos terminais - a artéria genicular descendente, a artéria safena e a artéria poplítea - são originários da artéria femoral. O padrão de origem desses vasos também mostra semelhanças com as de canídeos domésticos, às vezes formando troncos e ocasionalmente originando individualmente. Assim, pode-se concluir que o padrão anatômico da artéria femoral e seus ramos em canídeos selvagens mostra semelhanças com a dos canídeos domésticos, mas variações inerentes em cada espécie também estão presentes.(AU)

Estudio biométrico de la arterias femoral, poplítea y tibial posterior en relación a los implantes de stents / Biometric study of the femoral, popliteal and posterior tibial arteries in relation to the stents

Los aneurismas de la arteria poplítea son los más frecuentes entre los aneurismas periféricos, pudiendo ser tratados con stents a través de cirugía endovascular. Sin embargo, tales stents poseen el mismo diámetro en la parte proximal y distal, no siendo compatible con la anatomía vascular de ese segmento. El objetivo del presente estudio fue determinar la diferencia entre el diámetro del tercio distal de la arteria femoral y el diámetro de la arteria tibial posterior, además de obtener el diámetro de otras arterias del miembro inferior. Se utilizaron 28 cadáveres formolizados de individuos adultos, de ambos sexos, los que fueron disecados en la región correspondiente. Los diámetros registrados fueron los siguientes: en el tercio distal de la arteria femoral (inicio de la arteria poplítea), parte final de la arteria poplítea antes de su bifurcación en arterias tibial anterior y posterior, arterias tibial anterior y posterior (tronco tibiofibular). En el sexo masculino, desde el tercio distal de la arteria femoral hasta la arteria tibial posterior hubo una reducción del diámetro de 27,92% (p<0,0001). En el femenino, la reducción fue de 52,61% (p < que 0,0001). Al comparar el diámetro del tercio distal de la arteria femoral entre ambos sexos, se obtuvo una diferencia estadísticamente significativa (p < 0,0497), así como entre los diámetros de las arterias tibiales posteriores (p< 0,0142). Estos datos son de importancia clínica para los procedimientos de cirugía endovascular, pudiendo reducir las complicaciones en tales procedimientos. Las endoprotésis deberán adaptarse a estas diferencias de diámetro.

The popliteal artery aneurysms are the most common among peripheral aneurysms and can be treated with stents through endovascular surgery. However, these stents have the same diameter at the proximal and distal part , not being compatible with the vascular anatomy of that segment. The aim of this study was determine the difference between the diameter of the distal third of the femoral artery and the diameter of the posterior tibial artery, and to obtain the diameter of others arteries of the lower limb. We study 28 formalized cadavers of adult individuals of both sexes, which were dissected in the corresponding region. The following arterial diameters were recorded: the distal third of the femoral artery, distal part of the popliteal artery, anterior tibial artery and posterior tibial artery. In males from the distal third of the femoral artery to the posterior tibial artery there was a narrowing of 27.92% (p < 0.0001). In women , the reduction was 52.61 % (p<0.0001). By comparing the diameter of the distal third of the femoral artery between the sexes, a statistically significant difference was obtained (p<0.0497), as well as between the posterior tibial artery diameters (p < 0.0142). These data are of clinical importance for endovascular surgery procedures and may reduce complications in such procedures. Stents must adapt to these differences in diameter.

The descending branch of the lateral femoral circumflex artery is a good option in CABG with arterial grafts / Ramo descendente da artéria circunflexa lateral femoral é boa opção para revascularização do miocárdio com enxertos arteriais

