Vascular anomalies in campomelic syndrome

We report on 4 patients with the campomelic syndrome (CS) in whom postmortem angiography of the lower limbs was performed. Of the 4 ptients, 3 were phenotypic females (2 of them with a 46,XY karyotype) and one was a male with a normal 46,XY karyotype. Three fulfilled the criteria fo CS, and one (phenotypically female with a 46,XY karyotype) lacked the lower limb bowing and the talipes equinovarus typical of CS. This infant may constitute a further example of the recently reported CS without campomelia. The results of the angiographic study are compared with 46 postmortem angiographies of normal fetuses and newborn infants at different gestational ages. In the first 3 Cs patients the main arterial axis of the lower limb, formed by the superficial femoral and anterior tibial arteries, has smaller diameters than expected while the profunda femoris and posterior tibial arteries had greater diameters than age-matched controls However, the most striking abnormality was the absence or marked deficiency of the anterior tibial artery. Its terminal branch, the doralis pedis artery, was also absent and the plantar arch was abnormally formed by the posterior tibial artery either alone or in conjunction with the peroneal artery. The normal arterial pattern was found in the patient who lacked bowed bones. This finding supports an developmental association between vascular defects and lower limb anomalies in CS. This aberrant arterial pattern in CS may affect or be affected by muscle development. The shortness of the posterior femoral and calf muscles fix the knee and the ankle joints. Bone bowing is probably related to the abnormal mechanical forces applied to the developing long bones of the lowe limb. © 1993 Wiley-Liss, Inc.     

介入治疗股骨头缺血性坏死的应用解剖

目的 介入治疗股骨头缺血性坏死提供解剖学基础.方法 选用经乳胶灌注防腐成人下肢标本20侧及新鲜成人下肢标本2侧,观察股深动脉的起点方位及分支类型,测量股深动脉及各分支长度和外径以及各分支起始部的角度.结果 股深动脉主要从股动脉后方(36.4％)和后外侧方(36.4％)发出,旋股内侧动脉从股深动脉发出(72.7％),从股动脉发出(27.3％).各主要血管的长度为:股深动脉(19.22±10.19) mm,其根部距腹股沟韧带的距离为(38±11.78)mm;旋股内侧动脉(12.56±6.17) mm;旋股外侧动脉(13.93±11.04) mm.各主要血管的外径为:股深动脉(5.20±1.57)mm,旋股内侧动脉(3.64±0.99) mm,其升支(2.66±0.99)mm;旋股外侧动脉(4.48±1.19) mm,其升支(2.12±0.59) mm.旋股内侧动脉升支以与主干成接近90°的夹角;旋股外侧动脉与其升支间约呈115.82°夹角.结论 熟悉股动脉应用解剖,有利于完善这种治疗方法.     

Patterns of the circumflex femoral arteries revisited

Knowledge of variations of the circumflex femoral arteries is important when undertaking clinical procedures within the femoral region and in hip joint replacement. Since the 19th century, many different patterns have been proposed to classify their origins. This work studied a statistically reliable sample, the lower limbs of 221 embalmed human cadavers (equal right-left and approximately equal sex distributions), and reviewed the previous literature to propose a unified and simple classification that will be useful to clinicians. Statistical comparisons were made using the chi(2) test. The medial and lateral circumflex femoral arteries have been classified into three different patterns based on the levels of their origin. Distribution related to sex and side was also studied. Pattern I: Both arteries arose from the deep femoral artery (346 cases, 78.8%). This pattern was more frequent in females, P = 0.01. There was no significant difference between sides. Type Ia, medial circumflex femoral artery origin was proximal to the lateral circumflex femoral artery origin (53.2%); Type Ib, lateral circumflex femoral artery origin was proximal to medial circumflex femoral artery origin (23.4%); Type Ic, both arteries arose from a common trunk (23.4%). Pattern II: One of the arteries arose from the femoral artery and the other from the deep femoral artery (90 cases, 20.5%). Type IIa, the medial circumflex femoral artery arose from the femoral artery (77.8%) and Type IIb, the lateral circumflex femoral artery arose from the femoral artery (22.2%). There were no significant differences between sexes or sides. Pattern III: Both arteries arose from the femoral artery (2 cases, 0.5%). In every disposition there was a significantly higher prevalence of unilateral rather than bilateral occurrence. In one dissection the medial circumflex femoral artery was absent. Awareness of these variations could avoid unexpected injuries.     

