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Researchers from the V.A. Nasonova Research Institute of Rheumatology have developed a new imaging strategy for large vessel vasculitis (LVV) based on the EULAR-2023 recommendations. The study highlights the importance of early diagnosis of LVV, which includes Takayasu's arteritis (AT) and giant cell arteritis (GCA), to prevent complications such as vision loss and cerebral insufficiency. The recommended imaging techniques for GCA include duplex ultrasound (USDS) and magnetic resonance imaging (MRI), while AT can be assessed using MRI, positron emission tomography (PET), computed tomography (CT), or ultrasound examination. MRI, CT, or ultrasound are also suggested for long-term monitoring of structural damage in LVV. [Extracted from the article]

The article from Koc University Faculty of Medicine discusses a study on the effects of lateral sagittal infraclavicular block (LS-ICB) on hemodynamic changes based on the inferior vena cava collapsibility index (VCI-CI). The study classified patients into two groups based on VCI-CI measurements and compared various parameters between them. The research found that blood flow increased after LS-ICB without a corresponding increase in axillary artery diameter, and Group 1 showed a tendency toward a lower perfusion index in the postoperative period. The study concluded that the dosage and number of patients requiring rescue analgesics were similar across both groups, with no reported complications. [Extracted from the article]

Researchers at the University of Southern California (USC) conducted a study on heart transplants using the Impella 5.5 device as a bridge to transplantation. The study analyzed outcomes of 45 patients who underwent heart transplants after being supported by the Impella 5.5 device. The research concluded that the Impella 5.5 device is a safe and reliable option for bridging to heart transplant. The study found that 98% of patients survived to discharge, with a 30-day survival rate of 95.6% and a one-year survival rate of 90.3%. [Extracted from the article]

A patent was issued to EmStop Inc. for valve replacement devices and methods developed by inventor Mark Groh. The patent focuses on an embolic material blocking catheter that can be deployed within a blood vessel downstream of a treatment site to prevent embolic material from causing complications. This innovation aims to improve the safety and effectiveness of transcatheter aortic valve replacement procedures, particularly in patients at risk of embolic events. The patent provides detailed descriptions of the device and methods for its use, offering a potential solution to reduce the risk of stroke and other complications associated with valve replacement procedures. [Extracted from the article]

A study conducted in Chengdu, People's Republic of China, compared bilateral and unilateral cerebral perfusion for total arch replacement surgery in patients with non-Marfan, Type A aortic dissection. The research found that patients who received bilateral cerebral perfusion had lower rates of permanent neurologic deficits and 30-day mortality compared to those who received unilateral cerebral perfusion. Additionally, the bilateral cerebral perfusion group showed lower levels of inflammation cytokines and higher levels of neuroprotective cytokines. The study concluded that bilateral cerebral perfusion was associated with better outcomes in these patients. [Extracted from the article]

A report from Westchester Medical Center in Valhalla, New York discusses the use of the axillary artery for inserting the Impella 5.5 device in patients with cardiogenic shock. The study analyzed data from 75 patients who underwent the procedure and found that the choice of laterality (right or left) and the size of the axillary artery did not significantly impact outcomes or safety. The research concluded that the axillary approach is a viable option for successful support with the Impella 5.5 device. [Extracted from the article]

A 66-year-old woman with a history of hypertension, diabetes, hyperlipidaemia, and morbid obesity experienced a lack of efficacy while being treated with aspirin for an ascending aortic thrombus. Despite neurology consultation advising to continue aspirin therapy, she later developed acute right upper extremity limb ischaemia with thrombosis of the right axillary and brachial artery, indicating the lack of effectiveness of aspirin. The woman underwent thrombectomy successfully but faced a poor prognosis, leading to palliative discussions with her family. [Extracted from the article]

A 38-year-old man with a history of renal transplant and focal segmental glomerulosclerosis developed an axillary aneurysm while on tacrolimus, mycophenolate mofetil, and apixaban. He presented with left arm symptoms and underwent urgent surgical intervention to repair the aneurysm. Following surgery, he showed improvement in symptoms and was discharged with anticoagulation therapy, experiencing significant improvement during follow-up visits. [Extracted from the article]

