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PubMed2000

[Clinical study on treatment of atherosclerosis obliterans by integrated traditional Chinese and Western medicine].

OBJECTIVE: To investigate the mechanism in treating atherosclerosis obliterans (ASO) with integrated traditional Chinese and western medicine (TCM-WM). METHODS: The changes in level of vasoactive factors, such as endothelin (ET), nitric oxide (NO), apoprotein and the iconographic changes in angiography before and after treatment were observed in 40 patients of ASO. RESULTS: All patients had high levels of plasma ET and low level of NO, abnormal metabolism apoproteins, and showed the signs of trunk artery obstruction and marked decrease of collateral circulation in affected limb. After treatment, the plasma ET, NO and apoprotein levels recovered to normal range in 30 markedly effective cases, as compared with those before treatment, the difference was significant (P < 0.01) and their collateral circulation in the affected limb significantly increased, showing obvious improvement of peripheral circulation. CONCLUSION: The therapeutic mechanism of TCM-WM in treating ASO might be related with its effects on vascular endothelium, lipid metabolism adjustment, collateral circulation establishment and microcirculation improvement.

Aged↗
PubMed1981

[Bilateral internal carotid artery thrombosis (author's transl)].

Nineteen patients with bilateral internal carotid artery thrombosis were analysed with respect to long term clinical course from first onset to admission. The patients comprised 19.3% of all patients with occlusive cerebral disease treated in past three years at our clinic. In reviewing the symptoms and signs associated with bilateral carotid occlusions and the clinical course, several patterns became evident and in this report the patients are divided into 3 types: Apoplectic type, those who had severe neurological deficit acutely after occlusion, whose angiography showed impaired or absent collateral circulation, and whose CT scan demonstrated bilateral diffuse low density areas; Progressing type, those whose neurological signs and symptoms grew progressively serious, whose angiography showed moderate or adequate retrograde filling with collateral circulation through posterior cerebral arteries and whose CT scan demonstrated low density lesions in the bilateral frontal lobes; TIA . RIND repeated type, those who had transient ischemic attacks or reversible ischemic neurological deficits repeatedly, whose angiography showed good normograde filling of bilateral internal carotid artery with collateral circulation through posterior communicating arteries and whose CT scan demonstrated no abnormal low density areas except findings of brain atrophy.

Adult↗
PubMed1987

Collateral mesenteric circulation.

The origins of historical terms, such as "Arc of Riolan" and "marginal artery of Drummond" are traced herein with emphasis on the inherent confusion caused when these terms are used. Basic mesenteric anatomy is briefly mentioned and pathologic anatomy with its altered direction of blood flow induced by atherosclerosis is stressed. The significance of the meandering mesenteric artery as the main collateral vessel between the superior and inferior mesenteric artery is emphasized along with preoperative and intraoperative ways to ascertain whether or not the origin of this latter vessel can be safely ligated. Specific operations, such as abdominal aortic aneurysmorrhaphy and sigmoid colectomy, which can potentially interfere with blood flow in the meandering mesenteric artery, are discussed in an attempt to prevent postoperative necrosis of any portion of the intestine that may have deficient mesenteric blood flow.

Blood Vessel Prosthesis↗
PubMed2005

Impact of coronary collaterals on outcome following percutaneous coronary intervention (from the National Heart, Lung, and Blood Institute Dynamic Registry).

