Accessory left hepatic artery arising from common hepatic artery

The knowledge of anatomical variations in hepatic artery are of importance to surgeons and radiologists while performing complicated procedures like liver transplantation and transarterial chemo-embolization for hepatic tumors. The incidence of accessory left hepatic artery is less common than the right accessory hepatic artery. Here we report an anomalous accessory left hepatic artery arising from common hepatic artery in a 55 year old male cadaver.     

Proximal superficial temporal artery to proximal middle cerebral artery bypass using a radial artery graft: an anatomic approach

We present the use of radial artery graft for bypass of the proximal superficial temporal artery to the proximal middle cerebral artery. Six adult cadaver sites were used bilaterally. After apterional incision, 2×2-cm minicraniectomy was performed which began 2 cm behind the zygomatic process of the frontal bone. The superficial temporal artery was transsected before exposing the zygomatico-orbital artery branch. The proximal side of the radial artery graft was anastomosed end-to-end to the proximal superficial temporal artery and the distal side end-to-side to the proximal middle cerebral artery. The mean calibers of the proximal superficial temporal artery and largest trunk of the middle cerebral artery were 2.25±0.35 mm and 2.3±0.3 mm, respectively. The average graft length was 85±5.5 mm. We conclude that such bypasses are simpler than proximal middle cerebral artery revascularization using long vein grafts. This method proves that the caliber of the proximal superficial temporal artery is more suited to providing sufficient flow than the distal superficial temporal artery, and the graft is short. Such bypasses to the middle cerebral artery may be an alternative to those from the distal superficial temporal artery or extracranial carotid artery.     

冠状动脉硬化性心脏病合并左锁骨下动脉严重狭窄非体外循环下同期手术的临床经验

目的探讨非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路治疗冠状动脉硬化性心脏病(冠心病)合并锁骨下动脉重度狭窄的手术方法及效果.方法2003年1月～2004年5月,我院治疗须行冠状动脉旁路移植术同时合并左锁骨下动脉近端重度狭窄3例,术中先行主动脉-锁骨下动脉旁路,左乳内动脉获得满意的流量后,再行非体外循环冠状动脉旁路移植.结果手术时间210～340 min,平均283 min,出血量570～1 630 ml,平均963 ml.游离左乳内动脉后量杯测流量均＜5 ml/min,主动脉-锁骨下动脉旁路后量杯测流量均＞50 ml/min,乳内动脉远端与前降支吻合后流量仪测流量12～27 ml/min,平均20 ml/min.术后临床症状缓解,未发现冠脉-锁骨下动脉窃血综合征.3例随访3～6个月,平均5个月,无心绞痛发作.结论非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路手术是治疗冠心病合并锁骨下动脉重度狭窄简单而有效的方法.     

Double-vessel revascularization using a composite graft approached from small left thoracotomy

Minimally invasive direct coronary artery bypass usually includes single vessel revascularization via a small skin incision. In most cases, the left internal mammary artery has been used for bypassing to the left anterior descending artery, and only single vessel revascularization used to be performed due to the limited operating field. We present 2 cases of successful double-vessel revascularization approached from a left small thoracotomy, using a composite graft of the internal mammary artery and the inferior epigastric artery, anastomosing to the left anterior descending artery and diagonal artery.     

冠状动脉病变程度与冠心病危险因素的相关分析

目的探讨冠心病患者冠状动脉病变的严重程度与冠心病危险因素的关系。方法选择冠心病患者116例为冠心病组,选择冠状动脉样硬化狭窄程度〈50%的患者66例为对照组。分析冠状动脉狭窄程度与冠心病危险因素的关系。结果多因素分析结果显示,LVEF、Ccr与冠状动脉粥样硬化程度呈负相关,而hs-CRP与冠状动脉粥样硬化程度呈正相关（P〈0.05或P〈0.01）。结论冠状动脉狭窄程度与LVEF、Ccr呈负相关,与hs-CRP呈正相关。     

