An Effective Guidewire Looping Technique for the Recanalization of Occlusive Segments of Infrapopliteal Vessels

Jian-bo Wang,Jun-gong Zhao,Ming-hua Li,Yue-qi Zhu,Jue Wang,Pei-lei Zhang 대한영상의학회 2010 Korean Journal of Radiology Vol.11 No.4

Objective: To determine the efficacy, safety and primary follow-up results of a guidewire looping technique for the treatment of infrapopliteal arteries. Materials and Methods: From October 2006 to May 2008, an intraluminal angioplasty of the infrapopliteal arteries was attempted in 200 consecutive patients. Altogether, 417 infrapopliteal lesions, with lengths varying from 2 cm to 32 cm, were treated as part of this study, including 305 lesions in the anterior tibial arteries, 89 in the posterior tibial arteries, and 23 in the peroneal arteries. The ‘U’-shaped guidewire technique was attempted in 393 lesions from 361 limbs. The tip of a hydrophilic 0.035-inch guidewire was formed into a ‘U’ shape with the aid of a 4-Fr catheter and collateral branch vessel to recanalize the completely occluded long segment lesions. Results: A successful angioplasty with at least one artery recanalized directly to the malleolar or dorsal foot was achieved in 322 limbs (89%). The looping technique had a success rate of 90% (352 of 393 lesions). After the procedure, the rest pain was relieved in 58 of 69 patients, while 207 of 245 limbs (85%) showed improvement for intermittent claudication. Complete wound healing was noted in 21 of 54 patients, while 20 of 54 patients showed an improvement in the wound size or depth. A total of 38 major immediate procedure-related complications were noted, including retroperitoneal hematoma, distal emboli, and vessel rupture. Conclusion: The results of this study suggests that the guidewire looping technique is a safe and effective method for the recanalization of the occluded lesions in infrapopliteal vessels. Objective: To determine the efficacy, safety and primary follow-up results of a guidewire looping technique for the treatment of infrapopliteal arteries. Materials and Methods: From October 2006 to May 2008, an intraluminal angioplasty of the infrapopliteal arteries was attempted in 200 consecutive patients. Altogether, 417 infrapopliteal lesions, with lengths varying from 2 cm to 32 cm, were treated as part of this study, including 305 lesions in the anterior tibial arteries, 89 in the posterior tibial arteries, and 23 in the peroneal arteries. The ‘U’-shaped guidewire technique was attempted in 393 lesions from 361 limbs. The tip of a hydrophilic 0.035-inch guidewire was formed into a ‘U’ shape with the aid of a 4-Fr catheter and collateral branch vessel to recanalize the completely occluded long segment lesions. Results: A successful angioplasty with at least one artery recanalized directly to the malleolar or dorsal foot was achieved in 322 limbs (89%). The looping technique had a success rate of 90% (352 of 393 lesions). After the procedure, the rest pain was relieved in 58 of 69 patients, while 207 of 245 limbs (85%) showed improvement for intermittent claudication. Complete wound healing was noted in 21 of 54 patients, while 20 of 54 patients showed an improvement in the wound size or depth. A total of 38 major immediate procedure-related complications were noted, including retroperitoneal hematoma, distal emboli, and vessel rupture. Conclusion: The results of this study suggests that the guidewire looping technique is a safe and effective method for the recanalization of the occluded lesions in infrapopliteal vessels.

