永存寰前节间动脉血流动力学特点分析一例

正永存寰前节间动脉(proatlantal intersegmengtal artery,PIA)属罕见的胚胎遗留血管,发生率为0.023%(1/4400)。PIA按起源部位不同分为Ⅰ型与Ⅱ型,Ⅰ型起源于C2~C3椎体水平的颈内动脉背侧,向上后外侧走行,上升至寰前间隙而不进入任何颈椎的横突孔,与椎动脉V3段汇合后,经枕骨大孔入颅;Ⅱ型PIA起源于颈外动脉,向后上方走行,     

超声对2型糖尿病患者颈部及下肢动脉病变的诊断作用分析

目的探讨和分析超声检查对2型糖尿病患者颈下部及下肢动脉病变的诊断特点及价值。方法选取于2012年7月-2013年11月在我院接受治疗的2型糖尿病患者124例为研究对象,记该组患者为观察组,其中检查颈部动脉及下肢动脉分别有55例和69例;同时选取同期在我院接受治疗的非糖尿病患者131例为对照组,其中检查颈部动脉和下肢动脉分别60例和71例,分析和对比两组患者血管壁、血管形态、有无斑块、IMT(血管壁内中膜厚度)、血管狭窄等情况。结果观察组124例对象,其颈部血管、下肢动脉血管IMT出现异常增厚,且该组血管腔内出现硬化斑块、狭窄或闭塞的几率明显高于对照组,两组间上述指标对比差异有统计学意义(P0.05)。观察组患者下肢动脉出现粥样硬化病变多呈现为弥漫性和多节段性,主要分布在双侧,而管腔狭窄、闭塞引发的远端受累动脉主要为胫后动脉、胫前动脉、足背动脉等最明显,而对照组下肢动脉病变主要呈现得单发性、局灶性。结论超声检查能有效诊断出2型糖尿病患者颈部动脉和下肢动脉的病变情况,其对预防及治疗2型糖尿病有一定的参考价值。     

术中影像导航下切除脊髓圆锥处脊髓动静脉瘘

日本的学者们进行了直接手术切除脊髓圆锥动静脉瘘（AVF）的研究。报道了2例由脊髓前动脉供血的脊髓圆锥动静脉瘘,经术中影像导航（如DSA、动脉内染料注射或吲哚青绿荧光造影）成功进行了手术闭塞瘘口。治疗脊髓AVF的关键是完全闭塞瘘口,同时保证脊髓的正常血供。术中必须首先安全分离供血动脉、血管巢和引流静脉,然后通过术中影像导航,明确瘘口的血流和解剖定位。第1例患者在也脊髓节段有血管巢,由脊髓前动脉通过左L1节段性动脉供血。第2例患者的血管巢位于IA／5脊髓水平,由脊髓前动脉通过左T11肋间动脉供血。     

应变-血压指数评价终末期肾病患者中型动脉弹性

目的探讨应用应变-血压指数评价终末期肾病患者肱动脉和胫前动脉弹性的可行性及临床价值。方法随机选取终末期肾病患者39例作为终末期肾病组,健康志愿者46例作为对照组。全部应用应变和应变率成像对肱动脉和胫前动脉进行检查。通过应变和应变率成像获得肱动脉和胫前动脉的最大圆周应变,同时测量被检者肱动脉和胫前动脉血压,计算肱动脉和胫前动脉的应变-血压指数,对终末期肾病组和对照组的参数进行对比分析。结果终末期肾病组的胫前动脉应变-血压指数(4.01%±0.59%)明显低于对照组(5.71%±0.55%,P<0.01);终末期肾病组和对照组的肱动脉应变-血压指数(3.82%±0.39%比3.95%±0.46%)差异无统计学意义(P>0.05)。结论应变-血压指数可以作为评价终末期肾病患者中型动脉弹性改变的新指标。     

