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PubMed1978

[Umbilical collateral circulation in liver cirrhosis - Cruveilhier-v. Baumgarten syndrome (author's transl)].

Embryonal development and anatomy of the liver are shortly discussed; they do explain collateral circulation in liver cirrhosis. A case report is given of a patient with umbilical collateral circulation (Cruveilhier-v. Baumgarten syndrome), exhibiting impressive clinical and radiological findings. Such an umbilical collateral circulation will develop in up to 21% of all patients with an intrahepatic block. This is only one variant - not prone to complications by the way - of a multitude of different portosystemic shunts in liver cirrhosis. Therefore it should not be talked about as an independent syndrome.

Collateral Circulation↗
PubMed1990

Importance of myocardial ischaemia for recruitment of coronary collateral circulation in dogs.

STUDY OBJECTIVE: The aim of the study was to investigate collateral coronary flow and regional myocardial function following different coronary occlusion protocols. DESIGN: Effects of brief left anterior descending artery (LAD) occlusions in dogs (using a pneumatic occluder around the proximal artery) on collateral circulation were evaluated using three different protocols, each producing the same period of pressure gradient across the collateral network: (1) 10 s occlusion X 30 at 1 min intervals; (2) 1 min occlusion X 5 at 1 min intervals; (3) 5 min occlusion X 1. Each protocol was followed by a 10 s occlusion after a further 1 min period. SUBJECTS: 14 mongrel dogs of either sex were used, weight 10-21 kg. MEASUREMENTS AND MAIN RESULTS: Left ventricular pressure, left circumflex coronary artery (LCCA) flow, and subendocardial segment shortening (% delta L) in the area perfused by the LAD were monitored. Collateral blood flow from LCCA to LAD territory was measured as a stepwise decrease in LCCA flow on release of LAD occlusion. During the first 10 s of occlusion, % delta L decreased from 23.6(SEM 2.2)% to 14.2(2.9)%. After protocol (1), % delta L decreased from 23.1(2.2)% to 14.8(3.0)%. By contrast, after protocol (2) and (3) % delta L decreased only slightly, from 22.7(2.6)% to 20.5(2.8)%, and from 22.4(2.4)% to 19.8(2.4)%, respectively. Although collateral blood flow remained unchanged after protocol (1), it increased from 1.6(0.4) ml.min-1 during the first LAD occlusion to 3.0(0.7) ml.min-1 (p less than 0.05) after protocol (2), and to 3.5(0.6) ml.min-1 (p less than 0.05) after protocol 3. Haemodynamic measurements prior to each 10 s LAD test occlusion remained unchanged throughout the experiment. CONCLUSIONS: The pressure gradient across the collateral network cannot dilate pre-existing collateral vessels by itself, but ischaemia related metabolites may play an important role in the recruitment of collateral circulation.

Animals↗
PubMedDate not supplied

Physiologic assessment of the coronary collateral circulation in transplanted human hearts.

Coronary arteries of transplanted hearts frequently develop a vasculopathy characterized by severe lumenal narrowing in the distal coronary arteries. It has been thought, on the basis of angiographic studies, that the coronary circulation of transplanted hearts with vasculopathy fails to develop collateral vessels normally. To determine the extent of the collateral circulation in transplanted hearts with a significant coronary stenosis, we measured an index of the collateral circulation, the coronary artery occlusion pressure, during single-vessel coronary angioplasty in seven patients with allograft vasculopathy and 18 patients with atherosclerotic disease who did not undergo transplantation. Aortic and coronary artery pressure distal to the stenosis in the epicardial artery were measured during balloon occlusion (> or = 45 seconds). Measurement variability for determination of coronary occlusion pressure was assessed by measuring occlusion pressure on two separate balloon inflations (n = 17). The severity of the dilated stenotic lesion was assessed with quantitative angiography (Reiber-PIE Data method). The indexes of stenosis severity were similar in coronary arteries of transplanted and native hearts. Coronary occlusion pressure measurements were highly reproducible (mean absolute difference between measurements, 1 +/- 1 mm Hg, r = 0.98). Coronary occlusion pressure in transplanted hearts (32 +/- 4 mm Hg) was nearly identical to that measured in coronary arteries of native hearts (29 +/- 2 mm Hg). When vessels with total occlusion were excluded and corrections were made for minor differences in hemodynamics (heart rate and blood pressure) were made, the coronary occlusion pressure in transplanted hearts remained nearly identical to native hearts.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1986

[Intraventricular hemorrhage after carotid endarterectomy. Role of moyamoya-type collateral circulation].

