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PURPOSE: We aimed to evaluate whether bronchial artery can supply a percutaneously inoculated canine transmissible venereal tumor (CTVT) in a lung tumor model. METHODS: Fresh CTVT tissue blocks were percutaneously inoculated into unilateral or bilateral lungs of six immunosuppressed dogs at the mid zone of the middle or lower lobe. Tumor growth was monitored by computed tomography (CT). Ten weeks after inoculation, pulmonary arterial digital subtraction angiography (DSA), bronchial arterial DSA, transpulmonary arterial contrast-enhanced multislice CT, transbronchial arterial contrast-enhanced multislice CT (BA-MSCT), and transpulmonary arterial lipiodol multislice CT were performed. RESULTS: Tumor growth was seen in all 10 inoculated sites, with a maximum diameter of 2.734±0.138 cm at 10th week. Bronchial arterial blood supply was evident in 9 nodules on DSA, and was equivocal in one which was later demonstrated on BA-MSCT. No obvious pulmonary arterial blood supply was observed in any of the nodules. Lipiodol deposition was displayed in two of the small distant metastases, which indicated that pulmonary artery was involved in the supply of the metastases. CONCLUSION: Our results demonstrated bronchial arterial blood supply in this new lung cancer model. This model may be used in further research on transbronchial arterial intervention for lung cancer.

Dynamically developing oncoplasty, i.e. the application of plastic surgery methods in oncological breast surgeries, requires excellent knowledge of mammary gland anatomy. This article presents the details of arterial blood supply and venous blood outflow as well as breast innervation with a special focus on the nipple-areolar complex, and the lymphatic system with lymphatic outflow routes. Additionally, it provides an extensive description of the axillary fossa anatomy.

This study aimed to design arterial ischemic and venous congested areas on the same multi-territory perforator flap, assessing the effects of arterial blood supply and venous return on flap survival. Totally 68 rats were randomly divided into the experimental (Exp) and control (Con) groups. In the Exp group, flaps were based on left superficial epigastric artery and right superficial epigastric vein. In the Con group, flaps were based on the left superficial epigastric artery and vein. Immediate postoperative ink-gelatin angiography, epidermal metabolite levels detection, tissue edema measurement, survival rate evaluation in half of the flaps and average microvessel density assessment were performed. Blood in the Exp group flowed through most angiosomes, but only flowed around pedicled vessels in the Con group; metabolite levels of left halves in the Con and Exp groups were comparable with those of right halves. Angiosomes with high water contents occurred in the Exp group. Survival rates of left halves in the Con and Exp groups were higher than those of right halves, and more microvessels were found in the left ventral areas of both groups compared with the right ventral area in the Exp group. These findings revealed that on the same multi-territory perforator flap, arterial blood supply, affected by venous return, is a prerequisite for flap survival.

We aim to gain further insight into identifying differential perfusion parameters and corresponding histogram parameters of intrahepatic mass-forming cholangiocarcinoma (IMCC) from hepatocellular carcinomas (HCCs) on triphasic computed tomography (CT) scans. 90 patients with pathologically confirmed HCCs (n = 54) and IMCCs (n = 36) who underwent triple-phase enhanced CT imaging were included. Quantitative analysis of CT images derived from triphasic CT scans were evaluated to generate liver perfusion and histogram parameters. The differential performances, including the area under the receiver operating characteristic curve (AUC), specificity, and sensitivity were assessed. The mean value, and all thepercentiles of the arterial enhancement fraction (AEF) were significantly higher in HCCs than in IMCCs. The difference in hepatic arterial blood supply perfusion (HAP) and AEF (ΔHAP = HAPtumor − HAPliver, ΔAEF = AEFtumor − AEFliver) for the mean perfusion parameters and all percentile parameters between tumor and peripheral normal liver were significantly higher in HCCs than in IMCCs. The relative AEF (rAEF = ΔAEF/AEFliver), including the mean value and all corresponding percentile parameters were statistically significant between HCCs and IMCCs. The 10th percentiles of the ΔAEF and rAEF had the highest AUC of 0.788 for differentiating IMCC from HCC, with sensitivities and specificities of 87.0%, 83.3%, and 61.8%, 64.7%, respectively. Among all parameters, the mean value of ∆AEF, the 75th percentiles of ∆AEF and rAEF, and the 25th percentile of HFtumor exhibited the highest sensitivities of 94.4%, while the 50th percentile of rAEF had the highest specificity of 82.4%. AEF (including ΔAEF and rAEF) and the corresponding histogram parameters derived from triphasic CT scans provided useful value and facilitated the accurate discrimination between IMCCs and HCCs.

Objective. Studying of clinical and morphological changes in the arterial blood supply of testicle in its surgical diseases and improvement of the surgical treatment tactics. Materials and methods. In the morphological stage of the study, there was obtained the material from 71 preparations of testicle and epitesticle, which were taken while doing necropsy in men of a mature age (22 – 35 years old), also there were processed 38 preparations of membranes in dropsy testicle, taken in a life–time, as well as postoperative material (in non–complete obliteration of vaginal sprout of peritoneum), and 17 testicular biopsy specimens, obtained in infertile men, which were taken during surgical intervention on testis in pediatric patients. Results. Introduction of the innovative method and implementation of complex program for diagnosis and surgical treatment of the testicular diseases in children into clinical practice have permitted to improve a testicular blood supply and to reduce a risk of the ischemia occurrence. Conclusion. Clinical and morphological changes in the arterial blood supply as a part of drainage systems of the testicle in its surgical diseases are expressed in development of total vascular spasm and ischemia, which were caused by narrowing of the arteries lumen, compensatory hypertrophy of the muscle layers of arterial wall, thickening of basal membranes, leading to increase in the number of blood vessels, sclerotic changes in stroma of spermatic cord, deformation of the ductus deferens.

