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PubMed1976

[Coarctation of the aorta on the plain chest x-ray (author's transl)].

Chest X-rays were analysed in 22 male and 16 female patients (mean age 30.7 years) with coarctation of the aorta. The results were correlated with angiography, haemodynamic pressures and operative findings. The left subclavian artery was prominent in 33 cases, signs indicating a collateral circulation (rib notching, internal mammary artery) were present in 26 cases. In addition there were changes of cardiac and aortic configuration. The least reliable sign was constriction of the aorta due to the stenosis itself. Frequent combinations of X-ray signs were dilatation of the left subclavian artery and a collateral circulation, in addition to signs of increased pressure (n = 25). Less frequently (n = 8) only a dilated subclavian artery and signs of increased pressure were found. The prominence of the subclavian artery was particularly marked in systolic pressure gradients through the stenosis of greater than 40 mm Hg, and the formation of a collateral circulation when average aortic pressure differences above and below the stenosis were less than 40 mm Hg. Collaterals were to be found most frequently with a correlation of 2:1 of the systolic gradient to the mean pressure gradient delta Ps/delta Pm. A very good correlation existed comparing X-ray signs with findings at operation. The diagnosis of coarctation of the aorta can thus be made with sufficient certainty from the plain chest X-ray.

Adolescent↗
PubMed1983

[Left coronary artery originating from the pulmonary artery as a syndrome found in infancy, childhood and adulthood].

The cases of two patients with Bland-White-Garland-Syndrome are reported. A 13 year old girl had been operated during infancy (ligation of the left coronary artery at its origin from the pulmonary artery) and showed reopening of the ligation with marked collateral circulation between the right and left coronary artery. She was operated again, successfully. A second critically ill patient with a typical pattern of anterolateral infarction in his ECG recovered so well that only five years later he was readmitted; then he showed the adult-type ECG with good collateral circulation between the right and left coronary artery. He underwent an equally successful operation. In both cases there is good evidence for the development of a sufficient collateral circulation after ligation of the coronary artery to pulmonary artery connection. Spontaneous formation of anastomoses between the right and left coronary artery enables even infants with this anomaly to survive. These findings confirm the suggestion that the "infancy-type" and "adult-type" of the Bland-White-Garland-Syndrome represent only different stages of the same disease.

Adolescent↗
PubMed1994

[An evaluation of the hemodynamic efficacy of an extra-intracranial microanastomosis in unilateral occlusion of the internal carotid artery].

The physicians of the A. N. Bakulev Institute for Cardiovascular Surgery examined 64 patients with unilateral atherosclerotic occlusion of the internal carotid artery (ICA). TCDG and angiography were employed before and after establishment of EICMA. TCDG proved highly informative in assessment of collateral circulation (sensitivity 95.6%). Indications to EICMA should be based on overall account of initial stage of cerebrovascular insufficiency and collateral circulation. EICMA is indicated for patients with compensated and relatively compensated cerebrovascular insufficiency (transient ischemic attacks, minor apoplexy, dyscirculatory encephalopathy), residue sequelae of ischemic apoplexy stroke, baseline poor collateral circulation. Differentiated approach to EICMA establishment allows improved outcomes of the surgery and revision of common among angio-neurosurgeons attitude to the above surgery in ICA occlusion.

Adult↗
PubMedDate not supplied

Effect of obesity on coronary collateral vessel development in patients with coronary artery disease.

The purpose of this study was to compare coronary collateral circulation and with other risk factors in patients with coronary artery disease and different body mass index. Between January 1999 and December 2001, of 867 patients who underwent angiography for the first time, 90 patients (24 women and 66 men), with occlusion in only 1 coronary artery participated in the study. Information regarding age, body mass index, sex, smoking, hypertension, diabetes mellitus, hyperlipidemia, preinfarction angina, and use of oral beta blockers and nitrates were recorded for all patients. The patients were separated into 2 groups in accordance with development of their coronary collateral circulation; those with insufficient (Rentrop 0, 1, and 2) and those with sufficient coronary collateral circulation. They were also divided into 3 groups on the basis of body mass index as follows: (I) 18.0-24.9 kg/m(2), (II) 25.0-29.9 kg/m(2), and (III) more than 30 kg/m(2). In the obesity and overweight groups, hyperlipidemia, diabetes mellitus, and nitrate use were identified more frequently than in the other groups (p < 0.05). Use of oral nitrates more than 6 months before the myocardial infarction and existence of preinfarction angina affected collateral coronary vessel development in the positive direction (p = 0.01, p = 0.03, respectively). There was no correlation between coronary artery disease and coronary collateral vessel development in the obese patients (p = 0.6). Although it has been shown that coronary collateral vessel development was affected negatively in obese patients with coronary artery disease, no statistical significance was identified.