INTRODUCTION: The descending branch of the lateral femoral circumflex artery is an option for coronary artery bypass grafting. OBJECTIVE: To evaluate the early patency and adaptation of lumen diameter using multidetector computed angiotomography. METHODS: Thirty-two patients were selected to undergo coronary artery bypass grafting using the descending branch of the lateral circumflex artery, the internal thoracic artery, and other grafts. Evaluations were carried out through high resolution computed tomography performed on the 7th and 90th postoperative day. Diameters of the descending branch of the lateral circumflex artery and the left internal thoracic artery were measured 3 cm before the distal anastomosis, in the middle portion, and 3 cm after the proximal anastomosis. Diameters were compared using paired t-test (P<0.05). RESULTS: Descending branch of the lateral femoral circumflex artery wDescending branch of the lateral femoral circumflex artery was used in 26 patients, as its use was not viable in six patients (18%). It was used as composite graft in all cases. The anterior descending branch was revascularized by the left internal thoracic artery in all cases. Patency rates of the descending branch of the lateral femoral circumflex artery were 96% and 92%, respectively. No occlusions were observed in the left internal thoracic artery (LITA) and no ischemic events were observed in the descending branch of the lateral circumflex. Descending branch of the lateral femoral circumflex artery increased the lumen diameter in the middle (P=0.001) and distal portions (P=0.006); the left internal thoracic artery (LITA) increased in the middle portion (P=0.001). CONCLUSION: Similar to the left internal thoracic artery, the descending branch of the lateral femoral circumflex artery showed high patency rate and positive luminal adaptation. This early evaluation confirms the descending branch of the lateral femoral circumflex artery as a potential alternative for grafting. Due to anatomical variations, preoperative femoral angiographic evaluation appears to be mandatory.

INTRODUÇÃO: O ramo descendente da artéria circunflexa lateral é um enxerto pouco avaliado e pode ser uma opção para a revascularização do miocárdio. OBJETIVO: Avaliar a perviabilidade e o remodelamento arterial do ramo descendente da artéria circunflexa lateral, em três meses de seguimento, por meio de angiotomografia de artérias coronárias. MÉTODOS: Foram analisados 32 pacientes submetidos à revascularização do miocárdio com ramo descendente da artéria circunflexa lateral, artéria torácica interna esquerda e outros enxertos. A avaliação foi realizada por meio da tomografia computadorizada de alta resolução, realizada no 7º e 90º dias de pós-operatório. O diâmetro do ramo descendente da artéria circunflexa lateral foi medido 3 cm antes da anastomose distal, na porção média e 3 cm após a anastomose proximal. As mesmas medidas foram realizadas para a artéria torácica interna esquerda. Os diâmetros foram comparados pelo método t de Student pareado (significância P<0,05). RESULTADOS: O ramo descendente da artéria circunflexa lateral foi adequado para a utilização em 26 pacientes. Em seis (18%) pacientes, o ramo descendente da artéria circunflexa lateral era inviável. Em todos os casos, o ramo descendente da artéria circunflexa lateral foi empregado sob a forma de enxerto composto. Todos os pacientes receberam artéria torácica interna esquerda para o ramo descendente anterior. A perviabilidade do ramo descendente da artéria circunflexa lateral foi de 96% e 92%, em 7 e 90 dias de pós-operatório, respectivamente. Não foram detectadas oclusões da artéria torácica interna esquerda. Não foram detectados sinais de espasmo do ramo descendente da artéria circunflexa lateral. O ramo descendente da artéria circunflexa lateral apresentou aumento de diâmetro nas porções média (P=0,001) e distal (P=0,006) e a artéria torácica interna esquerda, aumento na porção média (P=0,001). CONCLUSÃO: O remodelamento positivo sugere que o ramo descendente da artéria circunflexa lateral tem comportamento semelhante à artéria torácica interna esquerda e pode ser uma excelente opção para a revascularização do miocárdio com enxertos arteriais. Em virtude das variações anatômicas, estudos de pré-operatório podem auxiliar na seleção de casos.

Unusual branching pattern of external iliac artery: case report / Patrón inusual de ramificación de la arteria ilíaca externa: reporte de caso

During the routine dissection, a rare anomaly was observed in left lower limb of a female cadaver. The external iliac artery continued as femoral artery, branched on lateral side as the lateral circumflex femoral artery and on medial side as profunda femoris artery. On tracing the lateral circumflex femoral artery, the ascending branch towards the spinous anastomosis was very thin and coursed behind the rectus femoris muscle. The transverse and descending branches were not observed, however, the artery coursed along the vastus lateralis towards the knee. The femoral artery had its normal course and continued as popliteal artery. The profunda femoris artery originated from the medial side of the external iliac artery, initially superficial to the femoral vein, coursed downwards and posteriorly, relating posteromedial to femoral artery. The medial circumflex femoral artery originated as thin branch, which further divided into two divisions. The profunda femoris gave origin of 3 perforators and continued as 4th perforator. The unusual branching pattern was observed to be novel and not reported in the literature.