신동맥의 자기공명 혈관조영술

배상훈 대한영상의학회 1993 대한영상의학회지 Vol.29 No.1

We reviewed MR angiograms to evaluate its efficacy for visualizing the renal arteries and detecting renovascular disease. 41 renal arteries in 19 patients were examined by MR angiography. 3-D time-of-flight technique was used as routine examination method for MR angiography and 2-D time-of-flight technique was added in some particular cases to visualize venous flow. Within two weeks after MR angiography was performed, 23 renal arteries in 10 patients were additionally examined by conventional angiography or intraarterial DSA. The success rates of vessel visualization on MR angiography in normal renal arteries were 100% in main 67.7% in segmental, and 11.8% in intrarenal arteries. As a result of comparative study in normal main renal arteries with MR angiograms and conventional angiograms, overall correspondence in the number and the shape was noted and the caliber discrepancy between two examination did not exceed 3.0 mm. one arteriovenous fistula with aneurysm, one stenotic artery and two occluded arteries were well evaluated One arteriovenous fistula with aneurysm, and two occluded arteries were well evaluated by MR angiography. However three stenotic lesions were misdiagnosed as occlusions on MR angiography. and the overall accuracy was 87% We conclude that MR angiography has the potential to be a noninvasive and useful screening method for determining the number of renal arteries and for detection of abnormalities of main renal arteries.

Prevalence and clinical relevance of the anatomical variations of suprarenal arteries: a review

Ananya Priya,Ravi Kant Narayan,Sanjib Kumar Ghosh 대한해부학회 2022 Anatomy & Cell Biology Vol.55 No.1

The suprarenal arteries are arising from three sources: superior suprarenal artery, middle suprarenal artery, and inferior suprarenal artery. Variations in the arterial supply of the suprarenal glands in respect to origin and number are quite common and very frequently reported. The most common variation noted is in the inferior suprarenal artery followed by the middle suprarenal artery and the least common variations were observed in the superior suprarenal artery. Arteriogram of the inferior suprarenal artery is crucial in suprarenal tumour diagnosis but variation in the branching pattern and multiplicity of these arteries can cause hindrance in arteriography. The absence of middle suprarenal artery was seen to be associated with increased number of the inferior suprarenal artery. Variation in the multiplicity of arteries was observed more frequently in the inferior suprarenal artery and middle suprarenal artery which was more on the right side in most of the studies. Also, the variation in suprarenal arteries was often correlated to variations in inferior phrenic and gonadal arteries. The variations were observed to be more common on the left side therefore right adrenalectomy should be preferred over the left one. The loop formed by the inferior suprarenal artery around the right renal vein can cause venous obstruction. These variations of suprarenal vasculature are explained on the developmental basis, and prior knowledge of such variants is crucial for nephrologists to ensure minimum blood loss while performing laparoscopic adrenalectomy especially for large adrenal tumours and pheochromocytoma where the duration of surgery exceeds the usual.

Mirror pattern of cerebral artery atherosclerosis in patients with ischaemic stroke

Kim, Y. D.,Choi, H. Y.,Jung, Y. H.,Nam, C. M.,Yang, J. H.,Cho, H. J.,Nam, H. S.,Lee, K-Y.,Heo, J. H. Blackwell Publishing Ltd 2009 European Journal of Neurology Vol.16 No.10

<P>Background and purpose: </P><P>Although it has been suggested that bilateral symmetry of atherosclerosis can be found in paired arteries, including external carotid arteries and femoral arteries, it has remained unknown in intracranial arteries. We determined whether bilateral symmetry (a mirror pattern) of atherosclerosis presents in the entire cerebral arterial system.</P><P>Methods: </P><P>Angiographic findings of 795 consecutive patients with ischaemic stroke, after excluding those with cardiac sources of embolism or other causes of stroke, were reviewed retrospectively. The presence (location) and severity (the degree of stenosis) of atherosclerosis were compared between left and right sides at 26 predetermined arteries/segments.</P><P>Results: </P><P>We found 2230 lesions in predetermined segments/arteries from 669 patients. Amongst 509 patients with atherosclerotic lesions at two or more arteries/segments, mirror patterns were observed in 312 patients (61.3%). The mirror pattern increased steeply as the number of atherosclerotic arteries increased and was most frequently found in the carotid bulb (C1, 26.7%), followed by the middle cerebral artery (M1, 14.1%). The severity of stenosis was also correlated between left and right sides, and the correlation was highest in the C1 (<I>r</I> = 0.40, <I>P </I>< 0.001). Multiple logistic regression analyses revealed that the mirror patterns of atherosclerosis were more obvious in C1 and associated with a past history of ischaemic stroke and the number of stenotic lesions.</P><P>Conclusion: </P><P>Atherosclerosis in cerebral arteries may develop and progress in a mirror pattern. In patients with cerebral artery atherosclerosis, the occurrence and progression of atherosclerosis in the contralateral cerebral artery should be considered during follow-up examination.</P>