Aged↗
PubMed1998

Low-dose basic fibroblast growth factor and vascular endothelial growth factor for angiogenesis in canine acute hindlimb insufficiency.

Basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) have shown strong angiogenetic effects in ischemic animals; however, whether such a beneficial effect could be achieved using low doses remains to be determined. The effects of identical low-level doses of these substances on the creation of collateral circulation in canine acute hind limb insufficiency were evaluated. Anesthetized dogs that had undergone left femoral artery occlusion received 20 microg (2 microg/kg) intravenous boluses of either bFGF or VEGF 3 times at 2-day intervals for the first week only, animals on vehicle saline injection served as controls. All groups, control (n=8), bFGF-treated (n=8), and VEGF-treated (n=6) underwent angiography, blood flow measurement (in ml/min) on the day of ligation (day 0), and at 7, 14 and 28 days, then underwent ischemic limb muscle biopsy at 28 days. Angiogenic-treated groups showed remarkable enhanced collateral circulation at 7 days, which was maintained up to 28 days, and the main collateral source artery of the angiogenic-treated groups dilated by 14 days. Many neovascularized arterioles in specimens of the angiogenic groups were recognized without any tissue edema or necrosis. Even low doses of bFGF or VEGF were enough to augment collateral circulation with no side-effects, and short treatment after acute ischemia was effective. Low-dose bFGF or VEGF may be therapeutical effective options in patients with acute lower limb vascular disease.

Animals↗
PubMed1993

Importance of non-stenosed donor coronary arteries for collateral flow reserve.

To elucidate whether the presence of significant stenoses in donor coronary arteries compromises collateral flow reserve, coronary arteriography was performed in 22 patients with stable effort angina who had a complete obstruction in one of the major coronary arteries. The patients were divided into two groups according to the absence (group I: n = 11) or presence (group II: n = 11) of significant stenoses (> or = 75% stenosis of the luminal diameter) in donor arteries. After conventional cardiac catheterization, coronary arteriography was repeated before and during rapid atrial pacing. Coronary collateral circulation was evaluated by means of angiographic contrast appearance time (CAT) which was defined as the time (s) until the epicardial segments distal to the site of complete occlusion were opacified after the injection of contrast medium into the donor artery. The pressure gradient across the collateral circulation (mean aortic pressure minus left ventricular end-diastolic pressure) remained unchanged before and during rapid atrial pacing (group I: 95 +/- 14 vs. 99 +/- 15 mmHg; group II: 91 +/- 18 vs. 94 +/- 16 mmHg). Rapid atrial pacing decreased the contrast appearance time in group I from 1.73 +/- 0.34 to 1.47 +/- 0.37 s (P < 0.01), but was not changed in group II from 1.68 +/- 0.36 to 1.73 +/- 0.51 s (P = n.s.). It was concluded that coronary collateral circulation is further augmented in response to an increase in myocardial oxygen demand in patients with non-stenosed donor coronary arteries and significant stenoses in donor arteries compromise an increase in collateral blood flow.

Aged↗
PubMed1990

Importance of myocardial ischemia for coronary collateral development in conscious dogs.

The purpose of this study was to evaluate the effects of myocardial ischemia on the development of collateral circulation. Thirteen conscious dogs were instrumented for serial measurements of subendocardial segment length in the area perfused by the left circumflex coronary artery, left circumflex coronary artery flow and left ventricular pressure. In 6 dogs (group A), 1 min left circumflex coronary artery occlusions were carried out at 30 min intervals. When the 442nd 1 min left circumflex coronary artery occlusion produced a reduction in segment shortening and a significant reactive hyperemia, the occlusion time was increased to 2 min. In the remaining 7 dogs (group B), 2 min left circumflex coronary artery occlusions were conducted hourly. In group A, following 451 +/- 201 (SD) min of total occlusion time with the mixture of 1 and 2 min left circumflex coronary artery occlusions (43 +/- 18 days) a left circumflex coronary artery occlusion produced no reduction in segment shortening and negligible reactive hyperemia. By contrast, in group B, 218 +/- 99 min of total occlusion time (18 +/- 8 days) was required to develop adequate collateral circulation. The relative contribution of the first and second 1 min of left circumflex coronary artery occlusion to the collateral development was mathematically evaluated. This analysis indicated that the second 1 min of left circumflex coronary artery occlusion is 4.43-fold more effective than the first 1 min of occlusion in terms of the collateral induction. We concluded that severe myocardial ischemia plays an important role in the development of collateral circulation.