Durante una disección de rutina, se observó una rara anomalía en el miembro inferior izquierdo de un cadáver de sexo femenino. La arteria ilíaca externa dio origen en el lado lateral ala arteria circunfleja femoral lateral y en el lado medial a la arteria femoral profunda. En el recorrido de la arteria circunfleja femoral lateral, la rama ascendente era muy delgada y corría detrás del músculo recto femoral. No se observaron ramas transversales y descendente, sin embargo, la arteria descendió hacia la rodilla a lo largo del músculo vasto lateral. La arteria femoral tuvo su curso normal y continuó como arteria poplítea. La arteria femoral profunda, inicialmente superficial a la vena femoral, se dirigió inferior y posteriormente colocándose posteromedial a la arteria femoral. La arteria circunfleja femoral medial se originó como una rama delgada, que otorgó dos arterias. La arteria femoral profunda dio origen a tres ramas perforantes y continuó como cuarta perforante. Este patrón de ramificación inusual es una descripción nueva no reportada en la literatura.

Arteria circunfleja iliaca superficial: importancia anátomo quirúrgica / Superficial circumflex iliac artery. anatomical surgical importance

La arteria circunfleja ilíaca superficial es un pequeño vaso que se origina, generalmente, en la arteria femoral a nivel del triángulo femoral, dirigiéndose paralela al ligamento inguinal hacia la espina ilíaca anterosuperior. Actualmente es utilizada frecuentemente en colgajos libres llevados a cabeza, cuello, miembros e incluso en reconstrucciones peneanas. Disecamos 68 regiones inguinales de cadáveres formolizados en la disciplinas de anatomía topográfica de las Universidades de La Frontera, Chile y Federal de Sao Paulo, Brasil. La arteria cincunfleja ilíaca superficial tuvo un diámetro externo de 1,42 mm en promedio y la distancia desde su origen al ligamento inguinal fue de 15,1 mm. La arteria se originó directamente de la arteria femoral en 47 casos (69,1 por ciento); de un tronco común con la arteria epigástrica superficial en 14 (20,5 por ciento) y de la arteria circunfleja femoral lateral en tres casos (4,41 por ciento) y en otros cuatro orígenes (5,9 por ciento). Aunque tiene un pequeño diámetro, la arteria circunfleja ilíaca superficial es importante tanto para el anatomista como para los cirujanos vasculares y plásticos, siendo fundamental para el éxito en la obtención de un buen colgajo.

The superficial circumflex iliac artery is a small vessel that originates, usually in the femoral artery at the femoral triangle, heading parallel to the inguinal ligament to the anterior superior iliac spine. Currently it is frequently used in free flaps for head, neck, limbs and even in penile reconstruction. We dissected 68 inguinal regions in corpses in formolized topographic anatomy courses of the Universidad de La Frontera, Chile and Federal University of São Paulo, Brazil. The superficial circumflex iliac artery had a diameter of 1.42 mm on average, and the distance from its origin to the inguinal ligament was 15.1 mm. The artery originated directly from the femoral artery in 47 cases (69.1 percent), from a common trunk with the superficial epigastric artery in 14 (20.5 percent) and the lateral femoral circumflex artery in three cases (4.41 percent) and four other sources (5.9 percent). Although it has a small diameter, superficial circumflex iliac artery is important for the anatomist as well as vascular and plastic surgeons, and essential for success in obtaining a good flap.

Absence of the arteria profunda femoris / Ausencia de la arteria femoral profunda

At arteria femoralis, arteria profunda femoris is the main branch feeding the thigh. After iliofemoral embryological evolution many variations can be seen in this vessel. The absence of a. profunda femoris is one of the rare seen variation among these variations. Knowing the anatomy and variations of a. profunda femoris well, is important in low extremity ischemia, vessel surgery and angiography applications. In this study, 1036 films belonging to low extremity found in the Radiology department of School of Medicine of Cumhuriyet University were examined as retrospective. Among these films at four of them of male cases, absence of a. profunda femoris was detected. In cases at ages of 32, 37, 47 and 53 respectively, in the first and second case at the right low extremity there was no a. profunda femoris and at the left low extremity it was seen that a. circumflexus femoris medialis and a. circumflexus femoris lateralis emerged from a. profunda femoris. In the third case it was detected that at left low extremity a. profunda femoris did not exist, and at right low extremity a. circumflexus femoris lateralis emerged from a. profunda femoris, and a. circumflexus femoris medialis emerged from a. femoralis. In the fourth case at left low extremity there was no a. profunda femoris and at right low extremity it was seen that at a. profunda femoris and a. femoralis were in unsteady course. The absence of a. profunda femoris had 0,4 percent. The results were discussed by comparing with literature data.