Different Mechanisms for K<SUP>⁢</SUP>-Induced Relaxation in Various Arteries

Suk Hyo Suh,Sung Jin Park,Jai Young Choi,Jae Hoon Sim,Young Chul Kim,Ki Whan Kim 대한생리학회-대한약리학회 1999 The Korean Journal of Physiology & Pharmacology Vol.3 No.4

<P> [K<SUP>⁢</SUP>]<SUB>o</SUB> can be increased under a variety of conditions including subarachnoid hemorrhage. The increase of [K<SUP>⁢</SUP>]<SUB>o</SUB> in the range of 5∼15 mM may affect tensions of blood vessels and cause relaxation of agonist-induced precontracted vascular smooth muscle (K<SUP>⁢</SUP>-induced relaxation). In this study, effect of the increase in extracellular K<SUP>⁢</SUP> concentration on the agonist-induced contractions of various arteries including resistant arteries of rabbit was examined, using home-made Mulvany-type myograph. Extracellular K<SUP>⁢</SUP> was increased in three different ways; from initial 1 to 3 mM, from initial 3 to 6 mM, or from initial 6 to 12 mM. In superior mesenteric arteries, the relaxation induced by extracellular K<SUP>⁢</SUP> elevation from initial 6 to 12 mM was the most prominent among the relaxations induced by the elevations in three different ways. In cerebral arteries, the most prominent relaxation was produced by the elevation of extracellular K<SUP>⁢</SUP> from initial 1 to 3 mM and a slight relaxation was provoked by the elevation from initial 6 to 12 mM. In superior mesenteric arteries, K<SUP>⁢</SUP>-induced relaxation by the elevation from initial 6 to 12 mM was blocked by Ba<SUP>2⁢</SUP> (30 μM) and the relaxation by the elevation from 1 to 3 mM or from 3 to 6 mM was not blocked by Ba<SUP>2⁢</SUP>. In cerebral arteries, however, K<SUP>⁢</SUP>-induced relaxation by the elevation from initial 3 to 6 mM was blocked by Ba<SUP>2⁢</SUP>, whereas the relaxation by the elevation from 1 to 3 mM was not blocked by Ba<SUP>2⁢</SUP>. Ouabain inhibited all of the relaxations induced by the extracellular K<SUP>⁢</SUP> elevations in three different ways. In cerebral arteries, when extracellular K<SUP>⁢</SUP> was increased to 14 mM with 2 or 3 mM increments, almost complete relaxation was induced at 1 or 3 mM of initial K<SUP>⁢</SUP> concentration and slight relaxation occurred at 6 mM. TEA did not inhibit Ba<SUP>2⁢</SUP>-sensitive relaxation at all and NMMA or endothelial removal did not inhibit K<SUP>⁢</SUP>-induced relaxation. Most conduit arteries such as aorta, carotid artery, and renal artery were not relaxed by the elevation of extracellular K<SUP>⁢</SUP>. Among conduit arteries, trunk of superior mesenteric artery and basilar artery were relaxed by the elevations of [K<SUP>⁢</SUP>]<SUB>o</SUB>. These data suggest that K<SUP>⁢</SUP>-induced relaxation has two independent components, Ba<SUP>2⁢</SUP>-sensitive and Ba<SUP>2⁢</SUP>-insensitive one and there are different mechanisms for K<SUP>⁢</SUP>-induced relaxation in various arteries.

