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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.

The present study was conducted on 16 fresh cats’ hind paws to investigate the anatomical description of the arterial blood supply at the level below the tarsus, which considered as the potential site for intra- operation hemorrhage and thrombus formation. Six cat hind paws with intravascular latex injection, four limbs for surgical approach and three cats used in Duplex ultrasonography technique as a tool for estimating the diameter of the arteries of hind paw of potentially clinical relevant. This work reported that, the hind paw of the cat was supplied by branches from the saphenous A. and the cranial tibial A. Both dorsal and planter aspects of the paw was supplied by superficial and deep sets of arteries; the superficial set consists of the common digital arteries II, III and IV While, the deep set was formed of the metatarsal arteries II, III and IV.

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.

Purpose Several variations of the arterial blood supply of the orbit have been reported over the years. This review is aimed to provide an update focusing on three important issues: (a) variations of the ophthalmic artery origin; (b) contribution of the external carotid artery to the orbital blood supply; (c) orbital hemodynamic. Methods A PubMed and Google search was carried out with the following keywords: ophthalmic artery origin, ophthalmic artery anastomoses and ophthalmic artery anatomy. Results The site of origin of the ophthalmic artery displays a limited number of variations. However they are important as they are also associated with course variations. Anastomoses between the ophthalmic artery and the external carotid artery are numerous and many of them can acquire clinical relevance. Records on their anatomic frequency are limited. Orbital hemodynamic variations are a poorly studied subject. Recent investigations in children have unveiled unexpected variability and instability in the way the blood flows through the orbit. Conclusions The orbit shows several possible arterial variations. Some of them have a profound influence on its hemodynamic at least in children. More studies are required to ascertain if the hemodynamic variability observed in children can be pinpointed also in adults.

The aim of this meta-analysis was to analyze the available literature and provide comprehensive data on the prevalence and variations of the accessory pudendal artery and the 3 types of penile blood supply, including type 1-internal pudendal artery only, type 2-internal pudendal artery and accessory pudendal artery, and type 3-accessory pudendal artery only.We performed an extensive search of the major databases and identified 23 studies in a total of 4,945 patients suitable for inclusion in this meta-analysis. Studies eligible for inclusion included cadaveric, imaging or intraoperative studies. Extracted data were pooled into a meta-analysis with a random effects model using MetaXL, version 5.0 (EpiGear International, Sunrise Beach, Queensland, Australia). The chi-square test and Higgins IOur findings revealed that the most common type was type 1 with a pooled prevalence estimate of 61.9%, followed by types 2 and 3 with a pooled prevalence estimate of 32.8% and 5.4%, respectively. In our analysis of the accessory pudendal artery the vessel was present in 28.5% of patients. When present, unilateral accessory pudendal arteries were most common (pooled prevalence estimate 72.5%) or they were present on the right or the left side (pooled prevalence estimate 48.0% or 52.0%, respectively). They most commonly originated from the obturator artery and the inferior vesical artery (pooled prevalence estimate 48.9% and 29.6%, respectively). The most common type was apical accessory pudendal arteries (pooled prevalence estimate 60.9%).A penile blood supply originating at least in part from an accessory pudendal artery represents more than a third of cases. Based on the anatomical findings when an accessory pudendal artery is present, we advocate attempted preservation of the vessel during radical prostatectomy to best maintain the penile arterial blood supply, especially in patients with type 3 or in older patients with type 2.

The purpose of this study was to assess the efficacy of arterial-dominant phase images of gadolinium–ethoxybenzyl–diethylenetriamine pentaacetic acid (EOB)-enhanced magnetic resonance imaging (MRI) for evaluation of arterial blood supply in hepatocellular carcinoma (HCC) in comparison with that of multiphasic dynamic computed tomography (CT). This study comprised 30 patients (22 men and 8 women, mean age: 68.0 years) with 40 pathologically proven HCCs (well differentiated: 3, moderately differentiated: 30, poorly differentiated: 7, mean diameter: 45.1 mm), all of whom underwent EOB-enhanced MRI and dynamic CT preoperative assessment. Regions of interest were placed over HCCs and the adjacent normal liver, and signal intensities or CT values were measured by two experienced abdominal radiologists on the arterial-dominant phase images of EOB-enhanced MRI and dynamic CT images. HCC-to-liver contrasts [Michelson's contrast: CM=(SHCC− SLiver)/(SHCC+ SLiver)] were calculated and compared among the modalities. HCC-to-liver contrasts were also visually scored on a 5-point scale and compared. The mean CM and visual score for dynamic CT were significantly higher than those for EOB-enhanced MRI. Good agreements were obtained among the two observers. Dynamic CT is a more suitable modality than EOB-enhanced MRI for evaluation of arterial blood supply in HCC. This should be taken into account for diagnosis and management of HCC.