La arteria femoral profunda, se origina de la arteria femoral, siendo la rama principal que alimenta al muslo. Después de la evolución embriológica de las aa. iliofemorales, muchas variaciones pueden verse en este vaso. La ausencia de una a. femoral profunda es una rara variación observada dentro de estas variaciones. Conocer la anatomía y las variaciones de la a. femoral profunda, es importante para la isquemia de los miembros inferiores, cirugía vascular y aplicaciones en angiografía. En este estudio, fueron examinadas retrospectivamente 1036 placas imagenológicas del miembro inferior, pertenecientes al departamento de Radiología de la Facultad de Medicina de la Cumhuriyet University. Entre estas placas, en cuatro casos pertenecientes a hombres, se detectó la ausencia de la a. femoral profunda. Los casos comprendieron a individuos cuyas edades eran 32, 37, 47 y 53 años, respectivamente. En el primer y segundo caso en el miembro inferior derecho no había una a. femoral profunda y en el miembro inferior izquierdo, se vio que la aa. circunflejas femorales medial y lateral se originaban de la a. femoral profunda. En el tercer caso se observó ausencia de la a. femoral profunda en el miembro inferior izquierdo, y en el miembro inferior derecho, la a. circunfleja femorale lateral se originaba desde la a. femoral profunda, y la a. circunfleja femoral medial se originaba desde la a. femoral. En el cuarto caso en el miembro inferior izquierdo, no existía la a. femoral profunda y en el miembro inferior derecho se observó que tanto la a. femoral como la a. femoral profunda tenían un curso variable. La ausencia de la a. femoral profunda fue del 0,4 por ciento. Los resultados fueron analizados y comparados con la literatura.

Descrição anatômica do terço proximal da artéria circunflexa femoral medial: estudo em cadáver / Anatomical description of the proximal third of the medial femoral circumflex artery: a cadaveric study

OBJETIVO: Descrever através de estudo em cadáver a disposição anatômica do terço proximal da artéria cincunflexa femoral medial (ACFM). MÉTODOS: Foi avaliada a disposição anatômica do terço proximal da ACFM, através de dissecção em 12 quadris de cadáver, que após terem sua altura aferida em metros (M), foram determinados alguns parâmetros: Ângulo de lateralização da ACFM (Â), Profundidade da ACFM em relação a origem superomedial do músculo quadrado femoral (P), distância da ACFM em relação a inserção superolateral do músculo quadrado femoral (D). RESULTADOS: Quando comparamos a média dos parâmetros entre os sexos notamos: Masculino Â= 43.6 graus, feminino Â= 38.3 graus. Masculino D= 6mm, feminino D= 9.5mm. Masculino P= 20.8 mm, feminino P= 18.3mm. A média dos parametros  e P são menores no sexo feminino porém o parâmetro D no sexo feminino é maior. CONCLUSÃO: Devemos ter como parâmetro superficial de segurança para o terço proximal da ACFM o ponto de inserção superolateral do músculo quadrado femoral. Que o parâmetro D da ACFM no sexo feminino é maior do que no sexo masculino. Que desinserir o músculo quadrado femoral em sua origem no ísquio pode oferecer maior segurança a ACFM do que faze-lo em sua inserção femural. Nível de evidência IV, série de casos.