Stenotic lesions of the cervical arteries due to atherosclerosis or irradiation may provoke the development of a Moya-Moya type collateral network. Rupture of a vessel participating in this collateral circulation may be the cause of a hemorrhagic accident. The hemorrhage may be subarachnoid, intracerebral or more usually intraventricular. Intraventricular hemorrhage occurred in a patient who had developed a Moya-Moya type collateral circulation secondary to atherosclerotic stenosis of a carotid artery. The hemorrhagic incident occurred during carotid endarterectomy, suggesting a predisposing role for hemodynamic modifications resulting from the operation.

Carotid Artery Diseases↗
PubMed1996

[Effects of nicorandil on coronary collateral circulation depend on the donor arteries].

The effects of nicorandil on coronary collateral circulation during exercise-induced ischemia were compared between the different donor arteries in 13 patients with effort angina, 7 with complete obstruction of the left anterior descending artery (LAD) with well-developed collateral vessels from the right coronary artery (RCA) (LAD group), and 6 with complete occlusion of the RCA (segment 2-3) with well-developed collateral vessels from the LAD (RCA group). Initial percentage thallium (%TI) uptake (thallium-201 single photon emission computed tomography) and washout rate were measured in the anterior, septal and posterior regions during ergometer exercise. The submaximal treadmill exercise test was also performed using a cardiopulmonary monitoring system to measure Vo2 at anaerobic threshold (AT). After the controls were obtained, nicorandil (15 mg/day) was administered for 4 weeks, during which ergometer exercise and treadmill exercise tests were carried out repeatedly. A significant improvement of initial %TI uptake on exercise was observed in the LAD group with nicorandil therapy, but no improvement was shown in the RCA group. The AT significantly increased after nicorandil treatment in the LAD group (13.9 +/- 0.38-->16.8 +/- 1.18 ml/min/kg), reflecting the improvement of cardiac function through the increased collateral flow. However, in the RCA group, it remained unchanged, suggesting no improvement of cardiac function. Nicorandil was effective to increase collateral flow from the RCA, but ineffective on that from the LAD. Nicorandil is an effective coronary dilator and is reported to affect both large and small coronary arteries. The effect on the collateral circulation is dependent on the donor artery supplying different areas. The vasodilator effect of nicorandil is mainly on the LAD, which is large enough to supply blood to a wider area of the heart, rather than the RCA.

Adult↗
PubMed1991

[A case of aortitis syndrome with coronary steal syndrome due to collateral circulation from the right coronary artery to intracranial vessels].

A 44-year old female with aortitis syndrome complained of precordial pain on effort. Exercise electrocardiograms revealed significant ST segment depression in leads II, III, aVF and V. Coronary arteriograms demonstrated no stenosis. However, the right coronary arteriogram revealed collateral circulation arising from the sinus node artery to the bilateral vertebral arteries and the left internal carotid artery. Collateral vessels in aortitis.syndrome arising from the coronary artery to the lung have been reported sporadically. However, to our knowledge, the collateral circulation from the coronary artery to intracranial vessels as seen in the present case has never been reported. In the present case, the left ventricular hypertrophy was observed on electrocardiograms and echocardiograms. It can not be denied that it was a cause of the angina pectoris. However, exercise myocardial scintigraphy showed transient myocardial ischemia at stress on the inferoposterior wall corresponding to leads II, III, aVF and V on electrocardiograms. Therefore, coronary steal syndrome due to the collateral pathway from the coronary artery may be considered a likely cause of the angina pectoris. The collateral circulation was considered to be an important route of blood flow supply to the brain and, at the same time, a cause of coronary steal syndrome and consequently angina pectoris.

Adult↗
PubMed1991

Collateral circulation as a marker of the presence of viable myocardium in patients with recent myocardial infarction.

The relationship between the presence of viable myocardium and the extent of coronary collateral circulation to the infarct area was evaluated in 20 patients with a recent anterior myocardial infarction who had complete obstruction of the left anterior descending coronary artery. The viability of myocardial tissue was assessed by exercise thallium-201 myocardial scintigraphy, and the collateral circulation was angiographically evaluated by means of a collateral index ranging from 0 to 3. Patients were divided into two groups according to the presence (group 1, n = 10) or absence (group 2, n = 10) of viable myocardium in the perfusion territory of the infarct-related artery. The collateral index in group 1 was 2.5 +/- 0.5 (SD), which was significantly higher than the 0.7 +/- 0.8 in group 2. These findings indicate that the presence of ischemic but viable myocardium is intimately related to the development of collateral circulation in patients with myocardial infarction, and the existence of well-developed collateral channels predicts the presence of viable myocardium in the infarct area.

Collateral Circulation↗
PubMed1996

Visceral artery aneurysms secondary to collateral circulation.