Background: Conjoined flap viability is associated with arterial blood supply and venous return. This study aimed to assess the effects of venous drainage position on arterial blood supply and venous return within the conjoined flap. Methods: Fifty-four rats were divided randomly into three groups (n = 18 per group). In experimental group 2, only the right intercostal posterior artery and the left iliolumbar vein were maintained; meanwhile, only the right intercostal posterior artery and the left intercostal posterior vein were preserved in experimental group 1. The control group had only the right intercostal posterior artery and vein preserved. The distances between angiosomes were measured. At 7 days after surgery, flap survival was evaluated, lead oxide–gelatin flap angiography was performed, and average microvessel density was assessed by hematoxylin and eosin staining, and lactate levels were assessed. Results: The distance between angiosomes I and II was the shortest, whereas angiosomes I and III were most distant (p < 0.05). At 7 days after surgery, survival rates in experimental group 2 and experimental group 1 were both 100 percent, whereas 86.5 ± 1.6 percent of controls survived. Furthermore, angiogenesis was more obvious in experimental group 2 than in experimental group 1 and controls. Moreover, lactate levels were lower in experimental group 2 (7.47 ± 0.17 mM) and experimental group 1 (8.03 ± 0.31 mM) compared with control values (9.98 ± 0.37 mM; p < 0.05). Conclusion: Changes in position of venous drainage might cause continuous arterial high-pressure perfusion and venous superdrainage, which improves flap survival.

Pulmonary sequestration is defined as nonfunctioning lung tissue that is not in normal continuity with the tracheobronchial tree and that has a systemic arterial blood supply. Herein, we aimed to present a case of a 34-year-old male patient who had massive left-sided haemothorax on admission due to a giant intralobar pulmonary sequestration. An emergent repair was performed under cardiopulmonary bypass with axillofemoral cannulation.

Para estudo morfométrico, topográfico, da forma e das artérias da glândula tireóide, utilizou-se 30 fetos de bovinos, Bos taurus taurus, sendo 15 machos e 15 fêmeas, provenientes do Frigorífico Novilho do Valle, de Jaboticabal - SP. Canalizou-se a aorta torácica, injetou-se solução de neoprene látex corada e fixou- se com formol a 10%. Como média, encontrou-se, respectivamente, para comprimento e largura, para o lobo direito 15,45 mm e 15,16 mm, para o lobo esquerdo 18,61 mm e 16,14 mm e para o istmo 11,52 mm e 5,91 mm. O lobo direito encontra-se em nível do 2o anel traqueal (80,00%), 3o (10,00%), 4o (6,67%), 6o (3,33%), o lobo esquerdo encontra-se em nível do 2o anel traqueal (66,67%), 3o (20,00%), 4o (3,33%), 5o (10,00%). O lobo direito recebe as artérias tireóideas cranial e caudal em 73,34% dos casos e somente a artéria tireóidea cranial em 26,66%. O lobo esquerdo recebe as artérias tireóideas cranial e caudal em 60,00% dos casos e somente a artéria tireóide cranial em 40,00%. A artéria tireóidea cranial direita emitiu ramos que variaram entre 1 e 12 ramos, tendo como maior frequência de 3 em 30,00% das amostras, para a esquerda este número variou entre 2 e 9 ramos, tendo como maior freqüência de 3 em 36,67% dos casos. Ainda encontrou-se que a artéria tireóidea cranial pode ser dupla em 3,33% das peças, tanto para o antímero direito quanto para o antímero esquerdo, porém em peças diferentes. A artéria tireóidea caudal direita emitiu vasos que variaram de 2 a 5 ramos, tendo como maior frequência de 2 em 30,00% das amostras, para a esquerda este número variou de 2 a 6 ramos, tendo como maior freqüência de 2 em 23,34% dos casos. Encontrou-se que a artéria tireóidea caudal direita pode ser dupla em 6,66% das peças, e a esquerda em 3,33% dos casos estudados. A forma da glândula tireóide variou de ovalada a triangular, tendo a forma ovalada ocorrido em 90,00% dos casos, em ambos os antímeros The aim of this study was to analyze some morphometric, morphologic and topographic parameters of the arterial blood supply for the thyroid gland in 30 bovine fetuses (Bos taurus taurus), 15 male and 15 female, coming from Novilho do Valle Slaughterhouse, Jaboticabal, SP, Brazil. The thoracic aorta was canulated, latex neoprene colored solution was injected and specimens were fixed in a 10% formol solution. It was found that the mean length and width were, respectively, 15.45 mm and 15.16 mm for the right side, 18.61 mm and 16.14 mm for the left side, and 11.52 mm and 5.91 mm for the isthmus. The right side was found at level of the 2nd (80%), 3rd (10%), 4th (6.67%) or 6th (3.33%) traqueal rings. The left side was found at level of the 2nd (66.67%), 3rd (20%), 4th (3.33%) or 5th (10%) traqueal rings. The right side received the cranial and caudal thyroidea arteries in 73.34% of cases and only the cranial thyroidea artery in 26.66% of cases. The left side received the cranial and caudal thyroidea arteries in 60% of cases and only the cranial thyroidea artery in 40% of cases. The right cranial thyroidea artery gave off branches ranging from 1 to 12 twigs, with the highest frequency (3 branches) in 30% of the samples. For the left side, the range was from 2 to 9 branches, with the highest frequency (3 branches) in 36.67% of the cases. It was also found that the cranial thyroidea artery was double in 3.33% of the cases, in both the right and left sides, even so in different specimens. The caudal thyroidea artery gave off branches ranging from 2 to 5 twigs, with the highest frequency (2 branches) in 30% of the samples. For the left side, the range was from 2 to 6 branches, with the highest frequency (2 branches) in 23.34% of the cases. It was also found that the right caudal thyroidea artery was double in 6.66% of the cases while the left one was double in 3.33% of the studied specimens. Morphologically, the thyroid gland ranged from oval to the triangular shape, with the highest frequency (90% of the cases) in oval shape on both sides Dissertação (Mestrado)

The review of national and foreign literature sources presents information on arterial blood supply of the umbilical region in newborns having relevant practical significance due to the development of new surgical approaches in that part of the anterior abdominal wall. Scientific data on the course and location of arteries participating in the blood supply of the umbilical region are summarized. Particular attention is devoted to the description of superficial, superior and inferior epigastric arteries and umbilical arteries. The issues of intervascular connections between the named arteries and other blood vessels are discussed including information on various anastomosis variations and their extent. Various existing viewpoints regarding the location and depth of anastomoses between the vessels essential for blood supply of the umbilical region are presented as well as the layers, through which the main arteries pass, and the character and level of their branching. Features of arterial blood supply of the umbilical region in newborns are also noted. The paper contains data on the role of umbilical arteries in the umbilical region supply in children of that age. It is demonstrated that blood supply of the umbilical region in newborns still poses issues that are insufficiently researched and solved, such as assessing functional capacity of the umbilical arteries, revealing histotopographic peculiarities in the location of blood vessels within the layers and various segments of the umbilical region, topographic and anatomic identification of the segments that are most and least supplied with arterial vessels in that part of the abdominal wall.