Narwhal Medical LLC has been issued a patent for expandable mechanical hemodynamic support systems, devices, and methods. The patent describes blood pump systems, such as percutaneous ventricular assist devices, that are used in interventional cardiology procedures. These devices provide mechanical hemodynamic support and can be used to offload the heart during procedures. The patent outlines various features of the devices, including an elongate flexible drive shaft, an inflatable pump impeller, and a reconfigurable pump housing. The devices are designed to be delivered through smaller access sites and can be used in patients with smaller body structures. [Extracted from the article]

A study conducted by researchers at Chonnam National University in South Korea explores the variations in branches of the axillary artery. The researchers examined the upper-limb dissection of a 95-year-old Korean female cadaver and identified various anatomical variations in the branches of the axillary artery. The study emphasizes the rarity of these variations and their importance for educational, surgical, and radiological purposes. The research has been peer-reviewed and published in the International Journal of Morphology. [Extracted from the article]

A recent study from the University of South Florida School of Medicine explores an alternative approach to lower extremity revascularization in patients with limb ischemia caused by malignancy and a history of resection and/or radiation. The researchers describe a case study of a 68-year-old male with a history of liposarcoma who underwent multiple surgeries and radiation therapy. The patient presented with acute limb ischemia and underwent an axillary-to-lateral above knee popliteal artery bypass, which successfully restored blood flow and improved the patient's condition. The study highlights the challenges and potential solutions for revascularization in patients with complex medical histories. [Extracted from the article]

A recent study conducted by researchers at Istanbul University-Cerrahpasa compared the outcomes of aortic and axillary cannulation methods in hemiarch replacement surgeries. The study analyzed data from 91 patients who underwent the surgery and found no significant differences in safety and efficacy between the two methods. However, there were notable differences in aortic disease severity and classification between the two groups. The study also found that axillary cannulation was associated with a higher prevalence of acute kidney injury compared to aortic cannulation. Overall, the study provides valuable insights into the use of different cannulation methods in hemiarch replacement procedures. [Extracted from the article]

A recent study conducted by the Division of Vascular Surgery has found that radiation-induced arterial ischemia, a condition where blood flow is restricted due to radiation therapy, can occur in patients with Gorham-Stout Disease (GSD). GSD, also known as "Vanishing Bone Disease," is a rare condition that affects the bones. The study highlights the need for revascularization procedures in patients with GSD who are at high risk for radiation-induced arterial injury. This research provides valuable insights into the potential complications associated with radiation therapy in GSD patients. [Extracted from the article]

A recent report published by researchers at Kovai Medical Center and Hospital in Tamil Nadu, India, discusses two unusual cases of spontaneous thrombosis in neonates. In the first case, a baby was diagnosed with a left atrial thrombus shortly after birth and was successfully treated with thrombolytic therapy. The second case involved a baby with chronic left axillary artery thrombosis, resulting in limb ischemia. Although the limb perfusion and movements normalized with anticoagulant therapy, the baby experienced limb shortening due to chronic ischemia. The researchers emphasize the need for separate guidelines for managing thrombosis in neonates, given the increasing number of such cases in neonatal intensive care units. [Extracted from the article]

A recent study conducted at Kobe City Medical Center General Hospital in Japan examined cases of humeral fractures with associated axillary artery injuries. The study found that in cases of proximal humeral fractures with significant displacement, it is important to assess for concomitant axillary artery injury and promptly perform advanced imaging if there is a high suspicion. The researchers highlighted the need for early detection and appropriate surgical intervention in these cases. The study provides valuable insights for medical professionals treating patients with humeral fractures. [Extracted from the article]

A new report from researchers at Copenhagen University Hospital in Denmark describes a percutaneous approach for endovascular arch repair using a triple inner-branch device called the "Innominate Approach." The technique involves accessing the brachiocephalic artery and the left common carotid artery through the axillary artery, avoiding the need for carotid artery access. The researchers found that this approach reduces the number of vascular accesses required and allows for downsizing of the trans-axillary devices. The study has been peer-reviewed and published in the Journal of Endovascular Therapy. [Extracted from the article]

Silk Road Medical Inc. has been issued a patent for methods and devices for transcarotid access, addressing the need for improved systems for accessing the carotid artery. The patent describes devices and methods that enable safe and efficient access to the carotid artery for the treatment of vascular and neurovascular diseases. It also addresses the issue of radiation exposure during transcarotid procedures. [Extracted from the article]

