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PubMed1991

Transcatheter occlusion of pulmonary arterial circulation and collateral supply: failures, incidents, and complications.

Failures and complications were analyzed retrospectively in 45 patients treated with embolotherapy or occlusion of pulmonary arterial circulation. Pulmonary arterial branches were occluded with steel coils in 19 patients with pulmonary arteriovenous malformations, 17 with hemoptysis of pulmonary artery (PA) origin, and one with massive parenchymal shunt. Bronchial arterial supply to the lung was embolized with small particles in eight cases of hemoptysis and systemic to pulmonary arterial antegrade shunt secondary to chronic thromboembolism. Asymptomatic incidents included catheterization failures, vascular damage, partial occlusion, partial recanalization of the thrombus, ectopic deposition of a coil, and delayed bacterial contamination of the thrombus. A few cases of transient clinical and radiologic signs of pulmonary infarction were observed after complete occlusion of the PA and bronchial artery embolization. This complication was never observed after complete occlusion of main right or left PA, inferior right or left PA, or segmental branches. The management and prevention of these complications, the role of bronchial arterial collateral pathways, and the importance of the site of PA occlusion in the development of pulmonary infarction are discussed.

Arteriovenous Malformations↗
PubMed1991

[Transcranial color Doppler guided Matas' test].

Carotid artery involvement in head and neck tumor is a great concern to surgeons because of the unpredictable effects of its resection. For the investigation of brain collateral circulation, color Doppler guided Matas' test has been performed to examine blood flow in the middle cerebral artery (MCA) and internal carotid artery (ICA). SSA-270A convex (3.75MHz) and linear (3.75MHz, 2.5MHz) array probes (Toshiba Co., Ltd.) were used for this investigation. A temporary occlusion test (60 sec) was performed on the common carotid artery (CCA) in thirty patients who were scheduled to undergo radical neck dissection. The blood flow velocity of MCA during Matas' test was recorded. Then relative flow (percent blood flow before the test) of MCA during the 60 sec Matas' test was measured. The relative mean flow was 72% with a standard deviation of 15%. The results of thirty patients were classified into four groups according to the relative flow of MCA after 60 sec occlusion of the common carotid artery: Group A, over 87% (three cases); Group B, 86-72% (twelve cases); Group C, 71-57% (twelve cases); Group D, under 56% (three cases). Brain collateral circulation (BCC) of the Group A patients was considered to be excellent, and therefore reconstructive vascular surgery (RVS) was not necessarily indicated. In Group B patients (fair) and Group C patients (slightly poor) further investigation of BCC, i.e., Balloon Matas' test (occlusion of CCA and ICA), SPECT and brain angiography, was considered to be necessary. In Group D patients (poor) RVS was inevitable if either CCA or ICA had to be resected. Important information is provided by this noninvasive examination to predict the risk of carotid resection. This test seems to be useful to determine whether or not RVS is indicated.

Adult↗
PubMed1993

Pressure-flow characteristics of intramural and total coronary collateral networks.

The purpose of the present investigation was to determine the pressure-flow (PF) relationship of intramural collaterals and to determine whether their characteristics differ significantly from those of the total collateral network, defined as the epicardial plus intramural collateral network. Because a significant portion of the collateral flow is diverted away from the retrograde flow measurement, we embolized the coronary vessel on which the retrograde flow was measured with spheres of various sizes until the retrograde flow was maximized and retrograde flow diversion blocked. The PF relationship was obtained before and after the epicardial collaterals were cauterized to determine the characteristics of the total and intramural collateral network. PF data for the collateral circulations were obtained by changing the inflow pressure to all coronary vessels simultaneously and by measuring the retrograde flow while maintaining the retrograde outflow pressure at 0 mmHg. The PF characteristics of the total and intramural collateral circulations could be fitted by either a second-degree polynomial or linear equation. In both cases the pressure intercept crossed the origin of the axes. The average contribution of intramural collaterals to total retrograde flow was 58 +/- 5%. We conclude that the PF characteristics of intramural collaterals parallel those of the total collateral circulation.

Animals↗
PubMed1998

[Superior sagittal sinus occlusion due to calvarial metastasis of renal cell carcinoma: 2 cases report].

We report two cases of superior sagittal sinus (SSS) occlusion due to calvarial metastasis of renal cell carcinoma. Both cases were presented with bulging of the skull. No stigmata of increased intracranial pressure was detected. Cerebral angiogram showed the occlusion of the SSS. Tumor cells did not penetrate into the dura mater nor the galea and the tumors were able to be removed easily in both cases. One case without collateral circulation showed recanalization of the SSS on the postoperative angiography. Another case with development of collateral circulation did not show recanalization of SSS on the postoperative magnetic resonance angiography. In the latter case, cortical veins flowed into the occluded portion. We consider that SSS should be preserved to prevent venous congestion in the cases where collateral circulation has not developed.