The crab-eating fox (Cerdocyon thous) is a wild canid distributed throughout South America. It is one of the wild canids reported being hit by vehicles and injured in snares, thus inducing trauma or injury to the musculoskeletal system, possibly occurring in the brachial region. The main objective of this research was to provide an anatomic description of the crab-eating fox's intrinsic brachial muscles including shape, origin, insertion, innervation and arterial blood supply, compared with that of the domestic dog. We dissected from superficial to deep two thoracic limbs of seven dead specimens donated to the University of Caldas by CORPOCALDAS. These muscles presented anatomic characteristics similar to those reported in the domestic dog (Canis lupus familiaris) but with a variant in arterial blood supply, allowing us to suggest that surgical procedures that need the knowledge of intrinsic brachial muscles in the crab-eating fox may be homologous to the domestic dog. However, one should consider its variant arterial distribution by part of the collateral radial artery and deep brachial artery to prevent incorrect incisions that may damage these arteries.

A case history is presented of a 12 year old girl with pulmonary arteriovenous fistula. The diagnosis was based on clinical and radiological signs and on physiological evidence for a large arteriovenous shunting of blood in the lungs. As an unexpected other finding, diffusing capacity was markedly decreased. The largest radiologically apparent fistula, situated in the right lower lobe, was resected; peroperative clamping of pulmonary arterial blood supply to the affected lobe substantiated the presence of an arteriovenous fistula. Following surgery, arteriovenous shunting was found to be only slightly decreased (from 30 % to 25 % of cardiac output). In the resected lobe cavernous angiomata were demonstrated but also multiple capillary teleangiectases and marked thickening of alveolar walls. We suggest that the finding of a decreased diffuing capacity in patients with arteriovenous fistula indicates diffuse pulmonary disease which precludes surgical correction. A review of recent literature on pulmonary arteriovenous fistula is presented.

To clarify the frequency of fatty change in moderately and poorly differentiated hepatocellular carcinomas (mHCCs and pHCCs) and its relationship to arterial blood flow.One hundred and thirty-six surgically resected HCC lesions were studied. All patients had undergone dynamic magnetic resonance imaging (MRI) with chemical-shift-encoded water-fat imaging (CSI). The presence of fat was identified by a signal drop-off on CSI and confirmed at pathology. Lesions were classified into four groups in the arterial phase; G1, hypointense; G2, isointense; G3, slightly and heterogeneously hyperintense; G4, markedly and homogeneously hyperintense. The number of cumulative arteries (CAs) in the tumours in the pathology examination were counted.A fat component was observed significantly more frequently in the pHCCs (13/21; 61.9%) compared to the mHCCs (32/101; 31.7%; p=0.013). The numbers of lesions in each group were as follows: (G1, G2, G3, G4) = (18, 9, 23, 4) in the HCCs with fat; (1, 6, 24, 51) in the HCCs without fat (p0.001); (5, 5, 18, 4) in the mHCCs with fat; (0, 3, 19, 47) in the mHCCs without fat (p0.001); (11, 0, 2, 0) in the pHCCs with fat; (0, 2, 3, 3) in the pHCCs without fat (p=0.001). The number of CAs in the fat-containing HCCs (5.5±2.9) was significantly lower than that in the HCCs without fat (10.8±5.3; p0.001).A fat component was more commonly observed in the pHCCs than in the mHCCs. The present results showed a possible mechanism of fatty change in mHCCs and pHCCs in relation to decreased arterial blood supply.

Pulmonary sequestration is a rare anomaly, which does not have a connection with the bronchial system and gets its blood supply, generally, from the aorta or its branches. Anatomically, two different forms were described: intralobar and extralobar. Although 74% of intralobar pulmonary sequestrations get their blood supply from the descending thoracic aorta, they may get their blood supply from different arteries. Furthermore, there is more than one arterial anomaly in 14.8% of cases. We report an intralobar pulmonary sequestration, in which arterial blood supply is from two different origins (Arcus aorta and celiac trunk). To the best of our knowledge, this is the first case in the literature.