Animals↗
PubMed1989

[Photoplethysmography evaluation of collateral blood flow before puncture of the dorsalis pedis artery].

Prior to cannulation of the dorsalis pedis artery the collateral circulation through the plantar arch should be examined to evaluate the consequence of an occlusion of this artery. Since the performance of the Allen's test is impossible for assessment of the plantar arch, another suitable technique has to be chosen. We selected the photoelectric plethysmography. Toe pulses were recorded with photoelectric plethysmography in 20 neurosurgical patients. The pulse amplitudes were measured before and during successive compression of the dorsalis pedis and the posterior tibial artery. Obvious decrease or absence of the pulse wave during compression of the dorsalis pedis artery is indicating an inadequate collateral circulation and cannulation of this artery seems not to be safe. In our study this occurred in 4 of 32 examined feet (12.5 percent). The photoelectric plethysmography has proved to be a simple and accurate means for assessment of collateral circulation.

Adult↗
PubMed1987

The role of external carotid endarterectomy in the treatment of ipsilateral internal carotid occlusion: collective review.

Complete occlusion of the internal carotid artery (ICA) may result in a variety of clinical states. Neurologic symptoms in the setting of ICA occlusion may be due to embolic events through the external carotid artery (ECA) circulation, hemodynamic insufficiency resulting from inadequate collateral development, or propagation of clot intracranially. External carotid reconstruction has been used to prevent neurologic events from the first two mechanisms. This review attempts to place in perspective the current indications for, techniques of, and results from ECA revascularization. A discussion of the cerebral collateral circulation is included for reference. Twenty-three series were collected from the literature. Cases were excluded in which procedures other than ECA reconstruction were undertaken, leaving 218 cases for analysis. These represented 195 EC endarterectomies and 23 ECA bypasses. Resolution of symptoms was seen in 83% of patients with another 7% showing marked improvement. The perioperative mortality rate was 3%; neurologic deaths accounted for most perioperative deaths. The overall neurologic complication rate was 5%. More recent reports were notable for improved mortality and morbidity. A diseased contralateral carotid artery was associated with higher neurologic morbidity whereas disease in the vertebral arteries had no impact on outcome. The best results were obtained when surgery was performed to relieve specific hemispheric or retinal symptoms as opposed to nonspecific neurologic complaints or previous stroke. The symptomatic patient with ICA occlusion has a poor neurologic prognosis. In selected circumstances ECA reconstruction should be considered among the treatment options in this clinical setting.

Carotid Artery Thrombosis↗
PubMed1975

Inferior myocardial infarction and right coronary artery occlusive disease. A correlative study.

The present study represents an attempt to correlate the electrocardiogram and coronary arteriogram in patients with an inferior transmural infarct - or total occlusion of the right coronary artery. The influence of the collateral circulation on these findings was also evaluated. Fifty patients with a total occlusion of the right coronary artery had characteristic electrocardiographic changes of an inferior infarct in 44 per cent, very suspicious changes in 32 per cent, and no changes suggesting an inferior infarct in 24 per cent. However, in this latter group who had no evidence of an inferior infarct, we were able to recognize a small number who showed an anterior wall infarct. Collateral circulation was more frequently present and more extensive in those patients whose electrocardiograms did not show changes typical of inferior transmural infarction. This suggested that collateral circulation might minimize some of the electrocardiographic abnormalities which would normally result from occlusive disease of the right coronary artery. Another 50 patients, selected because of definite electrocardiographic evidence of typical inferior transmural infarction, were evaluated by coronary arteriography. Severe obstructive disease of the right coronary artery was present in 86 per cent of the group. In the remaining 7 patients (14 per cent) minimal or no disease was found. Infarction of the inferior wall may have resulted from occlusive disease of the anterior descending artery or have been the result of a right coronary artery occlusion with subsequent recanalization. We conclude from our study that a careful analysis of electrocardiographic abnormalities in theinferior leads will, with certain limitations, permit us to estimate the likelihood of a severe lesion in the right coronary artery, and, in the face of definite electrocardiographic evidence of an inferior infarct, to predict the diseased artery.

Angiography↗