Coronary collateral circulation is beneficial in patients with coronary artery disease, but controversy still exists regarding the association between angiographic collaterals and outcome after percutaneous coronary intervention (PCI). We compared the baseline characteristics and cumulative 1-year event rates of consecutive patients undergoing PCI by target vessel collateral status-no angiographic evidence of collateral circulation (NC; n = 5051), treated artery supplied collaterals (SC; n = 239), and treated artery received collaterals (RC; n = 893)-using the National Heart, Lung, and Blood Institute Dynamic Registry. Patients in the SC group were older and had more previous coronary bypass surgery, myocardial infarction, co-morbid illness, and heart failure than the NC and RC groups and had less often undergone revascularization for acute myocardial infarction (p <0.01 for all). The total angiographic PCI success was comparable for the SC and NC groups but higher than for the RC group (94.1% vs 94.4% vs 83.9%, respectively; p <0.001). Overall stent use was 77.5% and was highest in the SC group (82.4%, p <0.001). At 1 year, significant differences in outcome were observed by collateral status. Compared with the NC group, patients with PCI of a SC artery had higher adjusted mortality (relative risk [RR] 1.95, 95% confidence interval [CI] 1.27 to 3.01, p = 0.002) and death/myocardial infarction (RR 1.75, 95% CI 1.26 to 2.45, p <0.001) rates. Patients with PCI of a RC vessel, conversely, had lower adjusted death/myocardial infarction (RR 0.72, 95% CI 0.54 to 0.96, p = 0.02) and repeat revascularization (RR 0.73, 95% CI 0.59 to 0.91, p = 0.005) rates. In conclusion, our results suggest that PCI on collateralized vessels is warranted, but that patients with PCI in arteries that supply collaterals are a high-risk group that may benefit from closer follow-up and complete revascularization.

Aged↗
PubMed1993

[A case of asymptomatic common carotid artery occlusion with the persistent proatlantal intersegmental artery].

A case of asymptomatic common carotid artery occlusion with direct vertebrocarotid anastomosis (proatlantal intersegmental artery) in a 70-year-old male is reported. Despite the acquired left common carotid artery occlusion, there was no demonstrable neurologic deficits that would occur by the involvement of the area supplied by the occluded carotid system. Cerebral angiography revealed, in addition to efficient collateral circulation from the contralateral carotid system through the anterior communicating artery, a collateral channel from the left vertebral artery to the ipsilateral external carotid artery via the proatlantal intersegmental artery. These collateral circulations were indicated to be important in prevention of possible grave neurologic consequences. The proatlantal intersegmental artery, though rarely visualized by ordinary cerebral angiographic procedures, was thus demonstrated to be capable of serving as a collateral channel of potential usefulness in the event of severe intracranial hemodynamic alterations, including acquired common carotid artery occlusion.

Aged↗
PubMed2006

Transitional angiogenesis and vascular remodeling during coronary angiogenesis in response to myocardial infarction.

Coronary artery disease (CAD) is a major source of morbidity and mortality in the industrialized world. CAD causes ischemia as a prelude to angina, myocardial infarction and heart failure as specific forms of heart disease causing a decline in the quality of life. CAD or atherosclerosis and the resulting myocardial ischemia trigger a natural angiogenic response that generates collateral circulations. The long-term goal for these studies is to develop therapeutic angiogenesis that augments the natural coronary angiogenesis. This project makes use of an infarcted transgenic mouse model to characterize formation of those collateral circulations in the post-infraction heart. The experiments utilized thoracotomy and a microcauterizer to produce an infarct in transgenic mice and this stimulated neovascularization and allowed labeling of the coronary vessels, thereby defining the morphogenic processes involved in formation of collateral circulations. The results show that the heart consistently responds to infarcts with angiogenesis at 1d post-treatment (PT) that undergoes transition into vascular remodeling at 7d PT with complete remodeling at 14d PT. The vascular remodeling appears to mitigate any net increase in perfusion that may be achieved early in coronary angiogenesis. The results suggest that therapeutic approaches need to shift from an exclusive focus on stimulating angiogenesis to include modulation of vascular remodeling for increased long-term myocardial perfusion.

Actins↗
PubMed1995

Pre- and intraoperative methods of controlling cerebral circulation in giant aneurysm surgery.

