Coronary artery to pulmonary artery fistulas.

Twelve patients with a total of 14 coronary artery to pulmonary artery fistulas were discovered at the time of diagnostic coronary angiography. Six patients had severe coronary artery disease, five patients had normal coronary arteriography, one patient had insignificant coronary artery disease, and one patient had rheumatic heart disease. Only two patients had characteristic continuous murmurs; one patient had a normal coronary angiogram, and the second patient had severe coronary artery disease. Ten fistulas originated from the left anterior descending artery, three from the right coronary artery, and one from the left circumflex artery. The fistulas were either composed of one large (five fistulas) or one or more small channels (seven fistulas) or poorly defined plexiform channels (two fistulas). Hydrogen studies performed in two patients were negative and dye dilution curves performed in all patients were normal. In only four out of the six patients with severe coronary artery disease, the fistulas originated from a diseased vessel and in each case the origin was proximal to the narrowing. The pathogenesis and functional role of these fistulas is largely unknown.     

Interosseous artery as an access artery in case of late radial artery occlusion

We report a new technique of arterial access through the ipsilateral interosseous artery in a case of late radial artery occlusion (RAO). RAO, although not frequent, is a limiting iatrogenic complication after transradial intervention (TRI) and precludes repeat use of the same radial artery for future procedures. Our technique involves obtaining access to the ipsilateral radial artery (RA) in the distal postocclusion segment and use of collateral channel between this segment and the interosseous artery (IOA) for advancing a guidewire and sheath in the IOA lumen and in brachial artery thereafter. © 2017 Wiley Periodicals, Inc.     

Sequential radial artery grafting three-vessel coronary artery disease

Our objective was to compare the results of revascularization by sequential radial artery (RA) grafting with a left anterior descending left internal mammary artery (LIMA)-RA t-composite grafting technique. Patients were grouped as those with proximal anastomoses performed on the ascending aorta (Group A; n = 38), and those with proximal anastomoses performed on the LIMA as t-grafts (Group T; n = 13). Neither of the two groups revealed any mortality. The average number of grafts was lower in Group T (2.23 +/- 0.43 in group T and 2.85 +/- 0.69 in group A, p < 0.05). The results of the control coronary artery angiographies were superior in Group A. The patency rate of the RA grafts was 96.8% in Group A. Of the 20 distal anastomoses performed with RA grafts in 8 patients from Group T, nine (45%) were found to be patent. The patency rates of RA grafts with sequential distal anastomoses were found to be better when the proximal anastomosis was performed on the ascending aorta rather than on the LIMA. In conclusion, sequential distal anastomosis of RA grafts seem to be safe and effective when proximal anastomoses are performed on the ascending aorta.     

Carotid artery in-stent restenosis after carotid artery stenting

Carotid in-stent restenosis is a potential long-term sequela that may occur after carotid artery stenting. We report a single-center experience with this procedure and reviewed the database for individual patient characteristics and possible management options.     

Coeliac artery aneurysm: aorto-hepatic artery reconstruction.

Aneurysms of the coeliac axis are rare. Up to 1997, 137 cases had been reported. Here we present a coeliac aneurysm which involved the origin of the splenic, left gastric, and common hepatic arteries. After making a midline incision, infra-diaphragmatic control of the aorta was obtained. The aorta was clamped for 25 minutes to resect the aneurysm. The defect at the origin of the coeliac axis was closed with 1.5 cm PTFE patch. The distal segments of the splenic and left gastric arteries were ligated. A 6-mm ringed PTFE graft was interposed between the infra-renal aorta and the proper hepatic artery. The control arteriogram showed a good arterial flow. The patient recovered uneventfully after surgery with normalisation of hepatic function.     