OBJECTIVE: To evaluate dilatation of visceral arteries secondary to anomalies and collateral circulation. DESIGN: Case report. SETTING: Department of Vascular Surgery, University Hospital. PATIENTS: Two patients with secondary visceral aneurysms were reported. First patient (case 1) had a mid-aortic dysplastic syndrome with multiple aneurysms of the celiac trunk and right renal artery. Other patient (- case 2) presented an inferior pancreaticoduodenal artery aneurysm associated with proximal common hepatic artery occlusion. INTERVENTIONS: The case 1 was submitted to aortic and left renal artery angioplasty (PTFEE), while in the case 2 the resection of aneurysm was performed. RESULTS: Both patients had complete resolution of symptoms and are alive today. CONCLUSIONS: Clinical observations confirmed the development of visceral artery aneurysms secondary to arterial hypertension and collateral circulation.

Adult↗
PubMed1997

Evaluation of coronary collateral circulation in early ischemia in rat hearts. A morphological study.

Histological changes were examined in the left ventricular free wall of the heart in 40 rats after ligation of the distal anterior descending coronary artery for 15, 30 minutes and 1, 2, 3, 4, 5, 6 hours. Auto-injection of tracers for light microscopy was used to examine the development of collateral circulation. Morphological changes of the ischemic myocardium were observed by PAS staining and transmission electron microscopy. Fifteen minutes after coronary occlusion, the dye was observed in the vein of the ischemic zone; however, 30 minutes after coronary occlusion, the dye appeared in the capillaries of the outer-third layer. These findings suggested that the collateral circulation becomes functional between 15 and 30 minutes after coronary occlusion. Collateral circulation increased gradually in the capillaries of the ischemic zone. Thirty minutes after coronary occlusion the dye was seen only in the outer-third layer of the ventricular ischemic zone. One hour after occlusion, the dye appeared in the superficial space and the middle-third layer. Three hours after occlusion, the dye was seen in all layers of the ischemic zone. The dye appeared in the ischemic zone, where myocardium damage was not homogeneous. The positive reaction obtained by PAS staining corresponded with the capillaries, veins and superficial spaces in which the dye was evident. These results suggest that collateral circulation, verural back flow and superficial space flow are able to prevent myocardial infarction in early ischemia.

Animals↗
PubMed1992

Relationship between the preexistent coronary collateral circulation and successful intracoronary thrombolysis for acute myocardial infarction.

The purpose of this study was to evaluate whether the existence of coronary collateral circulation influences recanalization rates of intracoronary thrombolysis. The study population consisted of 85 consecutive patients undergoing intracoronary thrombolysis within 6 hours after the onset of the first acute myocardial infarction, all of whom had a complete occlusion of the infarct-related coronary artery. Intracoronary thrombolysis with high-dose urokinase (960,000 IU) was attempted at a rate of 24,000 IU/min. Of 18 patients (group A) who had good angiographic collateral circulation to the area perfused by the infarct-related coronary artery, the obstructed artery was recanalized to a residual luminal diameter stenosis of less than or equal to 90% (successful recanalization) in only five (28%). In contrast, of 67 patients (group B) with poor or no collateral circulation, recanalization was successful in 40 (60%) (p less than 0.05). Antegrade flow of infarct-related arteries was observed following thrombolysis in 12 (67%) of 18 group A patients and in 56 (84%) of 67 group B patients (p = NS). It was concluded that (1) the presence of collaterals correlates with the presence of high-grade stenosis; (2) the presence of collaterals correlates with the presence of high-grade stenosis; (2) the presence of collaterals is inversely related to the efficacy of thrombolytic therapy; and (3) the difference in successful recanalization rates observed between the two groups probably reflects the impact of underlying stenosis severity on the effectiveness of lytic therapy.

Adult↗
PubMed1987

Ischaemia induced development of functional coronary collateral circulation in ponies.

The response of coronary collaterals in nine ponies subjected to repeated reversible occlusions (2 min duration, 30 min interval) of the left anterior descending coronary artery was studied at rest. Each pony was instrumented with a Doppler flowmeter and hydraulic cuff occluder around the left anterior descending coronary artery, left ventricular subendocardial sonomicrometers, and a left ventricular micromanometer. Initial occlusions increased end diastolic myocardial segment length by 3% and decreased segment systolic shortening, stroke work, and velocity of shortening by 103%, 95%, and 79% respectively in the left ventricular apex. Left ventricular systolic and end diastolic pressure, peak positive dP/dt, and heart rate were not significantly changed by occlusion. After 421(70) (mean(SEM)) occlusions no sustained alterations in myocardial segment function occurred in response to occlusion. Thus the presence of a subendocardial plexus did not protect against a severe loss of myocardial segment function when the ponies were initially subjected to occlusions of the left anterior descending coronary artery. However, repeated reversible occlusions enhanced coronary collateral blood flow such that it was adequate to maintain left ventricular function in the absence of left anterior descending coronary artery flow. It is concluded that the pony is highly suitable for use in studies of coronary collateral circulation because of its coronary anatomical similarity to man and its capacity to develop functional collateralisation.