OBJECTIVE: To describe, in a cadaver study, the anatomical arrangement of the proximal third medial femoral circumflex artery (ACFM). METHODS: We evaluated the anatomic arrangement of the proximal third of the ACFM through dissection in 12 cadaver hips. After measuring their height in meters (M), several parameters were determined: angle of lateralization of ACFM (Â), Depth ACFM in relation to the superomedial origin of the quadratus femoris muscle (P), and distance of ACFM from the superolateral insertion of the muscle quadratus femoris (D). RESULTS: In the comparison of mean parameters between the sexes, it was noted that: Male  = 43.6 degrees, female  = 38.3 degrees. Male D = 6mm, female D = 9.5mm. Male P = 20.8 mm, female P = 18.3mm. The average for parameters A and P were lower in females, but parameter D was higher in females. CONCLUSION: We should use, as the secure surface parameter for the proximal third of the ACFM, the superolateral insertion point of the quadratus femoris muscle. The fact that the parameter D of ACFM is greater in females than in males. Disconnecting the quadratus femoris muscle at its point of origin in the isquio may offer greater security to ACFM than doing it at the point of femoral insertion. Level of Evidence.

High origin of the deep femoral artery: a case report and literature review / Origem alta da artéria femoral profunda: relato de caso e revisão da literatura

Arterial variations of the femoral triangle are rarely reported in the literature. In the present article, we have reported a case of high origin of the deep femoral artery, which was originating just lower to the inguinal ligament. It was also observed that the lateral circumflex femoral artery arose directly from the femoral artery instead from the deep femoral artery. We have discussed the anatomy, embryological basis, and clinical implications of these variations along with relevant literature review. The importance of knowledge about these variations in therapeutic and diagnostic interventions is discussed.

Variações arteriais no triângulo femoral têm sido pouco relatadas na literatura. No presente artigo, relatou-se um caso de origem alta da artéria femoral profunda, que estava se originando pouco abaixo do ligamento inguinal. Também foi observado que a artéria femoral circunflexa originava-se diretamente da artéria femoral, ao invés de ser originada da artéria femoral profunda. Discutiu-se sobre anatomia, base embriológica e implicações clínicas dessas variações junto com uma revisão da literatura pertinente. A importância do conhecimento sobre essas variações no quadro das intervenções diagnósticas e terapêuticas é discutida.

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.

Multidetector computed tomographic angiography evaluation of micropig major systemic vessels for xenotransplantation

Due primarily to the increasing shortage of allogeneic donor organs, xenotransplantation has become the focus of a growing field of research. Currently, micropigs are the most suitable donor animal for humans. However, no standard method has been developed to evaluate the systemic vascular anatomy of micropigs and standard reference values to aid in the selection of normal healthy animals as potential organ donors are lacking. Using 64-channel multidetector row computed tomographic angiography (MDCTA), we evaluated morphological features of the major systemic vessels in micropigs and compared our results to published human data. The main vasculature of the animals was similar to that of humans, except for the iliac arterial system. However, diameters of the major systemic vessels were significantly different between micropigs and humans. Specifically, the diameter of the aortic arch, abdominal aorta, external iliac artery, and femoral artery, were measured as 1.50 +/- 0.07 cm, 0.85 +/- 0.06 cm, 0.52 +/- 0.05 cm, and 0.48 +/- 0.05 cm, respectively, in the micropigs. This MDCTA data for micropig major systemic vessels can be used as standard reference values for xenotransplantation studies. The use of 64-channel MDCTA enables accurate evaluation of the major systemic vasculature in micropigs.

Anterolateral thigh flap: versatility and anatomic variations

To determine the pattern of the cutaneous perforator of the lateral circumflex femoral artery in anterolateral thigh perforator flap. Antero lateral thigh flap has become one of the most commonly used flap for the reconstruction of various soft tissue defects. The anterolateral thigh flap is known for variations of its vascular pedicle. Its major limitation has been uncertainty in predicting perforator anatomy, with the occasional absence of suitable perforators and high variability in their size and course. Reconstruction of 13 composite defects in 13 consecutive patients by free microvascular anterolateral thigh flap at the Department of Plastic and Reconstructive Surgery, Hayatabad Medical complex, Peshawar. Thirteen patients were operated and free microvascular anterolateral thigh flap was used. In 12 patients the main vascular supply was through the descending branch of the lateral circumflex artery [LCFA]. One patient has a vascular supply through the transverse branch of the lateral circumflex femoral artery. Transmuscular perforators [mostly 3,] were found in all the patients, commonly arising from descending branch of lateral circumflex femoral artery

The anatomy of the lateral circumflex femoral artery in anterolateral thigh flap.