A recent report from the University of Florida highlights a successful case of extracorporeal cardiopulmonary resuscitation (ECPR) despite aortic occlusion. The case involved a 62-year-old man with severe coronary artery disease who experienced refractory ventricular fibrillation cardiac arrest. The patient was successfully treated with ECPR using a surgical vascular graft, allowing blood flow to the central circulation through the axillary artery while ensuring blood flow to the left leg through a femoral-femoral graft. The patient recovered neurologically intact and was discharged home. This case demonstrates that ECPR can be effective even in the presence of a total occlusion of the infrarenal aorta. [Extracted from the article]

A new report from researchers at Islamic Azad University in Tehran, Iran, discusses a variation in the branching pattern of the left axillary artery. The researchers emphasize the importance of recognizing and documenting these variations for surgeons performing cardiovascular procedures. The study found that the third part of the left axillary artery gave rise to a common trunk, which then divided into several smaller arteries. This information can be valuable for medical professionals in understanding and treating cardiovascular diseases. For more details, the full report can be accessed through Acta Medica Iranica. [Extracted from the article]

Researchers from Istanbul University have published new data comparing different techniques for performing infraclavicular brachial plexus blocks in anesthesiology. The study aimed to compare the block onset times and performance features of costoclavicular techniques (medial and lateral approach) versus the traditional lateral sagittal technique. The researchers found that the lateral approach costoclavicular technique provided the fastest block onset time compared to the other techniques. They concluded that this technique could be a good alternative in clinical practice. The study was registered on clinicaltrials.gov and more information can be obtained from the authors. [Extracted from the article]

A study conducted at Brigham and Women's Hospital in Boston, Massachusetts, examined the perioperative risks associated with the use of andexanet alfa during emergency cardiac surgery with circulatory arrest. Andexanet alfa was administered to a patient undergoing emergency repair of acute type A thoracic aortic dissection to obtain a dry operative field. However, the use of andexanet alfa resulted in heparin resistance and thrombosis, requiring large amounts of unfractionated heparin and antithrombin III. The study highlights the challenging perioperative hazards associated with the use of andexanet alfa during emergency cardiac surgery. [Extracted from the article]

A patent has been issued for a branch stent graft and delivery method for endovascular treatment of iliac artery aneurysms. The patent, assigned to Medtronic Vascular Inc., describes a device that simplifies the procedure and reduces procedure time, allowing it to be performed on a broad patient population. The device includes an external iliac body, a common iliac branch, and an internal iliac branch, and is designed to be deployed without going up and over the aortic bifurcation. The patent provides detailed methods for deploying the device and describes its various components and features. [Extracted from the article]

A new report discusses research findings on giant cell arteritis (GCA) and the use of ultrasonography (US) for diagnosis of large vessel vasculitis (LVV). The study, conducted in Norwich, United Kingdom, analyzed the results of the first 1000 unique referrals for US. The protocolized US pathway used in the study reduced visual loss and demonstrated a high sensitivity for diagnosing LVV. The research suggests that composite testing with US and a second test can be recommended as a gold standard diagnostic tool for LVV. [Extracted from the article]

A new report from the Division of Cardiac Surgery in Pavia, Italy discusses the use of direct axillary artery cannulation during aortic surgery procedures. The study included 100 patients, ranging in age from 29 to 87 years, who underwent aortic surgery using this technique. The researchers found that direct axillary artery cannulation was a safe and effective method, with no major complications reported. The study supports the use of this approach as a first choice strategy for arterial cannulation during complex surgical procedures involving the thoracic aorta. [Extracted from the article]

A 57-year-old woman experienced a lack of efficacy while being treated with atorvastatin and ezetimibe for hyperlipidemia. She presented with left arm pain and cramping, and further investigations revealed stenosis in her subclavian artery. Despite an increase in the dosage of atorvastatin, her condition did not improve. Lipoprotein (a) levels were found to be elevated, and ezetimibe was discontinued while evolocumab was initiated. After six months, her condition showed improvement under evolocumab. [Extracted from the article]

A new report from Capital Medical University in Beijing, China, discusses the use of central (aortic) cannulation versus peripheral (axillary or femoral) cannulation in acute type A aortic dissections. The study conducted a meta-analysis of 10 retrospective observational studies involving 3,022 patients. The findings suggest that central cannulation is associated with lower short-term mortality and a lower occurrence of temporary neurological dysfunction compared to femoral cannulation. However, there was no significant difference in mortality and temporary neurological dysfunction between central cannulation and axillary cannulation. [Extracted from the article]