15具人尸枕动脉解剖

目的观察15具人尸的枕动脉解剖特点,探讨以枕动脉作为颅内—颅外后循环搭桥术的桥血管时,如何安全准确获取该血管。方法采用远外侧入路,开颅显微解剖15例尸头共30侧枕动脉,观察枕动脉的起源、行程、分支、邻近结构,并测量枕动脉各段的直径、椎动脉V3的直径、可移植段的长度以及与周围临近结构的距离。结果枕动脉一般在二腹肌后腹下缘起源于颈外动脉后壁或外壁,与颈外动脉平行、沿二腹肌后腹向上,然后转向二腹肌后腹深面,内侧紧邻颈内静脉,行于寰椎横突前上方,接近乳突尖或二腹肌沟转向内侧走行,途中经胸锁乳突肌、头夹肌和头最长肌深面(4侧经胸锁乳突肌、头夹肌深面及头最长肌浅面),在上项线下方的头半棘肌后面继续向内侧行走,经过斜方肌、头半棘肌的上方附着点,在此穿过斜方肌的附着点至上项线,与枕大神经相伴,继续在头皮浅筋膜内上行,并分出一个或两个终末支,远端分布于头皮。枕动脉起点直径为(2.3±0.3)mm,平行于寰椎横突上缘至越过上项线处的长度为(93.2±2.6)mm,平行于寰椎横突上缘处的外径为(1.9±0.4)mm,越过上项线处的外径为(1.8±0.3)mm。椎动脉V3段中点的直径为(3.2±1.4)mm,枕动脉距枕外隆突的距离为(21.4±0.9)mm,枕下段距离上项线最远距离为(23.7±1.2)mm。结论颅内—颅外后循环搭桥术术中以枕外隆突外侧25 mm、上项线下方30 mm以内、乳突、寰椎横突为标志,能安全准确获取枕动脉。     

腓骨滋养孔解剖特点及腓动脉解剖变异研究进展

腓骨细长，长度为26～38 cm，位于胫骨外后方，远端内侧关节面参与踝关节构成，上端头部供肌腱韧带附着，中段腓骨可以用作肢体骨缺损生物学重建供体来源，最大的可取长度约26 cm。腓骨滋养孔多集中于腓骨中1/3上份，多为一个滋养孔，二个或三个滋养孔为少数，且位置不一。常见的腓动脉解剖变异包括胫后动脉发育不良或缺如，远端由腓动脉替代；胫前动脉发育不良或缺如，胫前动脉的足背支由腓动脉替代；胫前、后动脉均发育不良或缺如，腓动脉为小腿主要供应动脉，胫后动脉远端及足背动脉由腓动脉替代；也可见腓动脉发育不良或缺如。     

皮层下分水岭梗死的临床及影像学特征

分水岭梗死指两条主要动脉供血区边缘带之间的局限性梗死，分为两类：一是位于大脑中动脉与大脑前动脉或大脑后动脉的皮层支之间的梗死灶，称作称皮层分水岭梗死。二是大脑中动脉的深穿支及表浅穿支之间或大脑中动脉及大脑前动脉的表浅分支之间边缘带的梗死灶，称作皮层下分水岭梗死（IWI）。本研究应用弥散磁共振成像（DWI）来确定颈动脉系统的急性IWI病灶，并探讨其与相关血管病变及预后的关系。     

老年性周围动脉闭塞性疾病的研究进展

周围动脉闭塞性疾病与老年人动脉退行性变,增殖,脂质沉积于血管内膜及动脉硬化有关。通常呈节段性分布,好发于手、足、脑等部位,但临床上多见于下肢。若不     

小脑前下动脉区梗塞

从小脑前下动脉的解剖，小脑前下动脉区梗塞的病因、病理、临床表现以及诊断治疗、预后等方面综述小脑前下动脉区梗塞的研究进展。     

83例脑动脉节段性缺血的观察

目的　观察脑动脉节段性缺血改变。方法　应用经颅超声彩色多普勒 (TCCDI)对有神经系统症状而 CT正常的 41例门诊患者及 42例 CT证实的脑梗塞患者脑动脉分段测量其内径、血流速度 ,同时观察对照组 46例。结果　有症状组单条单节段改变明显 ,脑梗塞组则以多条动脉多节段改变明显 ,与对照组比较差异显著 (P<0 .0 1 )。结论　 TCCDI在 CT未出现病灶之前即可以早期发现脑动脉的异常变化     