老年冠心病患者经桡动脉途径同时接受冠状动脉、肾动脉和下肢动脉造影的安全性及有效性探讨

目的探讨老年冠心病患者经桡动脉途径冠脉造影同时行下肢动脉及肾动脉造影的方法并分析其安全性及有效性。方法收集可疑冠心病伴外周动脉粥样硬化的老年患者275例(年龄≥60岁)行选择性冠脉造影同时行肾动脉及下肢动脉造影。按介入途径分为左桡动脉组(124例)及右桡动脉组(151例),各组再按年龄段分为三个不同亚组:低龄老年亚组(60~69岁),中龄老年亚组(70~79岁),高龄老年亚组(≥80岁),分别以左、右桡动脉途径运用TIG共用造影管(100cm)及MP A1造影管(125cm)依次行冠脉、双侧下肢动脉和肾动脉造影,比较桡动脉穿刺成功率、造影操作时间、对比剂用量、X线曝光时间及造影完成率等,并分析这些指标与年龄的相关性。结果左、右桡动脉组的穿刺成功率及对比剂用量差异无统计学意义,而左桡动脉组造影操作时间、X线暴露时间均低于右桡动脉组,造影完成率亦明显高于右桡动脉组;左、右桡动脉组造影操作时间均与年龄呈正相关,而X线曝光时间与年龄无相关性。结论老年患者经左桡动脉途径冠脉造影同时行下肢动脉及肾动脉造影完成率高,安全有效,可作为首选路径。     

Ruptured anterior spinal artery aneurysm: a case report

BACKGROUND

Spinal artery aneurysms are rare, and are usually found in association with arteriovenous malformations or coarctation of the aorta.

CASE REPORT

A 42-year-old man with a ruptured anterior spinal artery aneurysm is presented here. He experienced subarachnoid hemorrhage, which was confirmed by computed tomography. Magnetic resonance imaging revealed an aneurysm in front of the upper part of the medulla. Angiography demonstrated bilateral vertebral artery occlusion. Distal vertebral arteries and the basilar artery were perfused via the dilated anterior spinal artery, which originates in the right subclavian artery. The aneurysm was located at the distal part of the anterior spinal artery, and was successfully clipped through a lateral suboccipital craniotomy 2 months after bleeding from the aneurysm. After rehabilitation, the patient was able to walk with no apparent neurologic deficit.

CONCLUSIONS

This case suggests that the anterior spinal artery as a collateral route after bilateral vertebral arery occlusion is under hemodynamic stress, resulting in aneurysm formation and rupture.     

原位肝移植术中肝动脉变异及术后肝动脉血栓形成的处理

目的探讨肝移植术中肝动脉变异及术后肝动脉血栓形成的处理。方法统计2000年8月至2002年12月期间进行肝移植术的67例次供、受者肝动脉的变异情况；分析肝动脉的重建方式，探讨肝动脉变异与手术后肝动脉血栓形成的关系、肝动脉血栓形成的危险因素及肝动脉血栓形成后的处理。结果67例次供者肝脏和65例受者肝脏共出现肝动脉变异12例次，发生频率最高的为右肝动脉起源于肠系膜上动脉(5例)及左肝动脉起源于胃左动脉(3例)。肝动脉的重建方式如下：供者及受者肝总动脉与胃十二指肠动脉分叉处成型后吻合58例；腹主动脉与肝动脉搭桥2例；利用变异的肝动脉分支吻合7例。手术后发生肝动脉血栓形成3例，均经腹股沟处股动脉插管行肝动脉溶栓治疗，此3例患者中死亡1例。结论避免变异的肝动脉损伤、选择适当的肝动脉吻合方式可以保证移植肝脏的动脉血供。肝动脉血栓形成与肝动脉变异无关。作为肝动脉血栓形成后的保守治疗方法，肝动脉内溶栓治疗有可能避免2次移植。     

An anatomical variation of the thoracodorsal artery with comments on flaps based on the axillary artery

Summary A rare variation of the axillary artery is presented. On routine anatomical dissection in one male cadaver the thoracodorsal artery was found to originate from the acromiothoracic artery independently from the circumflex scapular artery. Numerous flaps based on the branches of the axillary artery have been described. As a result of this case, and a review of the literature to gain further knowledge of anatomical variations, it is advised that preoperative angiography is indicated prior to utilizing flaps from this area.     