A recent study conducted at Mount Sinai Hospital in New York City investigated the use of ultrasound-guided axillary artery catheter placement in critically ill patients. The study found that the most common complication associated with this procedure was minor bleeding, followed by catheter malfunction and vascular complications. The researchers concluded that ultrasound-guided axillary arterial catheters can be an alternative option for patients who cannot undergo radial or femoral arterial access. This information may be useful for individuals conducting research on axillary artery catheter placement and its associated complications. [Extracted from the article]

A recent report from researchers at VPS Lakeshore Hospital in Ernakulam, India discusses a rare case of compartment syndrome in the arm caused by an avulsion of the distal biceps tendon. Compartment syndrome is a serious injury that can have severe consequences. The patient, a 49-year-old male, presented to the emergency room after a road traffic accident and underwent emergency surgery to relieve the compression of the axillary vessels caused by the avulsed tendon. This case is rare, with only a few other instances of distal biceps tendon injury resulting in compartment syndrome in the arm and forearm known so far. [Extracted from the article]

A recent study from Brown University discusses a case of acute-on-chronic axillary artery thrombus after reverse total shoulder arthroplasty (rTSA) for a failed proximal humerus open reduction and internal fixation. The study highlights the importance of screening methods and clinical vigilance in diagnosing vascular injuries associated with rTSA, as the procedure becomes more common for managing proximal humerus fractures. The researchers emphasize the need for increased awareness of arterial injury risk factors in patients with anterior proximal humerus fracture dislocations. [Extracted from the article]

A recent study from Ferdowsi University of Mashhad has discovered an unusual relationship between the axillary artery and brachial plexus in a cross-breed dog cadaver. The researchers found that a part of the axillary artery took a different course, passing through the contributions of certain nerves and missing the common trunk for the median and ulnar nerves. This variation has not been reported before and may have implications for neuroarterial compressions. The study suggests that this relationship should be considered in both surgery and imaging. [Extracted from the article]

The patent application titled "Methods And Devices For Transcarotid Access" discusses the need for improved methods and devices for accessing the carotid artery to perform interventional procedures for vascular and other diseases. The inventors propose a system of devices that optimize ease and safety of transcarotid access, as well as minimize radiation exposure to the operator. The devices and methods described in the application aim to provide safe and efficient access to the carotid artery for various interventional procedures, including the treatment of coronary, peripheral, or neurovascular disease. The application provides detailed descriptions of the devices and methods involved. [Extracted from the article]

A study conducted by researchers at Huazhong University of Science and Technology in Wuhan, China, investigated the use of axillary artery cannulation (AAC) in type II hybrid aortic arch repair for acute type A aortic dissection (ATAAD). The study compared patients who underwent femoral artery cannulation (FAC) alone with those who underwent AAC. The results showed that patients who underwent AAC had a lower incidence of transient neurological dysfunction (TND) post-surgery compared to those who underwent FAC. However, the researchers noted that larger studies are needed to further explore this topic. [Extracted from the article]

A study conducted at Amandeep Hospital in Punjab, India, focused on a rare case of acute traumatic complicated right axillary artery pseudoaneurysm with quadrangular space syndrome. The researchers found that axillary artery pseudoaneurysms are relatively rare, with few reported cases in the literature. Prompt diagnosis using non-invasive imaging techniques such as ultrasound, magnetic resonance imaging, and computed tomography, along with angiography for immediate intervention, is crucial in preventing complications. The study presented a critical literature review of similar cases and identified only a few previously reported instances. For more information, readers can refer to the Indian Journal of Musculoskeletal Radiology. [Extracted from the article]

A study conducted at Norfolk and Norwich University Hospital NHS Trust in the United Kingdom has found that ultrasonography (US) is a highly sensitive diagnostic tool for large vessel vasculitis (LVV), specifically giant cell arteritis (GCA). The study analyzed the results of 1000 unique referrals and found that a protocolized US pathway, which includes scanning the superficial temporal artery and its rami, as well as the entire axillary artery, had a sensitivity of 96% and a negative predictive value of 98%. The addition of imaging other arteries improved the diagnostic yield by 9%. The researchers recommend composite testing with US and a second test, stratified by C-reactive protein (CRP) levels, as a gold standard diagnostic tool for LVV. [Extracted from the article]