Background : The thyroid is a brownish red, earliest endocrine gland in mammals. The blood flow to the thyroid gland is very high. The thyroid derives its arterial blood supply from three vessels; of these, the superior and inferior thyroid arteries are fairly constant. The third artery, the thyroidea ima, is an inconstant vessel. Diseases of thyroid may need surgical intervention.This study aims to find out the presence of the arteria thyroidea ima and its origin in Bangladeshi people. Objective : The present study was carried out on considering the day-to-day growing clinical importance, and insufficient morphological data and arterial supply by thyroidea ima artery of thyroid gland and possible geographical variations in Bangladeshi people. This study will also help in minimizing complications of thyroid surgery and tracheostomy. Materials and Methods : This descriptive crosssectional study was carried out on 54 postmortem human thyroid glands collected from individuals aged 5 to 65 years. Thyroid glands were collected from unclaimed dead bodies autopsied in the morgue of Sylhet M. A. G. Osmani Medical College, Sylhet. The collected specimens were examined by careful gross dissection method. Results : Thyroidea ima artery was present in 3.70% cases, which originated equally from brachiocephalic trunk and arch of aorta. Conclusion : Presence of this artery must be searched out during thyroid surgery and tracheostomy. J Enam Med Col 2018; 8(1): 25-28

Relevance. The issue of degenerative-dystrophic lesions of the hip and knee joints is becoming urgent in Ukraine. To date, in order to visualize degenerative-dystrophic and infectious-inflammatory lesions in the treatment and diagnostic process, the three-phase bone scintigraphy method is actively used, with the help of which it is possible to obtain a quantitative characteristic of metabolic changes and the morphological status of the organism. Objective. To determine the specific radionuclide parameters of three-phase bone scintigraphy for optimizing the prediction of paraendoprosthetic complications in pathological lesions of hip and knee joints of different genesis. Material and methods. The retrospective analysis of 455 patients with diseases of hip and knee joints of various genesis (including 274 women and 181 men), aged from 17 to 85 years, was conducted in the work. All patients underwent three-phase bone scintigraphy according to the standard protocol. Results. In the early static phase of bone scintigraphy, a gradual increase in the percentage of inclusion and distribution of radiopharmaceutical in degenerative-dystrophic and infectious-inflammatory foci is observed. The increase in accumulation of the indicator in the delayed static phase in the infectious-inflammatory foci of deforming osteoarthrosis is caused by an increase in the intensity of blood flow in the angiographic phase, which indicated the intensification of the arterial blood supply of such foci, due to active inflammation, exposure to an infectious agent or increased osteoblastic activity. Conclusion. The determination of the kinetic parameters of bone scintigraphy and the application of the radionuclide model of «dual time point imaging» contribute to the early detection of paraendoprosthetic complications in the postoperative period, the reduction of the number of revision procedures and the reduction in the duration of rehabilitation and recovery measures after endoprosthetics.

The blood supply pattern of the partial-thickness musculomucosal pedicle flaps is different from the traditional Abbe flap. The arterial blood supply and venous drainage are highly reliable during clinical practice.To describe the reconstruction of the philtrum in the cross-lip flap transfer using nasolabial muscle tension line group reconstruction.From January 1, 2014, through June 31, 2015, a total of 6 patients with upper lip defect were treated with philtrum reconstruction in the same stage of the split cross-lip flap transfer at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. These patients underwent reconstruction of the philtrum by nasolabial muscle tension line group reconstruction. The patients were compared with a randomly chosen group of 5 individuals without upper lip defects by measuring the 3-dimensional scans.In the patient group, the split flap was elevated from the posterior portion of the oris orbicularis muscle after the inferior labial arteries were divided. Then the partial-thickness flap was rotated 180° horizontally and inverted 180° upward to the upper lip defect. The philtrum was reconstructed using the nasolabial muscle tension line group reconstruction.Three-dimensional scans were performed from the 2-month to 28-month revisits.A total of 11 individuals were included in the study: 6 in the patient group (mean [SD] age, 17.0 [4.8] years; 2 [33.3%] female and 4 [66.7%] male) and 5 in the control group (mean [SD] age, 15.2 [6.0] years; 2 [40.0%] female and 3 [60.0%] male). In the patient group, 5 of 6 musculomucosal pedicle flaps were viable. A stable philtrum with philtral ridge and philtral dimple was reconstructed on the 5 flaps. The shape of the philtrum was natural according to the 3-dimensional scan measurement. One flap partially necrosed, and the scar retraction was severe postoperatively.The blood supply of the partial-thickness cross-lip flap was from the small vascular network of the lower lip. It is reliable to reconstruct a philtrum in this stage of flap transfer. A complete philtrum structure can be reconstructed by applying muscle tension on the flap.4.

Animal models are used to examine the results of experimental spinal cord injury. Alterations in spinal cord blood supply caused by complex spinal cord injuries contribute significantly to the diversity and severity of the spinal cord damage, particularly ischemic changes. However, the literature has not completely clarified our knowledge of anatomy of the complex three-dimensional arterial system of the spinal cord in experimental animals, which can impede the translation of experimental results to human clinical applications. As the literary sources dealing with the spinal cord arterial blood supply in experimental animals are limited and scattered, the authors performed a review of the anatomy of the arterial blood supply to the spinal cord in several experimental animals, including pigs, dogs, cats, rabbits, guinea pigs, rats, and mice and created a coherent format discussing the interspecies differences. This provides researchers with a valuable tool for the selection of the most suitable animal model for their experiments in the study of spinal cord ischemia and provides clinicians with a basis for the appropriate translation of research work to their clinical applications. Anat Rec, 300:2091-2106, 2017. © 2017 Wiley Periodicals, Inc.