무수 에타놀의 백서 대동맥주입에 있어서 주입속도에 따른 초기색전기전의 차이에 관한 실험적 연구

한준구 대한영상의학회 1990 대한영상의학회지 Vol.26 No.4

In order to clarify the early mechanism of action of the tissue necrosis induced by intraarterially infused absolute ethanol, abdominal aortography and histopathologic examination after absolute ethanol infusion into aorta at fast(0.4$m\ell$/sec) and slow speed(0.04$m\ell$/sec) were performed on 22 rats(2 controls, 7 in fast infusion group, 7 in slow infusion group, 3 in fast and 3 in slow infusion groups during aorta compression, respectively). Histopathologic features under the light and scanning electron microscope were correlated with the angiographic findings within 30 minutes after ethanol infusion. The results are as follows ; 1. In fast infusion group, histopathologic examination of the kidney showed severe glomerular and tubular damage. Extensive damage on endothelial and medial layer was noted in arteries, and fresh thrombi originated from the damaged arterial wall were seen. 2. Angiographic findings in the fast infusion group were luminal irregularity and early obstruction of large arteries. And circulation time was prolonged. 3. In slow infusion group, histopathologic examination of the kidney showed focal area of severe glomerular and tubular damage on relatively normal background. endothelial and muscular damage was noted in arteries, but the degree of the damage was less severe than that of the fast infusion group. 4. Angiographic findings in the slow infusion group were focal perfusion defect of the kidney, delayed circulation time, and mild luminal irregularity, but obstruction of the major arteries was not seen. 5. Aorta compression group had only minima angiographic and histopathologic alteration compared with uncompressed fast infusion group, although hemorrhage and cast of desquamated cells in renal pelvis noted in compression group suggested the possibility of severe tubular damage and venous thrombosis. 6. In conclusion, there was difference in angiographic and histopathologic features between fast and slow infusion group. It is suggested that thrombus formation from the damaged vessel walls is the initial process leading to the obstruction of the arteries and necrosis of the target organ as well as the damage on the endothelium and perivascular tissue. The amount of the fresh platelet thrombi originated form the damaged endothelial surface and the mechanical occlusion of the arteries with the secondary emboli are the factors which determine the initial angiographic features of the ethanol infused organ. secondary emboli formed in slow infusion group might obstruct the proximal arteries so that protect the cells in distal area from the toxic effect of absolute ethanol. Therefore, the fast infusion of the ethanol is preferred to the slow one for the condition which requires complete ablation of the distal organ. 7. effect of absolute ethanol in aorta compression group needs further investigation.

동맥의 관점에서 본 머리의 수삼양경

송석모 경락경혈학회 2024 Korean Journal of Acupuncture Vol.41 No.1

Objectives : The Purpose of this study is to identify the anatomical correlates of the three Hand Yang meridians in the head (HYMH), i.e. the arteries of the head. Methods : The original text describing the HYMH in the Yellow Emperor’s Inner Cannon is presented and translated into Korean. Anatomical literature related to the arteries of the head are reviewed to identify those that correspond to the HYMH. Results : Arteries corresponding to the HYMH are as follows: The Hand yangming large intestine meridian corresponds to the facial artery and the superior and inferior labial arteries. The Hand Taiyang small intestine meridian’s first branch corresponds to the superficial temporal artery, the zygomatico-orbital artery, and the anterior auricular artery. The second branch corresponds to the transverse facial artery. The Hand Shaoyang triple energizer meridian’s first branch corresponds to the posterior auricular artery, the superficial temporal artery, and the transverse facial artery. The second branch corresponds to the posterior auricular artery, the anterior auricular artery, and the zygomatico-orbital artery. Conclusions : The HYMH correspond as arteries, specifically branches of the external carotid artery. It is anticipated that arteries corresponding to other meridians in the head can also be identified.

하지의 폐색성 혈관질환에서 표재대퇴동맥의 도플러 파형과 혈관조영소견의 비교

제환준,고영환,김경원,김현범,정진욱,박재형 대한초음파의학회 2000 ULTRASONOGRAPHY Vol.19 No.3

Arterial Switch Operation in Patients with Intramural Coronary Artery: Early and Mid-term Results

Hyungtae Kim,성시찬,김시호,장윤희,안효영,이형두 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.2