OBJECTIVE: To determine systematically the pattern of the cutaneous perforator of the lateral circumflex femoral artery (LCFA) in anterolateral thigh perforator (ALT) flap. MATERIAL AND METHOD: Sixty dissections of the LCFA were carried out in 30 preserved cadavers. The number; type, origin, and location of the cutaneous perforators of the LCFA were studied and measured. RESULTS: There were 169 perforators. In 79.3%, the perforators originated from the descending branch, 18.3% from the transverse branch. The perforator of the medial descending and the ascending branch were found in 1.8% and 0.6%, respectively. The most cutaneous perforators were concentrated in the middle third (14 to 28 cm from the ASIS) of the anterolateral thigh region. CONCLUSION: The perforator of the descending branch, which was located ranging from 21 to 35 cm, was appropriate for flap designing to avoid the perforator of the transverse branch, which was difficult to harvest.

The anatomy of the superficial external pudendal artery: a quantitative study

The importance of the superficial external pudendal artery in cases of lower limb obstructive arteriopathies has been established, and a perfect knowledge of its anatomy is desirable for the creation of successful flaps involving it. However, little information is available on the morphometry of this artery. PURPOSE: In this study, we conducted a quantitative investigation of the superficial external pudendal artery as the basis for skin grafts. METHOD: Twenty-five right and left sides of the inguinal region of male cadavers were dissected. After retracting the skin at the inguinal region, the femoral vessels and the sapheno-femoral junction were exposed. The following aspects were then analyzed: 1) the presence of the superficial external pudendal artery, 2) the place of origin of the superficial external pudendal artery and the common trunk, 3) the duplication of the superficial external pudendal artery, 4) the distance from the superficial external pudendal artery or the common trunk to the inguinal ligament, and 5) the diameter of the superficial external pudendal artery. RESULTS: The results were the following: 1) superficial external pudendal arteries were found in 46 of 50 sides (92 percent); 2) they originated from the femoral artery in 45 cases and from the deep femoral artery in only 1 case; 3) the arteries were found duplicated in 21 cases (46 percent), as a common trunk in 11 cases (24 percent), and as a single artery in 14 cases (30 percent); 4) the distance from the superficial external pudendal artery to the inguinal ligament ranged from 0.8 cm to 8.5 cm; from the common trunk, it ranged from 3.5 cm to 6.7 cm; 5) the diameter of the superficial external pudendal artery ranged from 1.2 mm to 3.8 mm; and 6) the diameter of the common trunk ranged from 1.35 mm to 5.15 mm. CONCLUSION: The results show that the superficial external pudendal artery generally originates from the femoral artery. It was found as a common trunk, duplicated,or as a single artery. There was a great variability in both the diameter of the artery and the distance from the artery to the inguinal ligament. Most of the data showed no significant differences between the right and the left sides.

A importância do conhecimento da anatomia da artéria pudenda superficial externa está bem estabelecida e um conhecimento adequado de sua anatomia é desejável para a criação bem sucedida de flaps. Entretanto, são escassos os trabalhos morfométricos sobre esta artéria. OBJETIVO. No presente estudo, foi feita uma análise quantitativa da artéria pudenda superficial externa, como base para enxertos de pele. MÉTODO. Foram dissecadas 25 regiões inguinais direitas e 25 esquerdas de cadáveres do sexo masculino. Após rebater a pele da região inguinal, os vasos femorais, a junção safeno-femoral e a artéria pudenda superficial externa foram expostas. Os seguintes aspectos foram então analisados: 1. Presença da artéria pudenda superficial externa; 2. Local de origem da artéria pudenda superficial externa ou do tronco comum; 3. Duplicação da artéria pudenda superficial externa; 4. Distância da artéria pudenda superficial externa ou do tronco comum ao ligamento inguinal; 5. Diâmetro da artéria pudenda superficial externa. RESULTADOS. Os resultados mostraram que: 1. A artéria pudenda superficial externa foi encontrada em 46 dos 50 lados dissecados (92 por cento); 2. A artéria teve origem na artéria femoral em 45 casos; em um único caso teve origem na artéria femoral profunda; 3. A artéria foi encontrada duplicada, em 21 casos (46 por cento), formando um tronco comum, que depois se bifurcava, em 11 casos (24 por cento) e como uma artéria única 14 vezes (30 por cento); 4. A distância da artéria ao ligamento inguinal variou de 0,8 cm a 8,5 cm; quando sob a forma de tronco comum, esta distância variou de 3,5 cm a 6,7 cm; 5. O diâmetro da artéria pudenda superficial externa variou de 1,36 mm a 5,15 mm. CONCLUSÕES. Os resultados mostram que a artéria pudenda superficial externa origina-se, na grande maioria dos casos, da artéria femoral. Foi encontrada como um tronco comum, duplicada ou como uma artéria única. O diâmetro da artéria mostrou grande variabilidade assim como distância da artéria ao ligamento inguinal. A maioria dos dados não mostrou diferença significante entre os lados direito e esquerdo.