A rare combination of variations in the arterial supply of the liver and gallbladder was encountered in a male cadaver. The simultaneous occurrence of an accessory left hepatic artery and an accessory right hepatic artery from which double cystic arteries arose (one of which was low-lying). This combination has not yet been reported. The accessory left hepatic artery originated from the left gastric artery. The accessory right hepatic artery originated from the superior mesenteric artery. Such arterial variations are caused by differences in embryological development. This, however, may lead to complications related to diagnostic and therapeutic procedures in the upper abdomen.

The risk of ischemia of segment IV after split liver resection is high. This anatomical study was done to identify the arterial blood supply and the intrahepatic distribution of liver segment IV. The anatomy of segment IV was studied in 29 livers from adult cadavers. To identify the arterial blood supply of segment IV, water and ink were injected into the various branches of the hepatic artery and the outflow through segment IV and discoloration of the liver parenchyma were observed. In 23 of the 29 livers (79.3%), the arterial perfusion of segment IV was separated by a line drawn from the left side of the inferior vena cava at the top of and lateral to the falciform ligament to the medial point of the gallbladder bed. The area lateral to this line was supplied mainly by the right hepatic artery, and the area medial to it was supplied mainly by the left hepatic artery. In addition to the classification system of Couinaud, we describe here a new division of liver segment IV based on arterial blood supply. These anatomical findings may be useful in defining the resection line for split liver to prevent necrosis of segment IV., This anatomical study describes in detail the arterial blood supply of segment IV arising from the right hepatic artery and left hepatic artery with a demarcation line in between, and discusses possible surgical consequences.

Purpose During the last decades, it has been established that there are numerous individual anatomical variations of the arterial blood supply in human liver. In the present study, we examined the liver vascularization of an intrahepatic cholangiocarcinoma patient. Methods For surgical planning, an enhanced CT scan was performed and a three-dimensional model of liver vascularization constructed. Results The patient was diagnosed as a Michel’s type VII hepatic artery variation. An accessory right hepatic artery arose from the superior mesenteric artery and had distributed into the right anterior liver to provide the blood supply of segments V and VIII, which was more medial than the territory of the right hepatic artery coming from the proper hepatic artery. At the same time, an accessory left hepatic artery originated from the left gastric artery. Conclusion We present a case in which an accessory right hepatic artery provided a territory more medial than a right hepatic artery coming from the proper right artery.

Jehovah's Witness patients have unique perioperative challenges involving blood products. We describe the use of a novel method to maintain a closed circuit between a Jehovah's Witness patient's arterial blood and the epidural space while performing a blood patch for postdural puncture headache. Previously described methods have utilized venous catheters to maintain a closed circuit between the body and the epidural space. This is the first report we are aware of that utilizes a closed-circuit arterial blood supply to create an epidural blood patch in a Jehovah's Witness patient.

Atherosclerosis, a disease affecting the large- and medium-sized vessels, is present in every human being. Atherosclerotic plaques can directly or indirectly cause obstruction of the arterial blood supply, causing ischemic damage distal from the occlusion.

Purpose How much do anatomical and histological texts inform medical students about the arterial supply to the skin? What is a good method in a system-based curriculum to highlight the importance of blood supply to the skin? Basic procedures Anatomical and histological texts were sourced for the following keywords: skin graft, skin flap, septocutaneous vessel, musculocutaneous vessel, perforator, angiosome, perforasome, sural artery, saphenous artery, gastrocnemial artery. From the skin flaps available for functional and cosmetic reconstructive surgery three were chosen as a good example of blood supply to muscle/bone and overlying skin to be illustrative to medical students. Findings Only few anatomical texts mention blood supply of the skin in some detail. Non demonstrate and link angiosomes to reconstructive surgical procedures. There are 3 skin flaps which are easy to dissect to demonstrate medical students the origin of the blood supply to the muscle (and bone) and the overlying tissues (skin). Pictures of these flaps show ease of procuring and detail for demonstration. Conclusions Anatomical and histological texts have not incorporated published research findings from basic science investigators and clinicians about angiosomes. Through the use of prosections of three skin grafts the medical student can appreciate the blood supply to the skin and understand the underlying principle in reconstructive surgery.

Background: Association between pulmonary sequestration and diaphragmatic hernia is well known. Extralobar sequestrations are masses of the non-functioning lung, surrounded by separate pleura, without bronchial communication, and with a systemic arterial blood supply. They may be placed in the thorax, within the diaphragm, or rarely in a sub-diaphragmatic position. Case Series: We present three cases of extra-lobar extra-thoracic pulmonary sequestrations associated with different types of diaphragmatic defects. In none of the three cases, the diaphragmatic defect was detected prenatally. Conclusion: Pulmonary sequestration may be involved in the embryological origin of the diaphragmatic defect. Simultaneously, it acts as an anatomical barrier and prevents the herniation of the abdominal content into the thorax. If extralobar pulmonary sequestration is diagnosed prenatally, a coexistent diaphragmatic hernia should always be considered.

PURPOSE We aimed to evaluate the therapeutic effect and safety of transarterial embolization using bleomycin-iodinated oil and polyvinyl alcohol particles for the treatment of symptomatic hepatic focal nodular hyperplasia (FNH). METHODS This retrospective study included 23 consecutive patients with symptomatic hepatic FNH, who underwent embolization using bleomycin-iodinated oil and polyvinyl alcohol particles between January 2005 and December 2012. Patients were followed-up with radiologic and clinical evaluation. Therapeutic effects including changes in lesion size and symptomatic improvement were evaluated after the procedure. RESULTS Embolization was performed for 27 lesions in 23 patients. Follow-up period ranged from three months to 89 months. The mean lesion diameters decreased significantly from 5.0±2.4 cm to 3.2±1.5 cm at 3-9 months after embolization (P < 0.001). Five lesions had complete resolution in the follow-up period. The clinical symptoms were significantly relieved in all patients. Contrast-enhanced scans at follow-up showed complete lack of residual arterial blood supply in the majority of lesions. Local recurrence was found in one treated lesion at the 54-month follow-up. There were no major complications associated with the procedure. CONCLUSION Transarterial embolization using bleomycin-iodinated oil and polyvinyl alcohol particles for hepatic FNH is a safe and effective alternative treatment with good long-term symptomatic control and reduction in lesion size after embolization.