Background: The intramural coronary artery has been known as a risk factor for early death after an arterial switch operation (ASO). We reviewed the morphological characteristics and evaluated the early and mid-term results of ASO for patients with an intramural coronary artery. Materials and Methods: From March 1994 to September 15th 2010, 158 patients underwent ASO at Dong-A and Pusan National University Hospitals for repair of transposition of the great arteries and double outlet right ventricle. Among these patients, 14 patients (8.9%) had an intramural coronary artery. Mean age at operation was 13.4±10.2 days (4 to 39 days) and mean body weight was 3.48±0.33 kg (2.88 to 3.88 kg). All patients except one were male. Eight patients had TGA/IVS and 4 patients had an aortic arch anomaly. Two patients (14.3%) had side-by-side great artery relation, of whom one had an intramural right coronary artery and the other had an intramural left anterior descending coronary artery. Twelve patients had anterior-posterior relation, all of whom had an intramural left coronary artery (LCA). The aortocoronary flap technique was used in coronary transfer in 8 patients, of whom one patient required a switch to the individual coronary button technique 2 days after operation because of myocardial ischemia. An individual coronary button implantation technique was adopted in 6, of whom 2 patients required left subclavian artery free graft to LCA during the same operation due to LCA injury during coronary button mobilization and LCA torsion. Results: There was 1operative death (7.1%), which occurred in the first patient in our series. This patient underwent an aortocoronary flap procedure for coronary transfer combining aortic arch repair. Overall operative mortality for 144 patients without an intramural coronary artery was 13.2% (19/144). There was no statistical difference in operative mortality between the patients with and without an intramural coronary artery (p>0.1). There was no late death. The mean follow-up duration was 52.1±43.0 months (0.5 to 132 months). One patient who had a subclavian artery free graft required LCA stenting 6.5 years after surgery for LCA anastomotic site stenosis. No other surviving patient needed any intervention for coronary problems. All patients had normal ventricular function at latest echocardiography and were in NYHA class 1. Conclusion: The arterial switch operation in Transposition of Great Arteries or Double Outlet Right Ventricle patients with intramural coronary can be performed with low mortality; however, there is a high incidence of intraoperative or postoperative coronary problems, which can be managed with conversion to the individual coronary button technique and a bypass procedure using a left subclavian free graft. Both aortocoronary flap and individual coronary button implantation techniques for coronary transfer have excellent mid-term results.

하지동맥경화증과 동반된 관상동맥질환 : 혈관조영술 소견 분석

김지혜 대한영상의학회 1993 대한영상의학회지 Vol.29 No.6

We performed both peripheral and coronary angiographies in 52 patients with an arteriosclerosis in lower extremities. The severity of arteriosclerotic narrowing of the coronany and peripheral anteries were compared on angiographies. An angiographic vascular score (AVS, 0-5) reflecting the number and the degree of strenosis in 12 lower extremity arteries and three major coronary arteries was assigned to each angiogram and the sum of scores in the lower extremity arteries was compared with the incidence of significant coronary artery disease (more than grade 3) and coronary score. Relation of incidence and severity of vasular stenosis and four risk factors (diabetes mellitus, hypertension, smoking, and hypercholesterolemia) was also analyzed. Thirty-four of 52 patients (65%) had an angiographically significant coronary artery disease. Thirteen of these 34 patients (38%) had no clinical symptom and sign of the ischemic heart disease. There was no statistically significant difference in the incidence and severity of coronary artery disease between high (more than 30) and low AVS group in lower extremity(p<0.14) All patients had at least one risk factor and 49 of 52 patients (94%) had multiple risk factors. Coronary angiography was normal in three patients with only one risk factors, and angiographically significant coronary artery disease existed in nine of 16 cases (56.3%) with two risk factors. 13 of 17 cases (76.5%) with three risk factors, and 12 of 16 cases (75.0%) with all four risk factors. There were no significant correlations between individual risk factors and incidnece, severity of arteriosclerosis in coronary and lower extremity arteries. In conclusion, angiographic evaluation of the coronary artery disease in patients with lower extremity arteriosclerosis is neccessary because of the high chance of coronary artery disease and difficulty in the prediction of coronary artery disease with a severity of the peripheral arteriosclerosis, presence of various risk factors, and clinical symptoms.