Intima-media thickness evaluation by B-mode ultrasound: Correlation with blood pressure levels and cardiac structures

The aim of this study was to analyze the thickness of the intima-media complex (IMC) using a noninvasive method. The carotid and femoral common arteries were evaluated by noninvasive B-mode ultrasound in 63 normotensive and in 52 hypertensive subjects and the thickness of the IMC was tested for correlation with blood pressure, cardiac structures and several clinical and biological parameters. The IMC was thicker in hypertensive than in normotensive subjects (0.67 ± 0.13 and 0.62 ± 0.16 vs 0.54 ± 0.09 and 0.52 ± 0.11 mm, respectively, P<0.0001). In normotensive patients, the simple linear regression showed significant correlations between IMC and age, body mass index and 24-h systolic blood pressure for both the carotid and femoral arteries. In hypertensives the carotid IMC was correlated with age and 24-h systolic blood pressure while femoral IMC was correlated only with 24-h diastolic blood pressure. Forward stepwise regression showed that age, body mass index and 24-h systolic blood pressure influenced the carotid IMC relationship (r2 = 0.39) in normotensives. On the other hand, the femoral IMC relationship was influenced by 24-h systolic blood pressure and age (r2 = 0.40). In hypertensives, age and 24-h systolic blood pressure were the most important determinants of carotid IMC (r2 = 0.37), while femoral IMC was influenced only by 24-h diastolic blood pressure (r2 = 0.10). There was an association between carotid IMC and echocardiographic findings in normotensives, while in hypertensives only the left posterior wall and interventricular septum were associated with femoral IMC. We conclude that age and blood pressure influence the intima-media thickness, while echocardiographic changes are associated with the IMC

Origen de la arteria circunfleja ilíaca superficial / Origin of the superficial circumplex iliac artery

La arteria circunfleja ilíaca superficial es un pequeño vaso que se origina, generalmente, en la arteria femoral a nivel del trígono femoral, dirigiéndose paralela al ligamento inguinal hacia la espina ilíaca anterosuperior. Aunque de pequeño calibre adquiere importancia en algunas intervenciones quirúrgicas de la región. Disecamos 50 regiones inguinales de cadáveres formolizados en la disciplinas de anatomía topográfica de las Universidades de La Frontera, Chile y Federal de Sao Paulo, Brasil. La arteria cincunfleja ilíaca superficial tuvo un diámetro externo de 1,4 mm en promedio y la distancia desde su origen al ligamento inguinal fue de 14,9 mm. La arteria se originó directamente de la arteria femoral en 33 casos (66 por ciento); de un tronco común con la arteria epigástrica superficial en 11 (22 por ciento) y de la arteria circunfleja femoral lateral en dos casos (4 por ciento). Aunque tiene un pequeño diámetro, la arteria circunfleja ilíaca superficial es importante tanto para el anatomista como para los cirujanos vasculares y plásticos, ya que irriga las regiones inguinal y abdominal y el conocimiento de sus características reforzaría a estos profesionales durante los procedimientos quirúrgicos realizados en dichas regiones