The present study aimed to show the arterial blood supply of the udder of the Egyptian native breed of goat (Baladi goat) to be used as a guide during mastectomy and other surgical interferences. The study was carried out on the udder of twelve apparently healthy adult female Egyptian Baladi goats. Four goats were used for mastectomy, one specimen was used for radiography and the other specimens were subjected to gum-milk latex injection to clarify the origin, course and distribution of the main arteries supplying the udder. The results revealed that the udder of goat was supplied by the external pudendal artery and dorsal labial and mammary branch of the ventral perineal artery. The course of the external pudendal artery through the inguinal canal before reaching the base of the udder, as well as that of the dorsal labial and mammary branch of the ventral perineal artery in the perineal region, were briefly described to determine the appropriate site for ligation of these vessels before mastectomy. Moreover, the arterial interconnection between the two halves of the udder was emphasized to be highlighted during unilateral mastectomy. Vascular ligation of the main blood vessels supplying the udder on the basis of the anatomical description provided less traumatic surgery and reduced the severity of the blood loss.

Conventional angiography is still considered the gold standard for the study of the anatomy and of vascular diseases of the abdomen. However, the advent of multidetector computed tomography and techniques of digital image reconstruction has provided an alternative means of performing angiography, without the risks inherent to invasive angiographic examinations. Therefore, within the field of radiology, there is an ever-increasing demand for deeper knowledge of the anatomy of the regional vasculature and its variations. Variations in the renal vascular system are relatively prevalent in the venous and arterial vessels. For various conditions in which surgical planning is crucial to the success of the procedure, knowledge of this topic is important. The aim of this study was to familiarize the general radiologist with variations in the renal vascular system. To that end, we prepared a pictorial essay comprising multidetector computed tomography images obtained in a series of cases. We show patterns representative of the most common anatomical variations in the arterial blood supply to the kidneys, calling attention to the nomenclature, as well as to the clinical and surgical implications of such variations.A angiografia convencional ainda é considerada o exame padrão ouro no estudo da anatomia e das doenças vasculares do abdome. Entretanto, com o advento da tomografia computadorizada com multidetectores e técnicas de reconstrução de imagens digitais, este exame tem-se tornado uma opção, com a vantagem de não ter os riscos habituais dos exames angiográficos invasivos. Com isso, o aprofundamento do conhecimento dos detalhes anatômicos da vasculatura regional e suas variações é cada vez mais exigido nesta área da radiologia. As variações do sistema vascular renal são relativamente prevalentes, tanto no leito venoso quanto no arterial. O conhecimento do tema é de importância nas várias condições em que o prévio planejamento cirúrgico é crucial para o sucesso do procedimento. Para familiarizar o radiologista geral, enriquecendo sua experiência sobre o tópico, os autores elaboraram um ensaio iconográfico a partir de uma série de casos extraídos do banco de imagens de tomografia computadorizada com multidetectores da região abdominal, com os padrões representativos das mais frequentes variações anatômicas da irrigação arterial renal, chamando a atenção para sua designação terminológica e para suas implicações clinicocirúrgicas.

A promising strategy for liver cancer treatment is to deliver chemotherapeutic agents with multifunctional carriers into the tumor tissue via intra-arterial (IA) transcatheter infusion. These carriers should release drugs within the target tissue for prolonged periods and permit intra-procedural multi-modal imaging of selective tumor delivery. This targeted transcatheter delivery approach is enabled via the arterial blood supply to liver tumors and utilized in current clinical practice which is called chemoembolization or radioembolization. During our study, we developed Doxorubicin (Dox) loaded porous magnetic nano-clusters (Dox-pMNCs). The porous structure and carboxylic groups on the MNCs achieved high-drug loading efficiency and sustained drug release, along with magnetic properties resulting in high MRI T2-weighted image contrast. Dox-pMNC within iodinated oil, Dox-pMNCs, and Dox within iodinated oil were infused via hepatic arteries to target liver tumors in a rabbit model. MRI and histological evaluations revealed that the long-term drug release and retention of Dox-pMNCs within iodinated oil induced significantly enhanced liver cancer cell death.

Endoscopic sphenopalatine artery ligation has become the standard surgical therapy for posterior epistaxis refractory to nasal packing. A thorough understanding of the arterial blood supply to the nasal cavity is necessary for optimal surgical results. The crista ethmoidalis is the key landmark for identification of the sphenopalatine foramen. The sphenopalatine artery branches may be controlled with hemoclips, bipolar cautery, or both. Recent cost-benefit and cost-utility analyses have suggested endoscopic sphenopalatine artery ligation may be considered earlier in the epistaxis treatment algorithm.

Hepatocellular carcinoma (HCC) is dominantly supplied by arterial blood flow, whereas the normal underlying liver parenchyma is supplied by both the portal vein (75%) and hepatic artery (25%). This distinction in blood supply of tumor tissue relative to liver tissue led to the exploration of targeting the arterial blood supply as a means of therapeutic intervention. This chapter overviews the evolution of transarterial therapies for HCC from the initial attempts of hepatic artery ligation/infusion to the current standard care treatments, including variants of transarterial chemoembolization and radioembolization. Emerging therapeutic approaches, including biologic and biomimetic injection, are discussed as potential future strategies with improved tumor targeting and specificity for the treatment of HCC.

Purpose Our aim is to present a rare case of anatomic variation of the arterial blood supply to the liver because preoperative knowledge of hepatic vascular variations is mandatory in hepatic surgery and liver transplantation. Methods We present a case of unusual arterial blood supply to the liver, a right hepatic artery coming from the splenic artery, associated to a classical common hepatic artery and a left hepatic artery from the left gastric artery. Preoperative diagnosis was made using CT-scan and 3D reconstruction. Results The right hepatic artery was found behind the portal vein and its diameter showed its importance in the vascularisation of the liver. To our knowledge this type of variation has only twice been described before. The accuracy of the 3D reconstruction allowed us to adopt the best surgical strategy to avoid lesions of the two accessory arteries which proved important sources of blood supply. Conclusions Precise preoperative evaluation of liver blood supply has great importance on surgical, transplantation strategy and outcome and rare anatomic variations have to be known to avoid lesions of potentially important arteries. New techniques of 3D reconstruction can ease the preoperative recognition of such difficult anatomic variations.