The surgical treatment of giant aneurysms usually requires temporary clipping of the aneurysmatic vessel. In planning the surgical approach and in applying temporary clips, the surgeon must consider collateral circulations. The functional integrity of the collateral vessels frequently decides the patient's outcome. In 8 patients with internal carotid artery giant aneurysm, measurements of blood flow velocities in the ipsilateral middle cerebral artery were performed preoperatively with transcranial Doppler ultrasound (TCD) during manual occlusion of the carotid artery at the neck. Three different perfusion patterns were established, and each collateral capacity was rated as insufficient, temporarily sufficient, or long-term unproblematic. Surgical strategies were conceived. In one patient with giant aneurysm of the middle cerebral artery the temporary occlusion test was not carried out preoperatively. Intraoperatively, collateral circulation was controlled using microvascular Doppler sonography (MVD). In 8 cases cortical blood flow (CoBF) was monitored by thermal diffusion flow probe and/or laser Doppler. In some cases, the complex pathological anatomy required a change in surgical strategy and a new MVD determination of collateral capacity. Despite these precautions 2 patients suffered ischemia of the basal ganglia and the white matter.

Adult↗
PubMedDate not supplied

[The results of a dynamic angiographic examination following the microsurgical revascularization of the brain].

The article deals with diagnostic and clinical examination conducted before and in different periods after operation for formation of extra- and intracranial microvascular anastomoses (EICMA) in 57 patients with occlusive lesions of the cerebral vessels. Preoperative angiography was undertaken to identify the character of the vascular lesion, study the collateral circulation, and appraise the condition of the other channels. Control angiography was performed in the early (the first 2 weeks) and late-term postoperative periods (from 3 to 48 months). Functioning EICMA were demonstrated in the first 1-2 days in 11%, at the end of the 2nd week in 70%, and in the late-term postoperative period in 92% of cases. Comparative analysis of the character of EICMA functioning depending on the collateral circulation showed them to be functioning in 80% of patients despite satisfactory development of collateral circulation along the parts of the circle of Willis through the orbital anastomosis.

Carotid Artery Thrombosis↗
PubMed2000

Elevation of nitric oxide metabolites in the cerebrospinal fluid of patients with moyamoya disease.

BACKGROUND: To investigate whether nitric oxide (NO) contributes to formation of abnormal collateral circulation in patients with moyamoya disease. METHODS: Cerebrospinal fluid (CSF) samples were obtained from the subarachnoid space of the Sylvian fissure during combined bypass surgery for moyamoya disease and kept frozen until NO metabolites, nitrate and nitrite, were measured using a Griess method. RESULTS: Compared with control CSF obtained from 18 patients with hemifacial spasm, unruptured aneurysm, etc., concentrations of NO metabolites in 26 CSF samples of 18 patients with moyamoya disease were significantly higher (mean +/- SE; 17.6 +/- 1.2 vs. 10.5 +/- 1.0 microM, p < 0.01). In eight patients, the CSF samples from both the first and second operation could be obtained. NO metabolite concentrations (20.5 +/- 2.3 microM) in CSF obtained from the first surgery decreased to 15.7 +/- 1.8 microM (p < 0.01) in CSF obtained from the second, contralateral procedure. The cases of moyamoya disease with greater development of moyamoya vessels at angiographic stage 3 and 4 tended to show higher concentrations of NO metabolites than cases at earlier or later stages with a few moyamoya vessels. INTERPRETATION: Nitric oxide concentrations in CSF are chronically elevated in moyamoya disease, probably reflecting development of abnormal collateral circulation. i.e. moyamoya vessels. Vascular bypass surgery can reduce abnormal collateral circulation with reduced production of nitric oxide.

Adolescent↗
PubMed2005

Evaluation of cerebral circulation in patients with significant carotid artery stenosis.