A recent report from the All India Institute of Medical Sciences (AIIMS) highlights the case of a teenage boy with tubercular pseudoaneurysm of the axillary artery. The boy presented with left upper limb pain and gradually progressive motor and sensory deficit, with a history of tuberculosis. Imaging confirmed the presence of a pseudoaneurysm with compression of the underlying nerves. The boy underwent surgical thrombectomy and repair, along with antitubercular medications, and made a complete recovery. The researchers emphasize the importance of a high index of suspicion to diagnose such manifestations of tuberculosis and prevent serious complications. [Extracted from the article]

A study conducted at Ramaiah Medical College in Karnataka, India, examined the long-term outcomes of nonoperative management of acute nontraumatic upper-limb ischemia (AULI). AULI is a sudden loss of blood flow to the affected limb and can be caused by various factors. The study followed 31 patients who were conservatively treated for AULI for 5 years. The results showed that patients had good amputation-free survival and improved functional outcomes. None of the patients required surgical intervention for revascularization. Two patients underwent partial amputations, but limb salvage was achieved in all patients. The study suggests that conservative management can be effective for AULI. [Extracted from the article]

A recent report from St. Louis University discusses a unique case of arterial variations in the upper extremity. During a cadaveric dissection, researchers observed a rare arterial branching pattern in the right upper extremity of a 93-year-old male donor. The pattern involved a large superficial brachial artery that bifurcated into the subscapular artery and a common stem. The study concludes that this case is clinically and pathologically relevant. The research was supported by the Center for Anatomical Science and Education at St. Louis University School of Medicine. [Extracted from the article]

A recent meta-analysis conducted by the Lankenau Institute for Medical Research compared the effectiveness of central aortic cannulation to axillary artery cannulation in repairing acute type A aortic dissection. The study found that there were no significant differences in early clinical outcomes between the two approaches, including operative mortality, incidence of postoperative stroke, and other secondary endpoints. This suggests that aortic cannulation can be a viable alternative to axillary artery cannulation for the repair of acute aortic dissection type A. The research was funded by Thee Sharpe-strumia Foundation of Bryn Mawr Hospital. [Extracted from the article]

A recent study conducted by researchers from the University of Arizona compared the outcomes of upper arm arteriovenous grafts (AVGs) in a large dataset. The study aimed to determine if there were any significant differences between axillary artery-based and brachial artery-based AVGs. The researchers found that axillary artery AVGs had lower patency rates and a higher risk of steal syndrome compared to brachial artery AVGs. This observational study provides valuable insights into the outcomes of upper extremity hemodialysis access. [Extracted from the article]

A recent study conducted by MBBS researchers has revealed new findings on angiology, specifically variations in the arterial pattern of the upper limb and its embryological basis. The study, which was conducted on 30 cadavers, found that the arterial pattern of the upper limb in adults shows a significant number of variations, which can be explained by the persistence of superficial embryonic vessels. Some specific variations observed include the presence of the superficial brachial artery, the brachioradial artery, the brachioulnar artery, and the superficial ulnar artery. The researchers concluded that this information is important for clinicians and surgeons performing invasive procedures in the arm and forearm. [Extracted from the article]

A study conducted at Texas A&M University provides new insights into the surgical repair of a specific type of aneurysm called a subclavian artery mycotic aneurysm. The researchers found that a procedure called median claviculectomy can be used successfully to treat this condition. They performed a subclavian artery to axillary artery bypass with median claviculectomy on a 23-year-old man with multiple comorbidities, and the patient experienced positive outcomes with no significant deformities. This case suggests that median claviculectomy can be an effective treatment option for patients with subclavian artery mycotic aneurysms. [Extracted from the article]

A recent report discusses research on vascular and endovascular surgery, specifically focusing on traumatic axillary and subclavian artery injuries. The study analyzed data from patients at the University of Louisville Hospital, a Level One Trauma Center, from 2015 to 2021. The findings revealed that both open and endovascular/hybrid strategies were effective in treating these injuries, with high rates of revascularization success and low rates of complications. Transection injuries were most commonly treated with open revascularization, and patients who required amputation had blunt transection injuries to the subclavian artery. [Extracted from the article]