巨长基底动脉的临床特点

目的　探讨巨长基底动脉的临床特点。方法　对 7例巨长基底动脉患者的临床资料进行分析。结果　巨长基底动脉为一少见病 ,无特异临床表现 ,主要表现为椎基底动脉供血不足 ,部分可以表现为脑干及颅神经或椎基底动脉及其分支血管被牵拉的症状 ,CT及CTA可以发现巨长基底动脉。结论　巨长基底动脉无特定的临床表现 ,CT及CTA可以明确诊断 ,疑诊时应进行相关的检查。     

原发性肺动脉肉瘤——附一例报告

目的 提高对原发性肺动脉肉瘤的认识。方法 通过一肺动脉肉瘤病例,详细分析此类疾病的临床症状、放射学特征及病理表现。结果 本病与其他肺动脉阻塞性疾病（包括肺血栓栓塞）的临床表现并无明显差异。对疑为肺血栓栓塞的病人,当放射影像学出现单侧肺动脉扩张、持续性软组织充盈的肺动脉、肺内肿块,临床呈现经抗凝和溶栓治疗后病情依然恶化等情况时,均高度提示本病。结论 肺动脉肉瘤极易误诊为其他肺血管阻塞性病变,应予重视     

Percutaneous angioplasty of the subclavian artery in patients with mammary-coronary bypass grafts

Severe coronary artery disease often coexists with peripheral vascular atherosclerosis. The assessment of the supra-aortic circulation in candidates for surgical coronary revascularization is of clinical relevance, and after intervention the patency of the supra-aortic trunks should be regularly evaluated in the clinical follow-up. We describe three cases of coronary artery disease treated with surgical revascularization using the internal mammary artery and concomitant atherosclerotic disease of the subclavian artery. The clinical presentation, the diagnostic procedures, and the therapeutic approach by means of percutaneous transluminal angioplasty of the subclavian artery are described and discussed.     

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??Abstract??Spontaneous cerebral artery dissections is a leading cause of stroke in young and midi-aged patients??accounting for almost 1/4 of stroke patients younger than 45 years old??and it includes internal carotid artery dissection and vertebral artery dissection.Dissection may occur in different positions with different clinical manifestations.The article reports a typical case of vertebral artery dissection and reviews the clinical manifestations of cerebral artery dissections.     

Congenital atresia of the left coronary ostium and hypoplasia of the left main coronary artery

The clinical and pathological findings are described in a six-month-old female with an unusual congenital malformation, atresia of the orifice and hypoplasia of the left main coronary artery. The literature is reviewed and the clinical findings are discussed. A comparison has been made with the anatomic findings in true single coronary artery and with the angiographic findings in anomalous origin of the left coronary artery from the main pulmonary artery.     

Stress myocardial perfusion imaging in the diagnosis and prognosis of women with suspected coronary artery disease

Coronary artery disease is the single largest killer of women in the United States and claims the lives of more than 250,000 women each year. For several decades, there was the misperception that coronary artery disease was a "man's disease." The fact is that women are indeed vulnerable to coronary artery disease; however, they typically develop the disease 10 to 15 years later than men. Once coronary artery disease is evident, women have worse outcomes as compared with men.Therefore, early and accurate diagnosis of coronary artery disease is crucial for reducing heart disease mortality in women. Stress myocardial perfusion imaging using contemporary techniques has been shown to have significant value in the diagnosis and prognosis of coronary artery disease in women. Myocardial perfusion imaging with exercise or pharmacologic stress has been shown to add incremental value to the use of clinical variables or exercise electrocardiogram stress testing alone in the risk stratification of women with an intermediate clinical pretest likelihood of coronary artery disease. This review provides an overview of the role of stress myocardial perfusion imaging in the clinical evaluation of women with suspected coronary artery disease.     

