Portal vein variations in 1000 patients: surgical and radiological importance

Objective:

The purpose of the study was to evaluate the spectrum and incidence of intrahepatic portal vein (PV) variations on triphasic abdomen multidetector CT (MDCT) and to discuss the surgical and radiological implications.

Methods:

A retrospective review of 1000 triphasic MDCT abdomen scans was performed in patients sent for various liver and other abdominal pathologies between January 2014 and August 2014. A total of 967 patients (N = 967) were included in the study. The variations in branching pattern of PV were classified according to classification used by Covey et al (Covey AM, Brody LA, Getrajdman GI, Sofocleous CT, Brown KT. Incidence, patterns, and clinical relevance of variant portal vein anatomy. AJR Am J Roentgenol 2004; 183: 1055–64) and Koç et al (Koç Z, Oğuzkurt L, Ulusan S. Portal vein variations: clinical implications and frequencies in routine abdominal CT. Diagn Interv Radiol 2007; 13: 75–80).

Results:

Normal anatomy (Type I) was seen in 773 patients (79.94%) out of 967 patients in our study. Trifurcation (Type II) anomaly was seen in 66 (6.83%) of cases. Right posterior vein as first branch of main PV (Type III) anomaly was seen in 48 (4.96%) of cases. Type IV anomaly and Type V anomaly was seen in 26 (2.69%) and 13 (1.34%) cases, respectively. 19 cases showed other types of variations.

Conclusion:

Variations in the hepatic PV branching patterns are commonly seen that are similar to variations in hepatic artery and biliary anatomy. Knowledge of these variations is extremely important for transplant surgeons and intervention radiologists.

Advances in knowledge:

Awareness of the variations in PV branching patterns is essential for intervention radiologists and vascular surgeons and avoids major catastrophic events.     

Unusual disposition of lateral circumflex femoral artery: Anatomical description and clinical implications

The anatomical knowledge of arterial variations of lower limb is of utmost significance for the present day surgeons and interventional radiologists for minimizing complications during vascular reconstructive procedures, catheterization procedures and surgical intervention for embolism. Lateral Circumflex Femoral Artery(LCFA) isan important branch of Profunda Femoris artery and precise knowledge of its variations can be of great relevance during surgical and radiological procedures in femoral region. The present study reports a unique case of anomalous route taken by LCFA posterior to femoral nerve associated with a prominent muscular branch from Femoral artery mimicking the course of LCFA. Documentation of such variations is highly significant. It may serve as guideline for surgeons in reducing the incidence of postoperative complications where LCFA is used as a long vascular pedicle in anterolateral perforator thigh flap and in breast reconstruction after mastectomy. Ignorance of such variations can lead to fatal intraoperative haemorrhage and incapacitating sensory and motor deficit due to injury to femoral nerve branches which are closely related to these vessels.     

Robotic-Assisted Percutaneous Coronary Intervention

Purpose of review

The goal of this review is to describe the benefits and limitations of robotic-assisted percutaneous coronary intervention (PCI), the most important and recent clinical data, and the future applications as robotic technology continues to develop.

Recent findings

Robotic-assisted PCI can reduce occupational hazards of ionizing radiation exposure and orthopedic injury to the interventional cardiologist while offering increased precision and fine control that may confer benefit to the patient. Recent studies have suggested the efficacy and safety of robotic-assisted PCI, yet widespread use of the technology has not been fully adopted due to limitations of the current technology and high costs.

Summary

Robotic-assisted PCI has potential to benefit both the operator and the patient. Despite some limitations of robotic-assisted PCI, it can safely and effectively be used in many patients with coronary artery disease requiring PCI. The value proposition for robotic-assisted PCI will depend on the evolution of robotic systems and its applicability to more complex coronary lesions, peripheral arterial interventions, and telemedicine.

     

Infection--an underappreciated cause of bone pain in multiple myeloma

Bone pain, especially back pain, is a common presenting feature of myeloma patients. We report three multiple myeloma patients with exacerbations of back pain and referred shoulder pain resulting from vertebral infections. Two patients were treated with surgery, and one patient had computerized tomography-guided percutaneous needle aspiration for diagnostic purposes. All three patients received a prolonged course of antibiotics. Vertebral infection resolved with this treatment in all three patients without any recurrence. Previous dexamethasone therapy, together with an episode of bacteraemia, appears to be a predisposing factor for vertebral infection. Magnetic resonance imaging enabled the diagnosis in all three patients.     

Role of kinin B2 receptor signaling in the recruitment of circulating progenitor cells with neovascularization potential

Reduced migratory function of circulating angiogenic progenitor cells (CPCs) has been associated with impaired neovascularization in patients with cardiovascular disease (CVD). Previous findings underline the role of the kallikrein-kinin system in angiogenesis. We now demonstrate the involvement of the kinin B2 receptor (B(2)R) in the recruitment of CPCs to sites of ischemia and in their proangiogenic action. In healthy subjects, B(2)R was abundantly present on CD133(+) and CD34(+) CPCs as well as cultured endothelial progenitor cells (EPCs) derived from blood mononuclear cells (MNCs), whereas kinin B1 receptor expression was barely detectable. In transwell migration assays, bradykinin (BK) exerts a potent chemoattractant activity on CD133(+) and CD34(+) CPCs and EPCs via a B(2)R/phosphoinositide 3-kinase/eNOS-mediated mechanism. Migration toward BK was able to attract an MNC subpopulation enriched in CPCs with in vitro proangiogenic activity, as assessed by Matrigel assay. CPCs from cardiovascular disease patients showed low B(2)R levels and decreased migratory capacity toward BK. When injected systemically into wild-type mice with unilateral limb ischemia, bone marrow MNCs from syngenic B(2)R-deficient mice resulted in reduced homing of sca-1(+) and cKit(+)flk1(+) progenitors to ischemic muscles, impaired reparative neovascularization, and delayed perfusion recovery as compared with wild-type MNCs. Similarly, blockade of the B(2)R by systemic administration of icatibant prevented the beneficial effect of bone marrow MNC transplantation. BK-induced migration represents a novel mechanism mediating homing of circulating angiogenic progenitors. Reduction of BK sensitivity in progenitor cells from cardiovascular disease patients might contribute to impaired neovascularization after ischemic complications.