椎动脉发育不良与胚胎型大脑后动脉

目的研究椎动脉发育不良的发生率以及椎动脉发育不良与胚胎型大脑后动脉合并存在的概率。方法在颈动脉超声检查的13 298例受检者中,筛选出行头颅磁共振血管成像检查,且入住神经内科病房的患者608例,将椎动脉内径≤2.5mm或双侧管径不对称>50%以上定义为椎动脉发育不良。胚胎型大脑后动脉包括完全型胚胎型大脑后动脉和部分型胚胎型大脑后动脉。将存在单侧或双侧椎动脉发育不良的患者306例作为观察组,无椎动脉发育不良的患者302例作为对照组,分析2组间胚胎型大脑后动脉的检出率。结果 13 298例患者中,检出椎动脉发育不良患者1342例,椎动脉发育不良的发生率为10.1%;观察组患者合并胚胎型大脑后动脉的患者150例,检出率49.0%,其中完全型胚胎型大脑后动脉109例,部分型胚胎型大脑后动脉30例;对照组合并胚胎型大脑后动脉的患者53例,检出率17.5%,其中完全型胚胎型大脑后动脉31例,部分型胚胎型大脑后动脉17例。与对照组比较,观察组胚胎型大脑后动脉的检出率明显升高(P<0.01)。观察组单侧胚胎型大脑后动脉患者95例(63.3%),双侧胚胎型大脑后动脉患者55例(36.7%),对照组中单侧胚胎型大脑后动脉患者37例(69.8%),双侧胚胎型大脑后动脉患者16例(30.2%)。2组单侧和双侧胚胎型大脑后动脉的发生率比较,差异无统计学意义(P>0.05)。结论椎动脉发育不良并不少见,并且常常合并胚胎型大脑后动脉。     

Dual right coronary artery associated coronary artery fistula

A 43-year-old man was admitted in our hospital for recurrentchest pain, breathlessness, and fatigue on exertion. Primarydiagnosis was coronary atherosclerotic heart disease. Detailedphysical examination, electrocardiogram (ECG), Chest X-ray,and     

Carotid artery involvement in patients of atherosclerotic coronary artery disease undergoing coronary artery bypass grafting

BACKGROUND: Patients with concomitant critical carotid and coronary artery disease are at risk of major neurological events while undergoing coronary artery bypass grafting. The presence of carotid artery stenosis increases the stroke rate in the perioperative period. In an effort to reduce the stroke rate, many institutions perform routine preoperative noninvasive assessment of the carotid arteries. METHODS AND RESULTS: We analyzed the clinical and laboratory data of 1,200 patients who underwent coronary artery bypass surgery in the last 2 years. Carotid Doppler was normal in 186 patients (15.5%), and showed <30% stenosis in 796 (66.3%), 30%-50% in 110 (9.2%), 50%-70% stenosis in 64 (5.3%) and critical (>70%) stenosis in 44 (3.7%) patients. Conventional risk factors such as hypercholesterolemia, hypertension, smoking and family history were not independent predictors of carotid artery stenosis. However, diabetes as a risk factor had a significant association with carotid artery disease (79.6% v. 43.8%, p<0.02). There was a trend towards increased prevalence of carotid artery stenosis in patients with > or = 2 risk factors (84.3% v. 68.8%). Patients with significant carotid artery stenosis had severe coronary artery disease (triple-vessel disease 93.3%, left main coronary artery disease 12.0%). Out of 44 patients with critical carotid artery stenosis, 27 were subjected to carotid angiography. Doppler findings correlated well with angiography. Seventeen patients underwent carotid artery intervention. None had any perioperative neurological events. A total of 5 (0.4%) patients had a major stroke. Coronary artery bypass grafting was done in 27 patients with critical stenosis without any intervention. The stroke rate (11.1%) was higher in these patients compared to patients with < 70% carotid artery disease or post-carotid intervention (2.5%) patients. Thus, untreated >70% carotid artery stenosis was associated with a higher stroke rate. CONCLUSIONS: Doppler screening of the carotid artery is helpful in detecting the subgroup of patients at increased risk of stroke. Patients with critical carotid artery stenosis should be subjected to angiography. Prophylactic intervention may reduce the occurrence of stroke in the perioperative period.     

Single right coronary artery with absence of the left main coronary artery,left anterior descending artery,and circumflex artery

Single coronary artery is an extremely rare congenital coronary anomaly in which the entire coronary arterial system arises from a solitary ostium. The Lipton's classification is used for single coronary artery anomalies. Herein, we present a 72‐year‐old woman with single coronary artery anomaly admitted with atypical chest pain. Coronary angiography and multidetector computed tomography coronary angiography findings were shared.