Endovascular techniques can now access the arterial blood supply of the pancreas in humans to enable therapeutics to reach the gland in high concentrations while concurrently avoiding issues related to non-targeted delivery. However, there is no way to replicate this in small animals. In a rat model, we therefore developed a novel non-terminal technique to deliver therapeutics to different regions of the pancreas, via its arterial blood supply.In female Wistar rats, selective branches of the celiac artery were temporarily ligated, depending on the region of the pancreas being targeted. Trypan blue dye was then administered as a surrogate marker for a therapeutic agent, via the celiac artery, and its staining/distribution throughout the pancreas determined. Postoperatively, animals were monitored daily, and serum was evaluated for markers of pancreatitis, liver, and metabolic function.Using this technique, we could selectively target the head, body/tail, or entire gland of the pancreas, via its arterial blood supply, with minimal nontarget staining. Following the procedure, all animals recovered with no evidence of pancreatitis or liver/metabolic dysfunction.Our study demonstrates a novel technique that can be used to selectively deliver therapeutics directly to the rat pancreas in a safe manner with full recovery of the animal.

Diagnosis and staging of duodenal gastrointestinal stromal tumors (GISTs) by noninvasive imaging is critical for effective treatment, but the imaging features of duodenal GISTs remain largely undefined because of their rarity. The purpose of this article was to characterize duodenal GISTs using CT.Thirty-four patients with duodenal GISTs were analyzed by clinical symptom evaluation, pathologic examination, and CT in this retrospective study. Unenhanced and contrast-enhanced examinations were performed in all patients. Imaging characteristics, including the lesion location, size, growth pattern, ulceration, internal components, arterial blood supply, intratumoral arterioportal shunting, intratumoral vessels, rim enhancement, and enhancement patterns were reviewed.The duodenal GISTs were solitary masses with well-defined margins. The average diameter was 7.1 cm. The second portion was the most common site (20/34). Ulceration was a common feature (15/34). Calcification was uncommon (3/34), and mixed growth pattern was more common (26/34). Rim enhancement (24/34) and mixed enhancement pattern (15/34) were common. Arterial blood supply, intratumoral vasculature, and draining veins were all detected and were obvious on the arterial phase. The portal venous trunk and superior mesenteric vein were the main veins into which early arterioportal shunting drained.Primary duodenal GISTs are generally large, well-defined, heterogeneously enhancing, and hypervascular masses with a prominent mixed growth pattern on CT images. Our findings suggest that CT can help depict the origin of the tumoral arteries and draining veins on the arterial phase and may be a key defining diagnostic feature for duodenal GISTs.

The aim of this study was to describe the arterial arrangement of the cervical spinal cord in hare. The study was carried out on 20 adult European hares. Ten hares were used in the corrosion technique and ten hares in the dissection technique. After the killing, the vascular network was perfused with saline. Batson’s corrosion casting kit no. 17 © was used as a casting medium. After polymerisation of the medium, in ten hares the maceration was carried out in KOH solution, and in ten other hares formaldehyde was injected by the dissection technique into the vertebral canal. We found high variability in blood supply of the cervical spinal cord. The origin of the ventral spinal artery from the right vertebral artery was found on average in 65 % of the cases and from the anastomosis of two ventral spinal arteries was found on average in 35% of the cases. The presence of ventral branches of spinal branches entering the ventral spinal artery in the cervical region was observed in 37.9% of the cases on the right side and in 62.1% of the cases on the left side. The presence of dorsal branches of spinal branches was observed in 66.2% of the cases on the left side and in 33.8% of the cases on the right side.

Intralobar pulmonary sequestration is a rare congenital malformation characterized by the presence of nonfunctional parenchymal lung tissue, receiving systemic arterial blood supply and lacking normal communication with tracheobronchial tree. Recurrent pneumonia and massive hemoptysis are life threatening complications associated with it. Delay in the diagnosis and management can be fatal. We report here a case of intralobar pulmonary sequestration in a 18 year old female who presented with recurrent severe episodes of pneumonia and hemoptysis forcing her to drop out of school. The diagnosis was confirmed by CECT Thorax and CT Angiography. The patient was managed by minimally invasive endovascular treatment in the form of feeding artery embolization. She made a full recovery with satisfactory outcome. On subsequent follow up, there was no recurrence of symptoms and she is doing well socially and academically. The aim of this case report is to show feasibility and safety of embolization as a less-invasive management option for adult pulmonary sequestration complicated with hemoptysis and LRTIs and emphasize the importance of such minimally invasive technique to enhance the quality of life in such patients.

Pedicle flaps based on the external maxillary (facial) artery were introduced during the World War I, precisely a century ago. Today they remain effective tools in facial soft-tissue repair. Recently, pedicle flaps based on the internal maxillary (sphenopalatine) artery have been chosen to reliably close dural defects after endoscopic skull-base surgery. Pedicle flaps, “biologic” to the extent they are based on a defined arterial blood supply, are the lasting contributions—the diuturnity”of Johannes (“Jan”) Fredericus Samuel Esser (1877–1946) of Leiden, Holland, and Chicago (IL).

Background Biliary complications are important during liver transplantation because of their effect on recipient and graft survival, incidence, and the long treatment period. These complications are associated with 50% morbidity and 30% mortality rates in recent studies. One of the most important reasons for biliary anastomosis complications is arterial ischemia. We present the results of our telescopic biliary anastomosis technique performed on the mucosa of the main biliary duct. Patients and Methods Fifty-six cases of telescopic biliary reconstruction were performed in 203 patients during 2015. Fifty cases and 52 patients who underwent standard reconstruction were chosen and compared. All patients had been scanned retrospectively. Statistical analyses were conducted with χ2 and Mann-Whitney U tests for the complications that occurred during the first 3 months. A P value Results No clinical or demographic differences were detected between the groups. About 90% of both groups were living donor liver transplantation cases. Five (10%) anastomotic leaks occurred in telescopic reconstruction group (n = 50), and 13 (25%) occurred in the standard reconstruction group (n = 52; P Conclusion The arterial blood supply is better if the biliary anastomosis is made on the mucosal side of the main biliary duct. Early period anastomotic leaks may decrease significantly.

Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related deaths worldwide with rapidly growing incidence rates in the USA and Europe. Despite improving surveillance programs, most patients are diagnosed at intermediate to advanced stages and are no longer amenable to curative therapies, such as ablation, surgical resection and liver transplantation. For such patients, catheter-based image-guided embolotherapies such as transarterial chemoembolization (TACE) represent the standard of care and mainstay therapy, as recommended and endorsed by a variety of national guidelines and staging systems. The main benefit of these therapies is explained by the preferentially arterial blood supply of liver tumors, which allows to deliver the anticancer therapy directly to the tumor-feeding artery while sparing the healthy hepatic tissue mainly supplied by the portal vein. The tool box of an interventional oncologist contains several different variants of transarterial treatment modalities. Ever since the first TACE more than 30 years ago, these techniques have been progressively refined, both with respect to drug delivery materials and with respect to angiographic micro-catheter and image-guidance technology, thus substantially improving therapeutic outcomes of HCC. This review will summarize the fundamental principles, technical and clinical data on the application of different embolotherapies, such as bland transarterial embolization, Lipiodol-based conventional transarterial chemoembolization as well as TACE with drug-eluting beads (DEB-TACE). Clinical data on 90Yttrium radioembolization as an emerging alternative, mostly applied for niche indications such as HCC with portal vein invasion, will be discussed. Furthermore, we will summarize the principle of HCC staging, patient allocation and response assessment in the setting of HCC embolotherapy. In addition, we will evaluate the role of cone-beam computed tomography as a novel intra-procedural image-guidance technology. Finally, this review will touch on new technical developments such as radiopaque, imageable DEBs and the rationale and role of combined systemic and locoregional therapies, mostly in combination with Sorafenib.

// Juxian Sun 1, * , Jie Shi 1, * , Bin Huang 2, * , Fantian Cheng 1, 3 , Weixing Guo 1 , Wan Yee Lau 1, 4 and Shuqun Cheng 1 1 Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China 2 Department of Imaging, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China 3 Department of Hepatopancreatobiliary Surgery I, The Central Hospital of Wuhan, Tongji Medical University of Science and Technology, Wuhan, China 4 Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China * These authors contributed equally to this work Correspondence to: Shuqun Cheng, email: chengshuqun@aliyun.com Keywords: blood supply, portal vein tumor thrombus, hepatocellular carcinoma, TACE Received: February 08, 2017 Accepted: June 29, 2017 Published: August 01, 2017 ABSTRACT Purpose: To investigate the degree of arterial blood supply of portal vein tumor thrombus (PVTT) in patients with hepatocellular carcinoma (HCC), and to evaluate its impact on overall survival after transarterial chemoembolization using lipiodol +/– gelatin sponge particles (TACE). Results: Of the 10 patients who underwent surgery, the number of patients with good/mild/poor staining of PVTT by methylene blue were 3, 4, and 3, respectively. The degrees of methylene blue staining in these patients correlated well with the degrees of accumulation of lipiodol in PVTT in these patients, i.e. good/mild/poor in 3, 4, and 3 patients, respectively. For the 77 patients who underwent TACE as treatment, they were divided into 2 groups: good accumulation of lipiodol ( n = 27) and mild/poor accumulation of lipiodol ( n = 50) on CT. The overall median survival between the 2 groups was 10.0 months vs 2.7 months, ( p < 0.001). Multi-variable analysis showed degree accumulation of Lipiodol (OR, 2.057; 95% CI,1.414–2.993; p < 0.001) to be an independent prognostic factor. Patients and Methods: Patients with HCC with PVTT who underwent surgical resection received preoperative TACE. At operation, arterial injection of methylene blue into the common hepatic artery was carried out. During the study period, other patients with unresectable HCC with PVTT were treated with TACE. Conclusion: In about 1/3 of patients with HCC with PVTT, the arterial blood supply from the hepatic artery to the PVTT was good. These patients responded better to TACE than those patients with mild/poor arterial supply.

Aim: optimization of the surgical treatment policy with orthotopic liver transplantation (OLT) depending on the results of intraoperative fl owmetry and the state of intrahepatic microcirculatory bloodstream according to immunohistochemical (IHC) study of microspecimens of the donor’s liver. Materials and methods . 60 patients are included in the study. Group I (n = 30) comprised of patients for whom it was not necessary to perform any additional interventions on the bloodstream in the hepatopancreatobiliary area during OLT. Group II (n = 30) had patients with insuffi cient arterial blood supply for the graft in the intraoperative stage where it was needed to perform additional and/or repeated interventions in the arteries of the hepatopancreatobilliary area. Intraoperative fl owmetry with assessment of the volume blood circulation (VBC) in the hepatic artery (HA) was carried out in the both studied groups. Reference value of VBC was 100 ml/min and higher. Before and after reperfusion in the liver biopsy material we performed immunohistochemical study with the use of endothelial marker CD 31 with subsequent morphometric estimation of the specifi c square of the microvascular bloodstream. Results . In both groups there was no change in the specifi c square in the areas of portal tract and central vein before and after restoring blood fl ow. In the second group, an 8 times increase of the specifi c square of sinusoids was observed after restoring blood fl ow (р < 0,01). Conclusion . Intraoperative fl owmetric control of the blood fl ow allows in due time to perform surgical correction of the graft arterial blood supply during OLT, and it reduces the risk of thrombosis up to 0%. The value of VBC in the hepatic artery (HA) has reliable dependence upon the state of microcirculatory bloodstream of cadaveric donor’s liver after reperfusion.