Scimitar syndrome refers to a form of anomalous pulmonary venous drainage which implies partial or total failure of the pulmonary veins to reach the left atrium. Aim To emphasize the role of MDCT in the diagnosis of Scimitar syndrome. Patients and methods We presented MDCT imaging findings in three patients with Scimitar syndrome. Results MDCT revealed anomalous arterial blood supply from abdominal aorta to right lower lung lobe and anomalous venous drainage into infradiaphragmatic IVC, hypoplastic right pulmonary artery and hypoplastic right lung as well as atrial septal defect and bronchial diverticulum. Conclusion MDCT is essential investigation in Scimitar syndrome.

Background and study aims Arterial bleeding from the major duodenal papilla is an uncommon but potentially life-threatening complication of endoscopic sphincterotomy. We investigated the arterial blood supply of the papilla to determine whether there might be a safer region for sphincterotomy. Methods Arteries supplying the major duodenal papilla were studied in 19 cadaver pancreaticoduodenal specimens (nine male, mean age 81 years, range 64 - 97 years) using a combination of microdissection and histology. The number, origin, caliber, and distribution of arteries within 5 mm of the major duodenal papilla were recorded. Results A total of 98 papillary arteries were identified by microdissection giving a mean of 5.2 arteries (range 3 - 9) per specimen. Papillary arteries originated from three sources: communicating arteries and the posterior and anterior pancreaticoduodenal arcade arteries. The majority of arteries were related to the antero-superior and postero-inferior quadrants of the major duodenal papilla, both at their point of entry into the duodenal wall or bile/pancreatic ducts (microdissection) and in their distribution 5 mm from the tip of the papilla (histology). The combined 10 and 11 o'clock segments of the papilla (as viewed endoscopically) contained only 10 % and 11 % of all papillary arteries on microdissection and histology, respectively, with seven of 19 specimens having no arteries in this region. Conclusions This study documents for the first time the distribution of papillary arteries around the circumference of the major duodenal papilla. Arterial bleeding complicating endoscopic sphincterotomy might be reduced by incising the papilla in the 10 - 11 o'clock region rather than the currently recommended 11 - 1 o'clock position.

Selective Internal Radiation Therapy (SIRT, Radioembolization) is used for the treatment of primary and secondary liver tumors. Currently, the treatment is performed when under classical and well established treatment concepts a tumor progression is detected or when the treatment has to be abandoned due to toxic effects. Microspheres are labelled with the beta-emitting isotope 90Yttrium and are infused into the hepatic arteries resulting in very high doses of radiation being selectively targeted to tumours via their arterial blood supply. The beta radiation of 90 Yttrium has an average penetration in soft tissue of approximately 2,5 mm und therefore provides high doses of radiation delivered to the tumor without harming the surrounding, healthy liver parenchyma.

Introduction Bone abnormalities and nerve compression are sparsely reported features of amniotic band syndrome. No studies of the vascular architecture of limbs affected by this syndrome have been published. Material and Methods Patients with amniotic band syndrome affecting the limbs were evaluated in the period between 1997 and 2007. The arterial blood supply was studied using magnetic resonance angiography or computed tomographic angiography. The subjects comprised 8 patients with bilateral and 2 with unilateral limb involvement. The patients' ages ranged from 2 months to 8 years. The male-to-female ratio was 4:6. A total of 20 limbs was investigated, comprising 18 lower limbs and 2 upper limbs. The amniotic bands were divided into superficial or deep. Results The patients were divided into 4 groups: group 1, thigh bands; group 2, below-knee amputations; group 3, leg bands; and group 4, upper limb bands. A single patient in group 1 with a deep band had a persistent sciatic artery. In group 2, three limbs demonstrated attenuated segments in the superficial femoral artery and/or abnormalities arising at the popliteal artery division. In group 3 (14 legs), 7 with deep bands showed some anomaly either in the popliteal artery division or its branches or both. In the other 7, and in group 4, all with superficial bands, no vascular abnormalities were seen except in one. Conclusion Our findings show that amniotic band syndrome is definitely associated with vascular abnormalities and the depth of the band is an important contributory factor.