Researchers at Menoufia University in Egypt have conducted a study comparing two arterio-arterial loop procedures for hemodialysis access. The study evaluated the use of the brachial artery in the arm versus the axillary artery on the chest wall. The results showed that the brachial artery loop graft was superior to the axillary artery loop graft in terms of operative time, blood loss, and hospital stay. This research provides valuable information for healthcare professionals considering alternative vascular access options for hemodialysis patients. [Extracted from the article]

A recent study conducted at the First Affiliated Hospital of Dalian Medical University in China focused on myxofibrosarcomas, a type of soft tissue sarcoma. The study described a rare case of low-grade myxofibrosarcoma in the axillary fossa, which infiltrated the brachial plexus, axillary artery, and axillary vein, causing severe pain. The researchers used ultrasound and contrast-enhanced ultrasound to accurately diagnose the tumor and determine its invasion scope. The study highlights the importance of accurate preoperative diagnosis and appropriate treatment strategies for managing myxofibrosarcoma. [Extracted from the article]

A recent report from Shizuoka Red Cross Hospital in Japan discusses a rare case of a ruptured axillary artery during open reduction surgery for shoulder dislocation with humerus fracture. The patient, a 58-year-old man, experienced bleeding during the procedure, and further examination revealed the ruptured artery. Stent grafts were promptly deployed to control the bleeding. The research concludes that endovascular repair is an effective alternative to open surgery in these cases. The study provides valuable insights into the management of axillary artery injuries during shoulder dislocation surgeries. [Extracted from the article]

A study conducted by researchers at the University of Catania in Italy focuses on the surgical treatment of axillary artery aneurysms. The researchers describe two cases of isolated axillary artery aneurysm that were managed through surgical resection and graft interposition. The patients did not experience any symptoms and both reconstructions remained patent after a 12-month follow-up. The study concludes that surgical repair of axillary artery aneurysms yields positive results, but further research with larger cohorts is needed to confirm these findings. [Extracted from the article]

A study conducted at University Hospital Tuebingen in Germany examined the use of right axillary artery cannulation for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in postcardiotomy patients who could not be weaned from cardiopulmonary bypass after cardiothoracic surgery. The study analyzed data from 179 patients who underwent VA-ECMO with femoral-axillary access between January 2014 and January 2019. The primary outcomes of the study were in-hospital mortality and 1-year survival rate, while secondary outcomes included cannulation-related complications, VA-ECMO-related complications, and systemic complications. The study found that right axillary artery cannulation is a safe and reliable method for VA-ECMO support with an acceptable complication rate in patients with acute left ventricular dysfunction after cardiothoracic surgery. [Extracted from the article]

A recent report from St. Franziskus Hospital in Munster, Germany discusses the rarity and complexity of axillary artery aneurysms in pediatric patients. The study aims to provide a comprehensive review of the existing literature on the etiology and management of this condition. The researchers found that open surgery repair with the great saphenous vein is the most effective long-term approach, but other options such as endovascular treatment, embolization, or conservative management can also be considered. This information is valuable for healthcare professionals and researchers studying cardiovascular diseases in children. [Extracted from the article]

Oftentimes, a selective catheter with a pre-bent or pre-shaped distal end may be used to facilitate proper orientation of the guide catheter within the aortic arch 10 and subsequent introduction of the guide catheter into the relevant arterial branch of the aortic arch 10. The method further comprises inserting the distal catheter end into the ostium of the blood vessel, and distally sliding the distal catheter end relative to the distal member end, such that the distal catheter end is further advanced into the blood vessel. Often times a diagnostic catheter is used for the same purpose as the selective catheter, selective catheters generally are different only in length so that they will fit inside a guide catheter or long sheath. An intravascular device, comprising: an elongated outer catheter body having a proximal catheter end, a distal catheter end, and an inner lumen extending between the proximal catheter end and the distal catheter end; an elongated inner articulating member slidably disposed within the inner lumen of the outer catheter body, the inner articulating member having a proximal member end and an articulatable distal member end; and a control assembly mechanically coupled to the proximal catheter end and the proximal member end, the control assembly configured for distally translating the outer catheter body over the inner articulating member, and for articulating the distal member end. [Extracted from the article]