Collateral circulation of the femoral and genicular systems in human lower limbs is highly uncommon

The descending branch of the lateral circumflex artery is a septocutaneous vessel that is vital for free and pedicle thigh flap transfer surgeries when repairing tissue defects. It also forms an anastomosis with the superior lateral genicular artery to create a collateral pathway for circumventing occlusions in the superficial femoral artery (SFA). Many anatomical texts and atlases imply the persistence of this anastomosis. However, previous studies indicate variability in the source of the arteries that form the anastomosis, and have reported cases where an anastomosis does not exist. We hypothesized that variations from the conventional accepted pattern can be predicted by comparisons of arterial diameters, and that unconventional anastomoses may be present to facilitate collateral circulation to the limb. Fifty-one limbs were dissected and analyzed to establish the source of the descending branch of the lateral circumflex artery, classify the types of anastomoses, and compare the diameters of the descending branch of the lateral circumflex artery, the SFA and the profunda femoris artery to the common femoral artery (CFA). Vessel diameters were normalized to the diameter of the CFA to allow comparison of limbs from both sexes and to minimize the effects of cadaver size on correlating vessel size to the presence or absence of collateral circuits. We report that 62.7% of limbs (32/51) had typical branching patterns; however, only 27.4% of limbs (14/51) had any anastomosis to connect the proximal and distal regions of the thigh. Importantly, the SFA had a wider relative diameter in limbs without anastomoses than in limbs that had normal anastomoses, perhaps precluding the formation of a collateral pathway. Overall, collateral circulation of the lower limb was highly uncommon, in contrast to information inferred from anatomical texts. This study suggests the need for more thorough procedures for determining viable anastomoses prior to thigh flap surgeries to ensure flap survival.     

Deep femoral artery with four variations: a case report

During our routine dissection course for students we found a complex variation of the femoral artery on the left side of a 72-year-old male cadaver. The deep femoral artery was originating from the anterior aspect of the femoral artery; the inferior epigastric and the external pudendal arteries were arising from the deep femoral artery. Besides, the lateral circumflex femoral artery was arising from the lateral aspect of the femoral artery and distal to the origin of the deep femoral artery.     

Arterial supply to the sciatic nerve in the gluteal region

The arterial supply to the sciatic nerve was investigated in 20 human lower limbs (10 right, 10 left) from 20 cadavers (14 females, aged 84 +/- 9.6 years, range 66-95 years: 6 males, aged 80 +/- 8.2 years, range 70-90 years). In all limbs examined at least 1 sciatic artery could be identified supplying the sciatic nerve in the gluteal region. In total 28 sciatic arteries were identified, of which 14 arose from the medial circumflex femoral artery, 11 from the inferior gluteal artery, 2 from the first perforating artery, and 1 from the internal pudendal artery. In 5 limbs, 2 sciatic arteries were observed, being independent branches from the medial circumflex femoral and inferior gluteal arteries in 4 limbs and separate branches of the medial circumflex femoral artery in 1 limb. In 1 limb, 4 sciatic arteries were observed: 1 from the inferior gluteal artery, 2 from the medial circumflex femoral artery, and 1 from the first perforating artery. In the remaining 14 limbs a single sciatic artery was observed, which in one case arose from the internal pudendal artery, a previously unreported observation.     

Deep femoral artery aneurysm presenting as lower limb swelling: a case report

We report a rare case of lower limb swelling due to compression of the superficial femoral vein by a solitary deep femoral artery aneurysm. The patient was a 58-year-old man presenting with acute swelling of the right lower limb caused by deep venous thrombosis. A multi-detector computed tomographic scan (CT) confirmed the diagnosis of a deep femoral artery aneurysm and revealed no evidence of aneurysms or occlusive lesions in the other arteries. Aneurysmectomy and ligation of the deep femoral artery were successfully performed. Preoperative multi-detector CT scanning is a valuable, non-invasive diagnostic tool to delineate not only the state of the aneurysm, but also that of the distal arterial tree.     

Persistent sciatic vessels associated with an arteriovenous malformation

The sciatic artery is the major arterial supply to the lower limb bud at an early embryological stage. It primarily originates from the dorsal root of the umbilical artery. After the 22 mm embryological stage, the sciatic artery involutes and the femoral artery system develops as the major inflow source to the lower limb. In the adult, remnants of the sciatic artery persist as the proximal portion of the inferior gluteal artery, the popliteal and peroneal arteries (Williams et al. 1989). It is suggested that either failure in development of the femoral system or failure in regression of the sciatic artery results in persistence of this artery (Arey, 1965). We report a rare example of persistent sciatic artery (PSA) accompanied by arterio-arterial and arteriovenous anastomoses.     