Background: Total blood supply to an organ, or its part, is proportional to its function. The aim of this project was to investigate whether there is a lateralisation of total functions of cerebral hemispheres by determining differences in the arterial blood supply to left and right cerebral hemispheres. Methods: Diameters of right and left anterior, middle and posterior cerebral arteries were measured at specific sites and cross-sectional areas calculated in 203 adult brains (51 donated and dissected brain specimens and 152 cerebral arterial Computed Tomography Angiography and Magnetic Resonance Angiography images). Findings: The sample size was large enough to provide a power of detecting as significant differences of 4%, but neither of the average cross-sectional areas of right anterior, middle and posterior cerebral arteries were significantly different from those of the anterior, middle and posterior cerebral arteries of the left side. Furthermore, combined areas of the three right cerebral arteries were not significantly different from combined areas of the left three arteries. This clearly indicates that the blood supply into the right cerebral hemisphere is not different from that of the left cerebral hemisphere. Therefore, there is no total functional lateralisation between the two cerebral hemispheres. Conclusion: Brain lateralisation, frequently discussed in the literature, does not deferentially influence the total activity levels of cerebral hemispheres. Refereed/Peer-reviewed

The spleen is the largest single mass of lymphoid tissue in all vertebrates. Arterial blood supply correlates with the functional capability of the human spleen. A cross-sectional, descriptive type of study was done in the Department of Anatomy, Dhaka Medical College, Dhaka, from January to December 2008, to see the arterial pattern in the human spleen. 30 human spleens were collected from the unclaimed dead bodies that were under examination in the Department of Forensic Medicine of Dhaka Medical College, Dhaka. The samples were divided into three age-groups including group A (15-29 years), group B (30-49 years) & group C (50-69 years). Then macroscopic dissection was done and radiological angiograph was taken to see the arterial pattern in the human spleen. The splenic artery was the origin of sole blood supply in all the specimens. Two lobar branches were found in 70% of specimens and three branches in 23%. Four lobar branches were evident in only 2 specimens. Moreover, several segmental branches and polar arteries were found in the spleen of different ages. The distance between the splenic artery (before giving its lobar branches) and the hilum of the spleen were found 2.99±0.73 cm, 3.79±1.43 cm and 3.51±1.66 cm in group A, B and C respectively. However, the difference was not statistically significant among the study groups. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21305 Medicine Today 2014 Vol.26(1): 15-17

Lateral medullary syndrome (LMS) is a constellation of varied neurologic manifestations seen in cerebrovascular accidents. The posterolateral part of the medulla oblongata of the brain stem and cerebellum receiving arterial blood supply from the posterior inferior cerebellar artery are the areas commonly affected. We present a case of a middle aged gentleman referred to our hospital for persistent intractable hiccups as presenting symptom of LMS. He presented to our emergency room with persistent hiccups and left sided cerebellar signs. The patient had significant past history of alcohol and tobacco (smoking) dependence since 30 years apart from being a hypertensive.

Summary Prevention of acute portal hyperperfusion in small-for-size livers by inflow modulation results in beneficial postoperative outcome. The objective of this study was to unravel the underlying mechanism, emphasizing the intimate relationship between portal venous (PV) and hepatic arterial (HA) blood flow (BF). Rats underwent partial hepatectomy (pHx), splenectomy before pHx or splenectomy and ligation of the A. hepatica before pHx. Portal venous blood flow (PVBF), hepatic arterial blood flow (HABF), and tissue pO2 were assessed during stepwise resection from 30% to 90%. Hepatic regeneration and hypoxia-responsive gene expression were analyzed in each group after nonlethal 85% pHx. 90% pHx caused a fourfold rise in PVBF, a slight decrease in HABF with a 50% reduction in pO2, and high mortality. Splenectomy before pHx reduced the PVBF and caused a rise in HABF with doubling in tissue pO2. An attenuation of hypoxia-responsive gene expression turned into enhanced hepatocellular regeneration and improved survival. A. hepatica ligation abolished the beneficial effect of splenectomy on tissue oxygenation, proliferation, and outcome. In conclusion, the beneficial effect of splenectomy in small-for-size livers can be attributed to a rise in HABF with sufficient oxygen supply rather than to a reduced portal venous hyperperfusion to the remnant liver.

