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PubMed1976

[Internal carotid artery occlusion - clinical-morphological correlations].

An attempt has been made by the authors to find correlations between the collateral circulation and clinical condition in thirty-three patients suffering from occlusions of the internal and common carotid arteries. It has been found that the course of disease will be less severe when a collateral circulation is developed; also, this results in late consequences being much less severe in character. The age and general condition of the patient were found to be of major importance to the course of disease. Patients of advanced age usually do not show any appreciable improvement even in those cases where a collateral circulation has developed. Anatomical examinations showed that there existed a large number of collateral circulations between the external carotid artery and the branches of the ophthalmic artery. Playing the most important role among these branches of the external carotid artery are the maxillary and facial arteries. This has also been confirmed by the results of angiographic examinations made in vivo. Also described in this paper are rare cases of development of collateral circulations which were reported in the literature and which may be considered as contributing to the compensation of conditions characterized by the occlusion of the internal carotid artery.

Adolescent↗
PubMed1980

Percutaneous transhepatic portography in the assessment of portal hypertension. Clinical correlations and comparison of radiographic techniques.

Sixty-four transhepatic portograms performed before transhepatic obliteration of varices in patients with variceal hemorrhage have been reviewed. Sixty-two patients had coronary gastroesophageal vessels feeding gastric and esophageal varices and other major collateral circulation was seen in 25 patients. There was no relationship between the presence of major collateral circulation and the height of portal pressure or the severity of hemorrhage from gastroesophageal varices. Failure to opacify the intrahepatic portal venous system was seen in 11 patients and was strongly associated with portal-systemic encephalopathy. In addition to transhepatic portography, 35 patients had a splenic portogram, and 27 patients had coeliac axis angiography. There was poor agreement between the findings of these three techniques. Transhepatic portography was markedly superior in demonstrating the portal-systemic collateral circulation. Because of the excellent anatomical definition obtained, transhepatic portography is a superior technique for visualizing the portal system. However, even this technique may occasionally fail to demonstrate gastroesophageal collateral circulation in patients with endoscopically documented variceal hemorrhage.

Adult↗
PubMed2000

Cerebral oximetry for the detection of cerebral ischemia during temporary carotid artery occlusion.

The near-infrared spectroscopy cerebral oximeter was assessed as a monitoring device for detecting and/or predicting cerebral ischemia during carotid endarterectomy (CEA) and the balloon occlusion test in 24 patients, 12 males and 12 females aged 28 to 77 years (mean 59.9 years). Tolerance testing of complete internal carotid artery (ICA) occlusion by balloon inflation for 20 minutes was performed in nine patients (cerebral aneurysm 6, neck tumor 3) and CEA was performed in 15 patients. The probe of the cerebral oximeter was placed on the forehead of the affected side and regional cerebral oxygen saturation (rSO2) was monitored continuously during all procedures. Stump pressure was measured just after ICA occlusion. Collateral circulation detected by digital subtraction angiography was classified into three groups: good, moderate, or poor. Stump pressure was 41-90 mmHg (mean 61.3 mmHg) in the good collateral circulation group, 40-43 mmHg (41.5 mmHg) in the moderate group, and 14-30 mmHg (23.8 mmHg) in the poor group. Change in rSO2 after ICA occlusion was +3.5(-)-4.2% (mean -1.6%) in the good collateral circulation group, -1.2(-)-6.6% (-3.2%) in the moderate group, and -2.4(-)-10.2% (-6.6%) in the poor group. Changes in rSO2 were significantly different between the good and poor collateral circulation groups (p < 0.01). A greater than 5% fall in rSO2 was observed in 0 of 15 patients in the good collateral circulation group, one of five in the moderate group, and three of four in the poor group. The cerebral oximeter is a useful, real-time, non-invasive method to measure brain oxygenation during CEA, skull base surgery, or other procedures which need to evaluate brain ischemia. A fall of greater than 10% from the rSO2 baseline value is dangerous, but less than 5% is safe.

Adult↗
PubMed2002

Color velocity imaging quantification in the detection of intracranial collateral flow.

BACKGROUND AND PURPOSE: The development of intracranial collateral circulation is associated with a lower risk of stroke. A noninvasive technique that can reliably detect the presence of intracranial collaterals would be a valuable factor in the assessment of risk in patients with occlusive cerebrovascular disease. METHODS: Color velocity imaging quantification was used to measure the blood flow volume of the common carotid and vertebral arteries in 40 patients with carotid occlusive disease. The blood flow volumes in these arteries were correlated with angiographic evidence of collaterals to establish the best cutoffs for detecting intracranial collateral circulation. RESULTS: A blood flow volume of either > or =370 mL/min in the common carotid artery or > or =120 mL/min in the vertebral artery was indicative of the presence of intracranial collaterals. The sensitivity and specificity for the common carotid artery were 92.3% [95% confidence interval (CI), 62.1 to 99.6] and 92.1% (95% CI, 77.5 to 97.9), respectively. The sensitivity and specificity for the vertebral artery were 75.0% (95% CI, 35.6 to 95.5) and 87.5% (95% CI, 66.5 to 96.7), respectively. CONCLUSIONS: Color velocity imaging quantification offers a noninvasive, accurate method for detecting the presence of intracranial collateral circulation and quantifying its magnitude. This technique would be a useful adjunct in screening or continuous monitoring of patients with severe carotid occlusive disease.

Aged↗
PubMed1994

[The efficacy of both antegrade and retrograde cardioplegia in coronary artery bypass surgery].