Aged↗
PubMed1993

Relation between collateral channel filling and flow grade in recipient coronary arteries in patients with stable effort angina.

OBJECTIVES: The purpose of the present study was to elucidate the relation between the extent of perfusion of the ischemia-related coronary artery and the degree of visualization of the collateral circulation to the ischemic area. BACKGROUND: Because it is difficult to accurately assess coronary stenosis severity with standard angiographic techniques, the inclusion of flow grade in recipient coronary arteries would provide an additional perspective concerning the effect of the progression of atherosclerotic obstructive disease on the development of collateral circulation. METHODS: The coronary arteriograms of 54 consecutive patients with chronic effort angina without prior myocardial infarction were examined. Patients were classified into four groups according to the extent of perfusion of the ischemia-related coronary artery (Thrombolysis in Myocardial Infarction [TIMI] grade 0 to 3). The degree of angiographically demonstrable collateral circulation was also classified into four grades (collateral index 0 to 3). RESULTS: Eighteen patients had TIMI grade 0, 6 had grade 1, 13 had grade 2 and 17 had grade 3 perfusion. The collateral indexes of TIMI 0, 1, 2 and 3 groups were 2.7 +/- 0.7 (mean +/- SEM), 2.2 +/- 0.6, 1.2 +/- 1.1 and 0.4 +/- 0.9, respectively (p < 0.01 vs. TIMI 0, p < 0.05 vs. TIMI 1). CONCLUSIONS: These findings indicate that all patients with chronic effort angina have the potential for collateral development as a result of coronary artery narrowing, and the functional state of well developed collateral vessels may be primarily determined by the pressure gradient across the collateral network.

Aged↗
PubMed1989

The effect of unilateral resection of segments of both palmar digital arteries on the navicular bone in ponies: an experimental study.

Clinical, radiographical, scintigraphical and histological effects on the navicular bone after resection of the medial and lateral palmar digital arteries in the pastern of one forelimb in ponies are evaluated. The acute disruption of the main blood supply of the distal extremity causes lameness due to the suddenness of the resection in which the collateral circulation is insufficiently developed. Because of the compensatory collateral circulation, no permanent symptoms of ischaemia occur despite the partial resection of both palmar digital arteries. Histologically the percentage of relative osteoid volume of the operated limb was significantly higher than in the control limb.

Angiography↗
PubMed1976

Left anterior descending coronary artery obstruction. Clinical, electrocardiographic, and angiographic correlates.

Seventy-six patients with severe (greater than 80%) occlusive left anterior descending coronary artery disease by coronary angiography were examined for the electrocardiographic characteristics of this disease in the presence (group A 59 patients) or the absence (group B 17 patients) of anterior wall asynergy (akinesis or dyskinesis). The incidence of clinically documented anterior myocardial infarction in these two groups of patients was examined. The collateral circulation to the left anterior descending coronary artery was also examined in the groups of patients with and without anterior wall asynergy. Thirty-eight of 59 (64%) patients with anterior wall asynergy (group A) showed electrocardiographic signs of anterior myocardial infarction, 17 per cent showed probable electrocardiographic signs of anterior myocardial infarction and 19 per cent showed no electrocardiographic signs. None of the 17 patients without anterior wall asynergy (group B) showed electrocardiographic signs of anterior myocardial infarction. In group A 74.6 per cent had documented clinical evidence of previous anterior myocardial infarction. Collateral filling of the distal left anterior descending coronary artery was seen in 71 per cent of group A and 100 per cent of group B patients. There was a significantly higher incidence (P = 0.02) of collateral filling in the patients without electrocardiographic evidence of definite anterior myocardial infarction (93% of 28 patients), than in those who showed definite electrocardiographic evidence of anterior myocardial infarction (66% of 38 patients).it is concluded that severe occlusive left anterior descending coronary artery disease with anterior wall myocardial asynergy is usually associated with electrocardiographic signs of anterior myocardial infarction, whereas equally severe left anterior descending coronary artery disease without anterior wall asynergy is rarely associated with electrocardiographic abnormalities of anterior myocardial infarction. Severe left anterior descending coronary artery obstruction without electrocardiographic and angiographic evidence of anterior myocardial infarction is usually associated with collateral circulation to the left anterior descending coronary artery and collateral circulation to the left anterior descending coronary artery is present less frequently when obstruction is associated with anterior myocardial infarction.

Adult↗