Zusammenfassung Mit Hilfe der korrosionsanatomischen Plastoidinjektionsmethode nach Schummer wurde das Blutgefassystem der Nasenhohlen bei Schaf und Ziege untersucht. Neben den Befunden uber die Endverzweigung der arteriellen Zuflusgefase zum Cavum nasi werden die Venenplexus hinsichtlich ihres Aufbaues, Vorkommens und ihrer Lage zum Hohlraumsystem der Nasenhohle, sowie die klappentragenden Abflusvenen beschrieben. Der Feinbau der Gefasarchitektur in der Nasenschleimhaut wurde untersucht und mit den Befunden bei bereits untersuchten Spezies verglichen. Arterio-venose Anastomosen wurden an Korrosionspraparaten und histologischen Serienschnitten nach Anzahl, Lage und Bau beschrieben. Abschliesend wurden an Hand der vorliegenden Untersuchungsergebnisse Fragen uber die Funktion der Schwellkorper und arterio-venosen Anastomosen diskutiert. Summary Vascular architecture of the nasal cavities of the sheep and goat With the help of the method of injecting plastoid and subsequent corrosion described by Schummer, the vascular system of the nasal cavities of the sheep and goat were studied. Apart from the observations on the terminal ramifications of the arterial blood supply to the nasal cavity, the venous plexus was also studied in relation to its structure, incidence and its relationship to the cavities of the nose and also the valve-bearing veins. The microscopic structure of the vessels and the nasal mucosa was studied and compared with that of other species already investigated. Arteriovenous anastomoses are described in corrosion preparations and histological serial sections in relation to their number, situation and structure. Finally, questions relating to the function of the erectile tissue and arterio-venous anastomoses are discussed. Resume La vascularisation de la cavite nasale chez le Mouton et la Chevre On etudia par la methode d'injection de plastoide et corrosion selon Schummer le systeme vasculaire sanguin de la cavite nasale du Mouton et de la Chevre. Les auteurs donnent les resultats obtenus concernant les ramifications terminales du systeme afferent arteriel de la cavite nasale et decrivent la structure, l'incidence et la situation par rapport aux conduits et sinus nasaux des complexes veineux, ainsi que des veines efferentes munies de valvules. On etudia la structure microscopique vasculaire de la muqueuse nasale et on la compara avec les resultats obtenus chez des especes deja etudies. Des anastomoses arterio-veineuses sont decrites d'apres les preparations par corrosion et les coupes histologiques en serie, en tenant compte de leur nombre, de leur situation et de leur structure. Enfin sur la base des resultats obtenus dans ce travail, certaines questions concernant la fonction des corps caverneux et des anastomoses arterio-veineuses sont l'objet d'une discussion. Resumen Arquitectura vascular de la fosa nasal en la oveja y en la cabra Con ayuda de la tecnica de inyeccion corrosionanatomica de plastoide segun Schummer se examino el sistema angiologico de la fosa nasal en la oveja y cabra. Al lado de los hallazgos sobre las ramificaciones terminales de los vasos arteriales de aflujo a la fosa nasal, se describen los plexos venosos con respecto a su estructura, incidencia y su posicion para con el sistema de la fosa nasal, asi como las venas de desague provistas de valvulas. Se estudio la microestructura de la arquitectura vascular en la mucosa nasal, comparandose con los nallazgos en las especies animales ya examinadas. Las anastomosis arterio-venosas describense en las preparaciones de corrosion y cortes histologicos seriados con arreglo a numero, posicion y estructura. Por ultimo, con ayuda de los resultados presentes de investigacion se discuten cuestiones sobre la funcion de los cuerpos cavernosos y las anastomosis arterio-venosas.

Summary Background: The Tranquilli-Leali and Atasoy volar VeY advancement flaps are considered workhorse flaps in the reconstruction of fingertip amputations. However, their description in the literature in terms of surgical dissection and blood supply is often indistinct. This study describes the differences between the two flaps and highlights their unique blood supply based on a thorough cadaveric study and review of the literature. Methods: Using 16 fresh cadaveric fingers, eight Tranquilli-Leali and eight Atasoy volar VeY advancement flaps were dissected, mapping the arterial blood supply using an injectable blue resin. In addition, a thorough literature search on the subject was done. Results: In all eight fingertips dissected as decribed by Tranquilli-Leali, the flap was supplied by the anastomotic connections between the terminal branches of the palmar digital arteries and dorsal nail-bed arcades via the fibro-osseous hiatus. In contrast, in all eight fingertips which were dissected as described by Atasoy, the flaps were perfused through the terminal branches of the palmar digital arteries. Conclusions: The Tranquilli-Leali and Atasoy volar VeY advancement flaps, used to reconstruct fingertip amputations, are distinct from one another in several ways. The most obvious difference is their technique of flap dissection, which, in turn, dictates a unique blood supply. Through careful dissection and a review of the literature, this anatomical study has brought to light the specific vascular supply to each flap that was evaluated.