同体肱动脉与桡动脉血压值比较的研究

目的探讨肱动脉血压与桡动脉血压值差别。方法采用台式血压仪监测169名观察对象,取右侧上肢分别测 量肱动脉血压与桡动脉血压,并将所测血压值进行比较。结果169名同体肱动脉血压和桡动脉血压值差异无显著 性意义(P>0.05)。结论必要时可采用测量桡动脉血压代替肱动脉血压值。     

Traumatic pseudoaneurysms of external carotid artery branch: Case series and treatment considerations

PurposeTo explore the diagnosis and treatment of traumatic external carotid branch pseudoaneurysms.MethodsEleven cases of traumatic external carotid artery branch pseudoaneurysms were admitted in our hospital. Digital subtraction angiography was performed in all patients. It revealed that the pseudoaneurysms originated from the internal maxillary artery in 5 cases, superficial temporal artery in 5 cases and occipital artery in 1 case. Five cases of internal maxillary artery pseudoaneurysms and 2 cases of superficial temporal artery pseudoaneurysms were treated by embolization; the other 3 cases were surgically resected.ResultsComplete cessation of nasal bleeding was achieved in all the 5 pseudoaneurysms of internal maxillary artery after the endovascular therapies. Scalp bleeding stopped and scalp defect healed up in 2 patients with superficial temporal artery pseudoaneurysms treated by interventional therapy. All patients were followed up for 0.5–2.0 years without recurrence of nosebleed and scalp lump.ConclusionFor patients with repeated severe epistaxis after craniocerebral injury, digital subtraction angiography should be performed as soon as possible to confirm traumatic pseudoaneurysm. Endovascular therapy is an effective method for traumatic internal maxillary artery pseudoaneurysms. For patients with scalp injuries and pulsatile lumps, further examinations including digital subtraction angiography should be performed to confirm the diagnosis. Surgical treatment or endovascular therapy for scalp traumatic pseudoaneurysm is effective.     

Bronchial to subclavian shunt in a CF patient. A potential pitfall for embolization

Bronchial artery embolization is a well accepted and widely used technique in the management of massive haemoptysis in cystic fibrosis (CF). It can be a complex procedure requiring a deep knowledge of the bronchial artery anatomy including the possible bronchial anastomoses. We report a case of complex vascular anatomy of the left bronchial artery with multiple anastomoses with the ipsilateral subclavian artery as cause of non-attempted embolization.     

Successful surgical management for aneurysms of single coronary artery with a fistulous connection to the right ventricle

While a coronary artery fistula with aneurysmal formation is rare, a fistula/aneurysm combination occurring in single coronary artery is even rarer. Here, we report the successful surgical correction of a right ventricular fistula with a large aneurysm of 30 mm and a daughter aneurysm within a case of single coronary artery.     

椎动脉V2段与周围结构关系的解剖学观察

目的 了解椎动脉V2段与周围结构的解剖关系,探讨颅外椎动脉供血不足的解剖学机制。方法 在20例头部尸体标本,解剖观察椎动脉与周围结构的关系;其中17例制成干骨,测量C3－C7有关横突孔参数。另在2例新鲜尸体标本取材行组织学切片观察椎动脉周围组织。结果 延续自颈椎、横突孔、关节突等骨膜组织形成明显的纤维鞘膜样结构,将椎动脉、椎静脉及神经根包裹在内。椎动脉外膜与钩突之间有纤维这样组织相连,限制椎动脉。横突孔内未见明显骨性狭窄。结论 椎动脉周围的骨性吸软组织性因素对椎动脉起到限制固定作用,在颈椎运动或不稳时,椎动脉易受波及而出现供血不足。椎动脉牵系机制在椎动脉供血不足发生中可能起着重要的作用。     

冠状动脉旁路移植术218例临床分析

目的：总结冠状动脉旁路植术（CABG）治疗冠心病的经验。方法：回顾分析2001年1月－2002年2月完成的CABG218例，体外循环下冠状动脉旁路移植手术（CCABG）152例，非体外循环下冠状动脉旁路移植手术（OPCAB）66例，对手术方法、主要并发症和围术期治疗进行分析。结果：院内死亡5例。1例术后第14天死于肺部感染、急性肾功能衰竭；1例术后第3天死于心肌梗死；1例术后第2天死于急性肺梗死；2例因ARDS、多器官功能衰竭死亡。余213例治愈出院。随访有6例复发心绞痛，药物治疗有效。结论：严格掌握手术适应证、充分的术前准备、手术技巧的完善、良好的心肌保护及加强围术期处理是提高CABG早期疗效的关键因素。     