Peripheral aneurysms in Behcet's disease

Behcet's disease is a multisystem inflammatory disorder which may involve the vascular system. In this report, 14 patients with Behcet's disease with a total of 16 periphral aneurysms are presented. All patients were male, ranging in age from 23-50 years. The most common site of aneurysm formation was the femoral artery in 10 patients [71%]. Others include: 2 brachial, 1 popliteal, 1 external iliac, 1 peroneal, 1 posterior tibial. Only two patients with known previous history of venous thrombosis and under treatment of Behcet's disease In the other patients [86%] the first presentation was peripheral aneurysm and recurrent scrotal ulceration +/- oral ulceration. Synchronous multiple presentation in one patient and dis-synchronous presentation in other patient We performed interposition vein grafts for11 [8 femoral, 2 brachial and 1 popliteal] and 3 interposition PTFE graft [2 femoral and 1 external iliac]. Simple ligation as initial procedure was done for two [1 peroneal and 1 posterior tibial]. Anastomotic aneurysm developed in 2 patients [14%], secondary haemorrhage ended with A.k amputation in one patient [7%]. Relapse as new aneurysm formation in the aorta in 3 patients [21%] with mortality in two of them [14%]. Behcet's .disease should be considered in the differential diagnosis of periphral arterial aneurysm in young person in our population. A combination of corticosteroids and immune-suppression should be considered to control relapses responsible for new aneurysm formation especially in patients presented with multiple aneurysms

Morphologic change of the internal elastic lamina in Buerger's disease

Morphologic features and pathogenesis of arterial changes occurring in Buerger's disease (thromboangiitis obliterans) are still controversial. This study describes histopathologic features of medium sized arteries from patients with Buerger's disease, particularly of the internal elastic lamina in relation to the immunologic mechanism of the injury. Seventeen segments of occluded arteries (femoral or popliteal arteries) from 17 patients with Buerger's disease were analyzed by histopathological and immunohistochemical methods. The most characteristic features were total luminal obliteration, together with a varying degree of recanalization and deposition of hemosiderin pigments. Detailed analysis, however, showed marked undulation and multiplication of the internal elastic lamina (100%) associated with basophilic degeneration and delicate linear calcification (47%). Lymphocytic infiltration along the internal elastic lamina was seen in 71% and was associated with localized edema. Lymphocytes along the lamina were consistently positive for T cell marker. Mild to moderate fibrosis was present at the media in 24%. Adventitial changes included mild, nonspecific and irregular fibrosis seen in 53%. Immunologic injury to the internal elastic lamina associated with T-lymphocytic infiltration might be the initial morphogenetic mechanism of the thrombotic occlusion and organization of medium-sized arteries in Buerger's disease.

Derivaciones extraanatómicas: Revisión de 33 casos / Extraanatomic bypass: Review of 33 treated cases

Reportamos nuestra experiencia de 33 casos de derivaciones extraanatómicas durante un periodo de 2 años en el Hospital de Especialidades del Centro Médico Nacional ®Siglo XXI¼. De los pacientes incluidos, 24 fueron del sexo masculino y 9 del femenino, con un rango de edad de 17 a 75 años y una media de 55.8 años. El 42.4 por ciento de los pacientes incluidos, 24 fueron del sexo masculino y 9 del femenino, con un rango de edad de 17 a 75 años y una media de 55.8 años. El 42.2 por ciento de los pacientes tenían historia de tabaquismo intenso. La principal indicación para la colocación del área quirúrgica vascular. La derivación más utilizada fue: Fémoro-femoral y axilo-femoral. El tipo de injerto más utilizado fue: PTFE y dacrón, obtuvimos una mortalidad de 15 por ciento y una morbilidad de 12.1 por ciento. Se obtuvo revascularización exitosa en 93.9 por ciento. A 3 pacientes se les realizó un procedimiento indirecto tipo simpatectomía quirúrgica lumbar. Conclusión. Un alto número de pacientes tiene contraindicaciones para revascularización directa por la vía antómica. En ellos es de utilidad las derivaciones extraanatómicas las cuales tienen un alto porcentaje de éxito mediano y largo plazo y así evitar un alto porcentaje de pérdida de extremidades

Persistência da artéria ciática com aneurisma associada à artéria femoral superficial hipoplásica / Persistent sciatic artery with aneurism associated with hypoplastic superficial femoral artery

Um caso de persistência da artéria ciática com aneurisma associada à artéria femoral hipoplásica no membro inferior direito é relatado. Esta associação é rara, sendo o primero caso descrito na literatura brasileira. As peculiaridades anatômicas, ultra-sonográficas desta observação são revistas