Blood velocity in human arteries measured by a bidirectional ultrasonic doppler flowmeter

Blood velocities in 12 arteries were recorded by an ultrasonic doppler flowmeter in 11 young adults. Two major types of velocity patterns existed at rest. In certain arteries (the common carotid, the external carotid, the superficial temporal and the proper palmar digital arteries) flow was towards the periphery throughout the entire pulse cycle. Other arteries (the common femoral, the popliteal, the posterior tibial and the pedal artery) exhibited retrograde flow in part of the pulse cycle. In each individual a spontaneous variation between these two velocity patterns was observed in the subclavian, the axillary, the brachial and the radial artery. The velocity pattern of each artery is described, and absolute blood velocities at recognizable instances during the pulse cycle are given. The influence of peripheral resistance on the velocity pattern was investigated by reactive hyperaemia of the femoral artery. We find that not only is there an upward displacement of the resting femoral curve relative to the line of zero, but the shape of the velocity pattern is also changed. Our conclusion is that peripheral resistance is of major importance not only for the mean velocity, but also for the shape of the velocity pattern in the artery.     

Flow-through旋股外侧动脉降支穿支皮瓣在上肢高压电击伤保肢治疗中的应用

目的　探讨Flow-through旋股外侧动脉降支穿支皮瓣对上肢高压电击伤的保肢效果。 方法　回顾性分析2017年7月至2019年2月笔者单位收治的5例上肢高压电击伤患者,患肢均存在广泛的软组织坏死伴血循环障碍,急诊予以患肢切开减张、坏死组织清除、血管探查及游离Flow-through旋股外侧动脉降支穿支皮瓣移植修复创面并重建肢体远端血运。彻底清创后创面面积6.0 cm×4.0 cm ~ 17.1 cm×10.3 cm,切取皮瓣面积为7.2 cm×5.0 cm ~ 18.3 cm×11.5 cm。供区均Ⅰ期闭合。 结果　1例患者术后7 d发生皮瓣下感染,经扩创缝合后顺利愈合;其余患者皮瓣存活良好,创面I期愈合。所有患者获随访6 ~ 18个月,平均12个月,保肢成功,皮瓣质地柔软、外形满意,患肢尺、桡动脉通畅,手、腕部血运良好,功能有一定恢复。供区残余片状瘢痕,小范围感觉麻木。 结论　Flow-through旋股外侧动脉降支穿支皮瓣可及时有效重建肢体血运的同时修复创面,是上肢高压电击伤保肢的理想方法之一,值得推广。     

Blood velocity in human arteries measured by a bidirectional ultrasonic doppler flowmeter.

Blood velocities in 12 arteries were recorded by an ultrasonic doppler flowmeter in 11 young adults. Two major types of velocity patterns existed at rest. In certain arteries (the common carotid, the external carotid, the superficial temporal and the proper palmar digital arteries) flow was towards the periphery throughout the entire pulse cycle. Other arteries (the common femoral, the popliteal, the posterior tibial and the pedal artery) exhibited retrograde flow in part of the pulse cycle. In each individual a spontaneous variation between these two velocity patterns was observed in the subclavian, the axillary, the brachial and the radial artery. The velocity pattern of each artery is described, and absolute blood velocities at recognizable instances during the pulse cycle are given. The influence of peripheral resistance on the velocity pattern was investigated by reactive hyperaemia of the femoral artery. We find that not only is there an upward displacement of the resting femoral curve relative to the line of zero, but the shape of the velocity pattern is also changed. Our conclusion is that peripheral resistance is of major importance not only for the mean velocity, but also for the shape of the velocity pattern in the artery.     

逆行缝匠肌皮瓣修复小腿皮肤缺损应用解剖学

目的为设计逆行缝匠肌皮瓣转位修复小腿皮肤缺损提供解剖学基础。方法解剖观测40侧缝匠肌的动脉来源、走行、外径、分布及吻合。取4侧新鲜成尸下肢标本进行动脉造影,观察缝匠肌内动脉吻合。结果营养缝匠肌的动脉为6～7支,呈节段性分布,缝匠肌的上1/5段动脉来源于旋髂浅动脉、旋股外侧动脉或股深动脉,中2/5段动脉来源于股动脉,下2/5段动脉来源于隐动脉。隐动脉起点位于内收肌结节上(10.2±1.0)cm处,外径(1.5±0.2)mm,向下发出3～5个分支入缝匠肌,隐动脉终末支在膝下内侧参与膝关节网。缝匠肌的各节段动脉在肌内分为4～7支沿缝匠肌纵轴走行,相邻动脉的分支在肌内形成链型吻合,吻合处外径0.3mm左右。深筋膜表面有皮动脉和肌皮动脉形成的链式血管吻合网,营养缝匠肌表面的皮肤。结论缝匠肌内动脉链型吻合为逆行缝匠肌皮瓣供血,扩大了该肌皮瓣的切取长度,故以隐动静脉为血管蒂的逆行缝匠肌皮瓣可修复小腿中下段软组织缺损。     