Several modifications to an esophageal replacement approach have been described, using the left, the right, or the transverse colon as an interposition flap. Interposition of the left colon has become the most popular procedure. Intraoperative clamping of the arterial blood supply and venous drainage of the flap is a possible reason for ischemic flap failure. Thus, we designed a novel model to investigate whether erythropoietin (EPO), which has a tissue-protective effect in ischemia, would have any protective effect on prepared colon flaps in rats.A total of 56 rats were randomly divided into four main groups, consisting of sham, sham + EPO, colon flap, and colon flap + EPO, and each main group was divided into two sub-groups. In the colon flap and colon flap + EPO groups, the colon flap was prepared and the pediculated free flap fixed tautly to the anterior abdominal wall. The sub-groups were subjected to post-reoperative histopathological investigation on the first and the seventh days, respectively.Our model was reliable for research related to colon interposition techniques. There was significant histopathological damage in the colon flap group both for the long and short limbs of the flap. On the other hand, EPO administration prevented the mucosal damage seen in the colon flap group.This study suggests that a colon flap attached tautly to the abdominal side wall simulates colon transposition techniques and also shows that intraperitoneal EPO markedly decreases flap damage in rats with prepared colon flaps.

A large number of methods are today available for the clinical evaluation of the arterial blood supply to an extremity or part of an extremity. However, these methods are not sensitive enough for determining the nutritional status of a tissue in the extremity affected by vascular disorders. This is especially true for the skin where most of the blood is used for thermoregulation and only a small fraction goes through the nutritional capillaries. Blood may enter the subpapillary vascular network through AV-shunts and bypass the nutritional skin capillaries. Therefore microcirculatory methods has to be used in order to be able to evaluate the nutritional status of a certain skin area. One of the clinically most useful methods for this purpose is vital capillary microscopy. By classifying structural changes of the nutritional capillaries in an area susceptible to ischemia, the risk of necrosis can be evaluated. Marked discrepancies between the total circulation of the are and the nutritional status of the tissue can be seen especially in patients with peripheral vascular disorders and/or diabetes. The total circulation may be markedly reduced but necrosis does not occur until the nutritional circulation of the ischemic skin area is completely abolished for a certain period of time. On the other hand it is sometimes seen in clinical practise that ischemic skin necrosis may develop in a region with rather good macrocirculation. These findings are of utmost importance when the effect of a certain treatment should be evaluated. The effect has to be studied directly in the target organ, and that is the nutritional vascular bed of the ischemic area.

A variety of techniques for leg ulcer surgery have been developed in the last 20 years. In literature these techniques are always presented as competitive surgical methods for treating different forms of leg ulcers and are compared regarding their success. From our point of view, this approach seems inappropriate. Essentially there are 3 different techniques available: shave therapy, LAF therapy (removal of liposclerosis and fasciotomy) and fasciectomy. The choice of methods must be based on a classification of the ulcers, as each procedure is not suitable for ever type of ulcer. First we have to differentiate between venous ulcers and mixed leg ulcers. The venous ulcers should then be subdivided in ulcers developed in liposclerotic skin and ulcers which developed in atrophie blanche lesions. Finally the liposclerotic ulcers are classified according to Hach's classification system into 4 stages. In case of mixed leg ulcers with relevant occlusive arterial disease, attention should first be directed to improving the arterial blood supply; further approaches depend on how successful this is.

Twenty-eight heads of clinically normal adult goats of both sexes were used to identify the different arteries supplying the principal salivary glands as well as the distribution of those arteries within each of theses glands. A latex injection, corrosion casting and radiographic preparations and tissue clearing procedures were employed. The obtained results had revealed that the parotid salivary gland received its arterial blood supply from from the external carotid, lingual, caudal auricular, superficial temporal, transverse facial and rostral auricular arteries.. The mandibular salivary gland received its main arterial supply through branches from the common carotid, external carotid and lingual arteries. The monsotomatic sublingual salivary gland received its arterial supply through the sublingual artery while The polystomatic one received glandular branches originated either from the lingual artery , the sublingual artery or from the arch between the two lingual arteries.

The masseter muscle attracted the attention of many investigators as it is considered the most important muscle of mastication. The lamination of the masseter muscle has been described by Toldot (1905) in the human and domestic animals, Yoshikawa et al. (1961, 1962) in mammals and ruminants respectively, Yoshikawa and Suzuki (1965) in mammals and Sasaki et al. (2001) in the giraffe. Little is known about the structure of the masseter muscle and its arterial supply in the donkey, so the present study is carried out to investigate the structure of the masseter muscle and its attachments to the skull as well as the relationships with its arterial blood supply