We evaluated the efficacy of the cardioplegic myocardial protection by combining antegrade cardioplegic induction via the aortic root with retrograde cardioplegia via the coronary sinus in patients who had LAD stenosis or occlusion with collateral circulation. In study I, forty-six patients were divided into two groups: antegrade group (group A; 32 cases), which were perfused by only antegrade fashion via the aortic root, and bi-directional group (group B; 14 cases), which were perfused by combining antegrade with retrograde fashion. In study II, patients were divided into four groups: 32 cases in group A were divide into three subgroups by the direction of the collateral circulation to LAD in preoperative coronary angiograms: group I (antegrade collateral circulation; 18 cases), group II (retrograde collateral circulation; 7 cases), group III (99% stenosis with delayed filling; 7 cases) and group B was as group IV. Myocardial injury was assessed with the use of enzyme indexes (total CPK, CPK-MB, %MB, peak CPK, peak CPK-MB and peak % MB) in study I and study II. There was no significant difference between the two groups in study I and the four groups in study II in terms of patients' profile, graft materials, number of grafts, aortic cross-clamping time, total cardiopulmonary bypass time and surgical results. Total CPK level in group B was significantly lower (p < 0.05) compared with group A at the point of 12 hr and 1 day after surgery and peak CPK level was also significantly lower (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Collateral Circulation↗
PubMed2004

Chronic total occlusion of left main coronary artery.

Chronic total occlusion of left main coronary artery is a very rare angiographic finding as majority of these patients do not survive long enough to undergo coronary angiography. We describe a patient with angiographic findings of chronic total occlusion of left main coronary artery with left coronary circulation collateralized from right coronary artery.

Arterial Occlusive Diseases↗
PubMed1992

[A right kidney autotransplant after inferior cavectomy].

We investigated the feasibility of diverting blood supply from the right kidney after resection of the vena cava by autotransplantation to the right iliac fossa. The experiment was conducted in 10 mini-pigs that had previously undergone partial ligation of the vena cava to produce collateral circulation. Although a good collateral circulation had developed, it was not sufficient to drain the complementary venous supply (right kidney). All the animals developed venous thrombosis and, consequently, irreversible renal failure.

Acute Kidney Injury↗
PubMed1991

[Ramus limbi dextri or "moderator band" artery].

A patient who died of acute left ventricular failure in the course of myocardial infarct is described. At autopsy anterior myocardial infarct was confirmed. Postmortem coronarography revealed almost complete occlusion of the left main coronary artery and a very well developed collateral circulation. Part of the collateral circulation was the moderator band artery (visualized during coronarography).

Acute Disease↗
PubMed2002

Cerebral angiography and MR perfusion images in patients with ischemic cerebral vascular disease.

OBJECTIVE: To evaluate the value of perfusion MR imaging and angiographic evidence of collateral circulation in symptomatic patients with ischemic cerebrovascular diseases (ICVD). METHODS: Cerebral angiography and perfusion MR were performed in 16 patients with symptoms of ICVD. Qualitative perfusion maps were calculated for regional cerebral blood volume (rCBV) and mean transit time (MTT). RESULTS: A total of 27 lesions were seen on the perfusion MR maps (6 infarcts and 21 ischemic lesions) and most of them (26/27) showed a prolonged MTT. MTT is sensitive to the presence of ischemic lesions, but not sufficient in distinguishing infarct from ischemia. All of the infarcts showed a decreased rCBV, while most of the ischemic lesions showed a normal or increased rCBV. When collateral circulation was identified on angiography, most ischemic lesions were not infarcts and had a normal or increased rCBV. The absence of angiographically identifiable cerebral collaterals may not always result in an infarct; 50% had decreased rCBV. Despite the absence of angiographic collaterals, the other half had normal or increased rCBV. CONCLUSION: Cerebral angiographic evidence of collateral circulation is important in identifying a favorable outcome in patients with ICVD. However, a lesion with a normal or increased rCBV suggests a sufficient collateral circulation even without angiographic collaterals. Perfusion images may be a potentially useful adjunctive tool in the prediction of the outcome of ICVD, particularly where no apparent collateral macrocirculation is seen on CA.

Adult↗
PubMedDate not supplied

Collateral pathways in patients with celiac axis stenosis: angiographic-spiral CT correlation.

Although celiac axis stenosis is a frequently encountered occlusive vascular disease, clinically significant ischemic bowel disease caused by celiac axis stenosis is rarely reported due to rich collateral circulation from the superior mesenteric artery (SMA). The most important and frequently encountered collateral vessels from the SMA in patients with celiac axis stenosis are the pancreaticoduodenal arcades and the dorsal pancreatic artery. Subtypes of collateral pathways via the dorsal pancreatic artery include a longitudinal pathway between the celiac branches and the SMA or its branches and a transverse pathway to either the splenic or gastroduodenal artery. A communicating channel between the right hepatic artery and the SMA can be a route for collateral circulation. Hepatic artery variants cause the development of unique collateral pathways that have different characteristics depending on the type of variant. These collateral pathways include intrahepatic interlobar collateral vessels, right gastric to left gastric arterial anastomoses, left hepatic to left gastric arterial anastomoses, and peribiliary arterial plexuses. Major collateral pathways in patients with celiac axis stenosis can be identified with spiral CT, and knowledge concerning this collateral circulation may be important for certain medical procedures such as interventional procedures for the management of hepatic tumors, pancreaticobiliary surgery, and liver transplantation.

Angiography↗