额颞皮瓣内动脉吻合情况的解剖学研究

目的：明确额颞皮瓣供养血管－颞浅动脉额支与眶上动脉的吻合情况，为临床实践提供可靠的解剖学资料。方法：用红色乳胶灌注17具成人尸头，解剖观察额颞浅动脉额支及眶上动脉的分支及其相互关系，结果：显示颞浅动脉额支的终末支平均为3．4支，其中，22／34侧的颞浅动脉额支以一终末支与眶上动脉分支直接吻合，8／34例以一交通支与眶上动脉分支相连，4／34侧两者之间则无明显的吻合或交通。结论：颞浅动脉与眶上动脉之间的吻合方式主要是颞浅动脉的终末支与眶上动脉分支直接吻合，或以一交通支相连。     

内窥镜采集桡动脉在冠状动脉旁路移植术中的应用及组织学评估

目的 观察冠状动脉旁路移植术(CABG)术中应用内窥镜桡动脉采集技术的效果,通过组织学观察评价内窥镜采集桡动脉的安全性.方法 2003年8月至2008年6月,87例CABG患者采用VagoView5内窥镜系统采集桡动脉.分别对各10例传统切开及内窥镜采集的桡动脉近端和远端各取4 mill,利用光学显微镜和透射电子显微镜检查进行组织学对照.结果 内窥镜采集耗时42～98 min,平均耗时(57.6±17.3)min;获取桡动脉长度15～20 cm,平均(17.5±1.6)cm;采集的桡动脉无明显损伤,除2例外所有采集的桡动脉都被用于CABG.7例患者术后早期拇指背侧有轻度感觉异常,随访3个月后明显改善.光镜和电子显微镜下桡动脉内膜、中层、外膜的损伤情况与传统切开组相似.结论 CABG术中应用内窥镜采集桡动脉可取得良好的外观效果,不损伤桡动脉血管结构,神经损伤可减到最小程度.组织学分析结果证实该方法与传统切开法具有同样的安全性.     

Minimally Invasive Multiple Coronary Artery Bypass Grafting with Composite Graft Using in situ Right Gastroepiploic and Radial Arteries

Minimally invasive surgery/coronary artery bypass grafting (MICS CABG) via left thoracotomy and multiple CABG is a reported alternative to the standard sternotomy approach. However, harvesting the right internal thoracic artery (RITA) under direct vision requires high surgical skill. We describe MICS CABG with the left internal thoracic artery (LITA) and a composite graft using the in situ right gastroepiploic artery (GEA) and radial artery (RA) to achieve complete coronary revascularization. No complications occurred, and postoperative computed tomography showed patency of all grafts. Our experience suggests that this composite graft can be used safely and effectively in MICS CABG for complete arterial revascularization without difficulty.     

超选择性肾动脉栓塞治疗肾部分切除术后假性动脉瘤4例报告

目的：探讨应用超选择性肾动脉栓塞技术治疗肾动脉假性动脉瘤的临床经验。方法：回顺性分析2010年10月～2012年8月肾部分切除术后出现4例假性动脉瘤患者的临床资料：均出现肉眼血尿,经肾动脉造影检查确诊,并同期行超选择性肾动脉栓塞治疗。结果：血尿于栓塞后消失,似性动脉瘤也完全消失。随访2个月～2年未见复发。结论：采用超选择性肾动脉栓塞术治疗肾部分切除术后假性动脉瘤安全有效。     

Anomalous supratendinous course of the fifth extensor compartment artery: a case report

Vascularized bone grafts have been successfully used in the treatment of carpal bone nonunion and avascular necrosis. The 4 + 5 extensor compartmental vascularized bone graft based on the fourth extensor compartment artery with retrograde blood flow through the fifth extensor compartment artery is the pedicle of choice for vascularized bone grafting of the lunate. This case report describes an anomalous supratendinous course of the fifth extensor compartment artery. The recognition of this anatomic variant is important for the safe dissection of the fifth extensor compartment artery.