Deep and superficial circumflex iliac arteries and their relationship to the ultrasound‐guided femoral nerve block procedure: A cadaver study

The in‐plane lateral to medial approach is a standard technique for ultrasound‐guided femoral nerve block (USG‐FNB). The first bifurcation of the femoral artery, which consists of the deep artery of the thigh (DAT) or occasionally the lateral circumflex femoral artery (LCFA), is regarded as the distal border for this procedure. We sometimes detect arteries along the estimated needle trajectory for USG‐FNB. The superficial (SCIA) and deep (DCIA) circumflex iliac arteries run laterally parallel to the inguinal ligament from the femoral or external iliac artery. The relationship between the SCIA and DCIA and other anatomical structures related to USG‐FNB around the femoral triangle region was studied by gross anatomical examination of 100 formalin‐fixed adult cadavers. At least one SCIA and one DCIA were identified around each femoral triangle; 81.8% of SCIA and 58% of DCIA originated from the femoral artery. All DCIA coursed between the fascia lata and fascia iliaca and 80% of SCIA penetrated the fascia lata. In 94% of femoral triangles, at least one arterial branch heading towards the lateral part of the thigh originated from the femoral artery from the level of the inguinal ligament to the first bifurcation of the femoral artery. The presence of SCIA and DCIA should be considered during USG‐FNB using the in‐plane lateral to medial approach to avoid inadvertently injuring them, as they are occasionally located along the presumed needle trajectory superficial to the fascia iliaca. Clin. Anat. 30:413–420, 2017. © 2017 Wiley Periodicals, Inc.     

A case of the persistent sciatic artery

During the dissecting practice of students at Gifu University School of Medicine in 1989, a rare developmental anomaly showing the sciatic artery was found in the left lower limb of a cadaver of 88-year-old Japanese female. The left sciatic artery (5 mm in diameter) arose from the internal iliac artery and appeared at the buttock between the piriformis and superior gemellus muscles through foramen infrapiriforme. The femoral artery (6 mm in diameter) of the left lower limb was normal in distribution and belonged to the type III by Adachi's classification (1928). The terminal vessel of the femoral artery was joined to the sciatic artery at the popliteal fossa.     

髌韧带与膝交叉韧带的血供及其在交叉韧带损伤重建中的意义

目的　探讨髌韧带和膝交叉韧带的血供特点,为临床韧带重建提供形态学依据。 方法　通过成人和胎儿股动脉红色乳胶灌注并解剖剥离、胎儿墨汁灌注组织透明和组织切片等方法,观察髌韧带和膝交叉韧带的动脉分布特点并测量胎儿韧带内微血管密度。 结果　髌韧带的动脉来自膝下外动脉、胫前返动脉、膝降动脉和膝下内动脉的分支;胎儿髌韧带不同区域微血管密度不同,且以韧带中心部为最低。前、后交叉韧带的动脉分别来源于膝中动脉、髌下脂肪垫以及膝下外动脉的分支。多数韧带内血管沿长轴走行,同时也有横向交通的小血管,血管网呈梯状或平行的丛状。近侧端和远侧端较密而中间部相对稀疏。 结论　①髌韧带和膝交叉韧带均存在中心部乏血管区;②韧带两端血供最丰富,且近侧段好于远侧段;③髌韧带血供优于膝交叉韧带,髌韧带重建交叉韧带具有血供基础。     

Rare variation of the arm artery: coexistence with the superficial brachial and superficial subscapular arteries in the absence of the normal brachial artery

A rare variation in the arterial pattern was found in the right arm of an 87-year-old male cadaver in a student dissection practice. In this case, the superficial brachial and superficial subscapular arteries coexisted in the absence of the normal brachial artery (A. brachialis profunda). After branching off a large-sized superficial subscapular artery, the axillary artery did not penetrate the brachial plexus and gave rise to a superficial brachial artery, which arose from the axillary artery at the point between the ansa pectoralis and ansa mediana, and descended ventral to the median nerve branching off the profunda brachii and superior and inferior ulnar collateral arteries. The superficial brachial artery finally divided into the radial and ulnar arteries in the cubital fossa. The superficial subscapular artery passed inferior and dorsal to the medial cord of the brachial plexus, giving off the lateral thoracic artery, and then branched off into the thoracodorsal, circumflex scapular and posterior circumflex humeral arteries. Thus the main nerves of the brachial plexus were sandwiched between the superficial brachial artery and the superficial subscapular artery system. The morphological and clinical significance of this variant are discussed.     