Animals↗
PubMed2005

The transient appearance of collateral circulation during coronary spasm.

This article reports a case of transient augmentation of collateral circulation due to spontaneous coronary arterial spasm during angiography. The patient's electrocardiogram revealed ST-segment depression during vasospastic attack; this depression differs from the typical change of the ST-segment elevation in coronary spasm without collateral circulation.

Collateral Circulation↗
PubMedDate not supplied

[Collateral circulation in patients with internal carotid artery occlusion depending on the localization of the ischemic stroke. Ultrasonographic study].

The relationship between computerized tomography (CT) location of ischaemic strokes and the appearance of collateral circulation on transcranial Doppler ultrasonography (USG-D) was investigated in 30 patients with internal carotid artery occlusion. Evidence of collateral circulation via the anterior communicating artery was observed less frequently (88%) among patients with ischaemic lesions in the anterior and middle cerebral artery distribution, as well as the border zone area between these arteries, than in those with ischaemic strokes in the border zone area between posterior and middle cerebral arteries (100%). In patients in whom focal lesions were not found on CT, good collateral circulation via ophthalmic (100%), anterior communicating (100%) and posterior cerebral (84%) arteries was found on transcranial USG-D.

Adult↗
PubMed1981

The effect of coronary artery bypass on collateral circulation.

The effect of coronary bypass upon collateral circulation (CC) was studied in 69 bypassed coronary arteries in which CC was seen on either the preoperative or postoperative angiogram or both. CC proved to be a highly reliable indicator of bypass effectiveness. Persistence or new development of CC on postoperative angiograms invariably indicated complete bypass obstruction or inadequate revascularization. Disappearance of preexisting CC on postoperative angiograms almost always indicated bypass patency. Occlusion of a bypass does not appear to jeopardize preexisting CC or prevent new CC from developing in most cases.

Adult↗
PubMed2002

Collateral circulation via the ophthalmic artery or leptomeningeal vessels is associated with impaired cerebral vasoreactivity in patients with symptomatic carotid artery occlusion.

BACKGROUND AND PURPOSE: In patients with carotid artery occlusion (CAO), collateral flow may reduce the risk of ischemic stroke. Collateral flow via the ophthalmic artery (OphthA) and flow via leptomeningeal vessels have been considered secondary collaterals, which are recruited only if the primary collateral circulation via the circle of Willis is insufficient. The aim of this study was to investigate whether patients with symptomatic CAO who have secondary in addition to primary collaterals have a worse flow state of the brain than those without secondary collaterals, as measured by vascular reactivity testing. METHODS: We studied 70 patients with symptomatic CAO who were independent for their daily activities. In all patients, collateral circulation through the circle of Willis was present. Vascular reactivity, measured by means of transcranial Doppler sonography with carbogen inhalation, was compared between patients with and without secondary collaterals. RESULTS: CO2 reactivity was lower in 64 patients with (mean +/- standard deviation 8 +/- 14%) than in 6 patients without secondary collaterals (33 +/- 18%) resulting in a mean difference of 24% (95% confidence interval 12-37%; p < 0.01). CONCLUSIONS: Patients with symptomatic CAO with collateral circulation through the OphthA or through leptomeningeal vessels in addition to collaterals via the circle of Willis have a worse hemodynamic status of the brain than those with Willisian collaterals only. Therefore the presence of these collaterals may indicate insufficiency of collateral blood flow via the circle of Willis.

Aged↗
PubMed1990

Improvement of ST segment depression by gradual recruitment of collateral circulation.

The purpose of the present study was to document that the coronary collateral vessels do not open immediately upon the occurrence of myocardial ischemia. A multistage bicycle exercise was performed to determine a maximal tolerable work load until the onset of angina and significant ST segment depression in 10 patients with well-developed collateral circulation. On a different day, exercise with the maximal tolerable work load was repeated for a comparable exercise duration. In 2 of the 10 patients, anginal pain was gradually alleviated despite the continuation of exercise with fixed work load. The extent of ST segment depression at 3 min of exercise with fixed work load was 0.20 +/- 0.10 (SD) mV, significantly (p less than 0.05) greater than 0.16 +/- 0.08 mV at the end of exercise with fixed work load. In contrast, the rate-pressure product was smaller at 3 min than at the end of exercise with fixed work load (20,900 +/- 5,500 vs. 22,700 +/- 5,700 mm Hg.beats/min; p less than 0.05). In 5 patients without well-developed collateral circulation, the extent of ST depression changed in parallel with changes in rate-pressure product during exercise with fixed work load. Thus, it is concluded that the delayed collateral opening plays a critical role in the pathogenesis of myocardial ischemia in patients with a totally occluded coronary artery.

Adult↗