Origin and distribution anomalies of the left anterior descending artery in 70,850 adult patients: multicenter data collection.

OBJECTIVES: To present the clinical and angiographic properties of the left anterior descending artery anomalies. BACKGROUND: Coronary artery anomalies are discovered in less than 1% of angiography series. Since the number of angiographies and coronary bypass operations are increasing significantly every day, these anomalies are of clinical importance. However, data about left anterior descending artery anomalies in literature is still scarce. METHODS: We reviewed the records of 70,850 patients who had undergone coronary angiographies at 4 different cardiology center from 1999 to 2005 years. RESULTS: Major congenital coronary anomalies were discovered in 171 of these cases (0,24%). The mean age of these patients was 61 +/- 11 (18-84) years. Ninety nine patients (58%) were male. Left anterior descending artery was involved in 12 patients (0.017%). In nine patients with the anomalous LAD there were concomittant congenital coronary artery anomalies. Concurrent coronary artery anomalies encountered were double left anterior descending artery type 4 (2 cases), double left anterior descending artery type 4 with double right coronary artery (1), double right coronary artery (1), double circumflex artery with anomalous left anterior descending artery (1), circumflex artery from right sinus of Valsalva (1), separate septal perforator and myocardial bridging of posterior descending artery (1), intercoronary communication, and ostial atresia of the left anterior descending artery and anomalous circumflex artery (1). CONCLUSION: Our series is the biggest series where relatively sufficient clinical and angiographic information about the LAD anomalies were provided.     

Coronary artery thrombosis in patients with unstable angina.

This report describes the clinical course, coronary artery anatomy, and ventricular function of 16 patients in whom coronary artery thrombosis was detected at the time of cardiac catheterisation. All patients had an unstable clinical course in which accelerated angina occurred a mean of four weeks (range four days to 12 weeks) before catheterisation, and four patients had recent subendocardial myocardial infarction. In all patients severe coronary artery disease was documented at catheterisation. Fifteen patients had segmental wall motion abnormalities involving the left ventricular wall that was supplied by the coronary artery in which there was thrombus. Three patterns of coronary artery thrombus were noted: (1) Thrombus proximal to high-grade coronary artery stenosis; (2) thrombus distal to high-grade coronary artery stenosis; and (3) thrombus in segments of the arterial tree in which there was no high-grade coronary artery stenosis. Though the precise cause of the coronary artery thrombosis in our patients is unknown, it may have been a result of stasis, a ruptured atherosclerotic plaque, or coronary spasm. The common clinical course with unstable angina of acute onset suggests the possibility that the thrombus may have been responsible for the abrupt change in clinical condition or may have been a contributing factor in the patients' course.     

An unusual case of hypertensive diastolic heart failure with bilateral subclavian artery stenosis

Severe stenosis or occlusion of the subclavian artery is a rare clinical finding, even more so for bilateral existence of the condition. Subclavian artery stenosis and occlusion leads to erroneously low blood pressure values when measured at the brachial artery on the ipsilateral side. Widespread clinical reliance on a sole brachial measurement of blood pressure, particularly in the emergency room setting, may result in inappropriate clinical management in patients with conditions that alter brachial blood pressure. Currently, there is no published English-language literature on the implications of bilateral subclavian artery stenosis and occlusion in heart failure. A case of an apparently hypotensive patient with frequent emergency room visits for symptoms of heart failure exacerbation is presented.     

椎动脉优势、基底动脉弯曲与后循环卒中

椎动脉优势一般被认为是一种先天性血管变异或是无意义的临床发现.许多研究表明,椎动脉优势造成的双侧椎动脉血流不对称易于导致基底动脉弯曲.一些研究显示,椎动脉优势和基底动脉弯曲与后循环卒中均存在一定的相关性.