Anatomical variants of the lateral femoral circumflex artery: an angiographic study

The descending branch of the lateral femoral circumflex artery (LFCA) has found recent use as a new arterial graft for coronary artery bypass grafting (CABG). Anatomical variants of the LFCA were assessed on femoral arteriograms obtained before CABG in 131 adult patients. The most common pattern, found in 78.6% of extremities, consisted of the LFCA arising from the deep femoral artery, and the arterial graft was selected from this pattern in 92.3% of patients in whom the descending branch of the LFCA was used for CABG.     

Clinical significance of understanding lateral and medial circumflex femoral artery origin variability

The common femoral artery (CFA) divides into the superficial femoral artery (SFA) and deep femoral artery (DFA). The lateral circumflex femoral artery (LCFA) and medial circumflex femoral artery (MCFA) are most often branches of the DFA, although a large number of different variations in their origin has been described. We performed microdissection on both lower limbs of 30 fetuses, gestational age from 7 to 10 lunar months. Our results show that the LCFA and MCFA usually arise from the DFA. In 78.3% of cases, the MCFA originated from the DFA. In 11.7% of cases, the MCFA originated from the CFA, and in 5% of cases from the SFA. One case showed a common trunk with the DFA. Also, the MCFA was missing in one case, and it had a common trunk with the LCFA in one case. In 83.3% of cases, the LCFA arose from the DFA and in 6.7% of cases from the CFA. In one case, it had a common trunk with the DFA, and in one case with the MCFA. In 3.3% of cases, the LCFA was missing. In 66.7% of cases, both arteries originated from the DFA, in 15% of cases one originated from the DFA and the other from the CFA or SFA. Our results are in accordance with some published studies but also differ from the outcomes of other studies. Comprehensive knowledge of different variation types is imperative in order to prevent complications during surgical and orthopedic interventions.     

A brachioulnoradial artery: a short report

Variations in the number and/or course of the arteries of the upper limb have clinical and surgical significance. During routine dissection of the left upper limb of a 50-year-old male cadaver, a brachial artery was noted that bifurcated into superficial and deep branches in the middle arm. The ulnar and radial arteries had a high origin from the superficial branch and proceeded superficially in the forearm, but had a normal termination in the hand. The common interosseous artery was termination of the deep branch. This report is a rare variation in arteries of upper limb and was not additional vessels.     

Flow-mediated dilation and exercise-induced hyperaemia in highly trained athletes: comparison of the upper and lower limb vasculature

Aim: The main purpose of the present study was to assess whether similar vascular adaptive changes could be obtained by long‐term intensive training involving predominantly either the lower or the upper limb musculature. Methods: In 11 cyclists (C), 10 swimmers (S) and 10 sedentary controls (Sed), duplex Doppler ultrasonography was used to measure post‐occlusion endothelium‐dependent flow‐mediated dilation (FMD), endothelium‐independent, glycerine trinitrate‐induced dilation (GTND) and exercise‐induced blood flow changes in the arm (axillary artery) and leg (superficial femoral artery). Limb‐specific exercise was achieved by one elbow‐flexion or one leg‐extension maximal exercise test, thereby allowing assessment of upper and lower limb muscle perfusion, vascular conductance and vasodilatory capacity of resistance vessels during effort. Results: C and S exhibited vascular remodelling associated with improved FMD and GTND in the predominantly trained limbs compared to Sed. Both showed greater muscle perfusion and vascular conductance than Sed during isolated exercise involving the predominantly trained musculature. C showed also higher FMD in the brachial artery and greater peak muscle perfusion and conductance in the non‐exercising muscles, whereas S presented only enhanced FMD in the superficial femoral artery. Conclusion: Therefore, in the upper as well as in the lower limb vasculature, repetitive exposure to increased shear stress over a long‐term period results in improved FMD of large conduit arteries as well as greater vasodilatory capacity during isolated exercise in the predominantly trained muscles. Long‐term training involving predominantly the lower limbs also results in enhanced vascular reactivity in upper limb conduit and resistance vessels.