Normal breast anatomy can be seen on a variety of imaging modalities. Knowledge of normal breast anatomy on imaging examinations is important for an interventionalist, primarily to avoid mistaking normal anatomy for a pathologic disorder, so as not to harm a patient with an unnecessary intervention. Knowledge of breast anatomy is also critical in planning safe breast interventions and unwanted procedural complications. The key anatomical structures in the breast include skin, fat, fascial layers, Cooper ligaments, fibroglandular tissue, lymphatics, and neurovascular structures, all positioned over the chest wall. In men, the breast parenchyma is usually only composed of fat, with absence of fibroglandular tissue. In women, fibroglandular tissue volumes vary with age, with many women having a predominance of fat within the breasts after menopause. Embryologically, the breast develops under genetic and hormonal influence from skin precursor cells during the fourth through twelfth weeks of gestation, and the resulting breast bud continues to lengthen and branch throughout the remainder of gestation, forming a complex network of radially arranged breast ducts that connect the nipple with the mammary lobules. The key arterial blood supply to the breast arises from the internal thoracic artery, but additional arterial blood supply is seen from intercostal and lateral thoracic arteries. The venous anatomy and lymphatic drainage of the breast generally parallels the arterial anatomy, with presence of variation in communicating channels between deep and superficial venous and lymphatic channels. Tools that assess breast vascular structures (eg, contrast-enhanced breast magnetic resonance imaging) and lymphatic structures (nuclear medicine lymphoscintigraphy) are routinely used to assess extent of breast disease and help guide breast interventions.

Objective: To demonstrate the efficacy of the ulcer piercing procedure, which allows constant cleansing of the ulcer and facilitates a positive pressure irrigation of any pierced hidden tracts, in order to reduce the negative impact of stasis on wound healing. Method: We designed a surgical procedure of ulcer piercing and drainage with a silastic tube, which allows positive pressure irrigation of any pierced tracts. This procedure was performed in a continuous series of 25 selected diabetic patients affected by a Wagner stage 3 ulcer of the toe (n=16), metatarsal midfoot (n=5) and plantar Charcot foot (n=4), and with adequate foot arterial blood supply. Results: Within 6 months of the ulcer piercing procedure, 23/25 of ulcers had completely healed. In two further cases, the ulcer piercing ring was still in place after 3 and 5 months, progressively healing with no active signs of infection. Conclusion: Taking into consideration the advantages and the lack of side effects afforded by this procedure, ulcer piercing represents a small but effective step towards an easier and safer approach to treating complicated diabetic neuropathic foot ulcers with adequate arterial blood supply. Declaration of interest: There were no external sources of funding for this study. The author has no conflicts of interest to declare with regard to the manuscript or its content.

This study aimed to report the case of a patient diagnosed with pulmonary sequestration accompanied by an intermittent haematemesis as the initial and life-threatening symptom. Emergent surgical intervention finally confirmed a rare direct fistula formation between the arterial blood supply of pulmonary sequestration and the oesophagus, which led to intermittent upper gastrointestinal haemorrhage. To our knowledge, this is the first case reported with this kind of fistula formation.

Background: The most common renal fusion anomaly is horseshoe kidney (HSK), a condition associated with variable arterial blood supply. The aim of this study was to determine whether the height of origin of the renal artery determines its diameter and whether it differs from the mean diameter of the renal arteries of normal kidneys (NK). Methods: Computer tomography angiography (CTA) studies of 336 patients (88 HSK and 248 NK) were obtained in a search of renal arteries, these were than classified into four groups according to height of its origin: Group I, branching from the aorta superior to the inferior mesenteric artery (IMA), Group II, branching from the aorta below the IMA, Group III, branching from the iliac artery, and Group IV, originating from the internal and external iliac artery. Results: The HSK group included 398 arteries (mean diameter 4.30 mm) and the NK group 598 (5.52 mm) (p &lt, 0.0001). In the HSK group, the mean diameters according to groups were: Group I, 4.54 mm, Group II, 4.28 mm, Group III, 3.41 mm, and Group IV, 3.43 mm. Statistically significant differences were found between arteries originating from the aorta and arteries branching from the iliac arteries (p &lt, 0.0001). In the NK group, the corresponding values were: Group I, 5.53 mm, and Group II, 4.45 mm. The number of arteries supplying the HSK wider than 3.0 mm were: Group I, 83.0%, Group II, 82.4%, Group III, 68.4%, and Group IV, 66.6%. Conclusions: The renal arteries of the HSK branch from their parental vessels at lower levels and have smaller diameters than those of NK.

We report a case of successful right hepatectomy plus pancreatoduodenectomy (Rt-HPD) with arterial reconstruction for extrahepatic bile duct carcinoma with obstruction of the celiac axis in a 76-year-old man. Obstruction of the celiac axis resulted in arterial blood supply to the upper abdominal organs coming from the pancreatic head arcade. The patient underwent arterial reconstruction before the Rt-HPD to maintain the blood supply from the pancreatic head arcade for as long as possible. His postoperative course was uneventful and he was well with no sign of recurrence when last seen, 64 months after surgery. To our knowledge, this is the first description of this modified HPD with arterial reconstruction. Thus, rational surgical planning based on careful preoperative assessment would expand the indications for HPD, even for patients with celiac axis obstruction requiring arterial reconstruction.

This article is intended to provide a review of clinically relevant neurovascular anatomy. A solid understanding of the vascular anatomy of the brain and spine are essential for the safe and effective performance of neurointerventional radiology. Key concepts to master include collateral pathways and anastomoses between the external and internal carotid circulation, the Circle of Willis as a route to otherwise inaccessible intracranial vascular distributions, and the origin of spinal arterial blood supply. These concepts will be highlighted using clinical angiographic examples with discussion of relevant embryology and pathology as needed.

Lateral medullary syndrome, also known also as Wallenberg syndrome, remains an interesting clinical entity with varied presentations of cerebrovascular accidents. The area of the brain stem involved is the posterolateral part of the medulla oblongata receiving arterial blood supply from the posterior inferior cerebellar artery. We present a 60-year-old man presenting with unilateral vocal cord palsy due to an unusual central cause, being part of lateral medullary syndrome. We reviewed the neuroanatomy and clinical aspects of this condition. Key words: Lateral medullary syndrome, Wallenberg syndrome, PICA syndrome, Vocal cord palsy.