BACKGROUND: A significant proportion of ischaemic stroke episodes are caused by atherosclerotic lesions in extracranial arteries. Assessment of haemodynamical profile of cerebral arteries in both symptomatic and asymptomatic patients with carotid artery stenosis is of clinical importance. AIM: To assess haemodynamic changes in cerebral arteries in patients with significant internal carotid artery (ICA) stenosis. METHOD: Patients (n=109) were divided into the following groups: group I (GI) - 42 subjects (64.6+/-9.0 years) with asymptomatic ICA stenosis > or =70%; and group II (GII) - 67 subjects (63.4+/-7.1 years) after stroke. The control group consisted of 30 patients (60.3+/-8.9 years) without significant stenoses of extracranial arteries on USG and angiography. In all cases ultrasonographic evaluation of flow velocities and directions in cerebral arteries within the circle of Willis and collateral flow was performed. RESULTS: The severity of ICA stenosis did not differ significantly between GI and GII. Patients in GI had flow velocity in the middle cerebral artery (MCA) increased by 15.7% and by 40.8% in the anterior cerebral artery (ACA) contralateral to the ICA stenosis (p<0.001 and p<0.001), whereas in GII no significant changes in flow velocity in these arteries were observed in comparison with the control group. Patients in the groups I and II had lower flow velocities in MCA ipsilateral to the ICA stenosis, however values for GII patients were significantly lower than in GI patients (p<0.001). The presence of collateral circulation through the anterior and posterior communicating arteries (ACoA and PCoA) was similar in GI and GII; however, the flow velocities in the ipsilateral MCA and ACA were significantly higher in asymptomatic patients (GI). The frequency of active collateral circulation through both ACoA and PCoA increased along with the increase of ICA stenosis severity (p=0.003; p<0.001). CONCLUSIONS: Collateral flow in the circle of Willis in subjects with ICA stenosis occurs equally often in symptomatic and asymptomatic patients; however, it is more efficient in patients without symptoms. The rate of development of collateral circulation depends on ICA stenosis severity. The important role in maintaining collaterals within the circle of Willis is played by ACoA, although in some patients MCA may also be supplied by PCoA.

Adult↗
PubMed1993

[Anterograde and retrograde cardioplegia in myocardial revascularization. An intraoperative contrast echographic study].

The aim of this study was to assess the distribution of antegrade and retrograde cardioplegia with intraoperative contrast echocardiography in patients undergoing coronary artery bypass grafting. Fifteen patients with chronic stable angina pectoris and severe coronary artery disease were studied. The severity of coronary artery disease was assessed at coronary angiography, using the Jeopardy Score System. The presence and the extent of collateral circulation was evaluated on the basis of preoperative coronary angiography and graded as: absent or poor; good or excellent. Coronary revascularization was carried out during extracorporeal circulation and myocardial protection was performed with antegrade (aortic root) and retrograde (right atrial) cardioplegia. The echo contrast agent was sterilely prepared 1 hour prior to surgery and consisted of a solution of sonicated 5% human albumin microbubbles. Two ml of sonicated albumin were injected along with antegrade cardioplegia and 4 ml with retrograde cardioplegia. The echocardiographic images were obtained with transesophageal echocardiography in the transgastric left ventricular short-axis view. Images were recorded on videotape for off-line planimetric measurement of percent myocardial opacification. Data were analyzed with the analysis of variance. Multiple comparisons were made with Student's paired t test and using Bonferroni's correction. Myocardial opacification was 58.9 +/- 12.9% during antegrade cardioplegia and 77.5 +/- 16.4% during retrograde cardioplegia (p = 0.003). This overall difference was mainly due to the impact of collateral circulation in the distribution of antegrade cardioplegia. Patients with absent or poor collateral circulation showed a lower degree of myocardial opacification than patients with good or excellent myocardial opacification (44.3 +/- 12.0% versus 64.2 +/- 8.6%; p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed2000

Breast varices: imaging findings of an unusual presentation of collateral pathways in superior vena caval syndrome.

Imaging findings are presented of an unusual pathway of collateral circulation consisting of bilateral and diffuse dilated breast veins from a patient with long standing superior vena caval syndrome. The main importance of this case is the extent of the collateral development through the breast veins, serving as the major pathway of collateral circulation. Identification of this unusual collateral development, which resembles breast varices, was performed with contrast-enhanced chest CT scans, digital subtraction venography, color Doppler ultrasonography, and mammographic studies. Collateral development was secondary to a long segment idiopathic venous occlusion involving bilateral subclavian and brachiocephalic veins as well as vena cava superior. We conclude that dilated breast veins when detected on any imaging modality should raise the suspicion of central venous obstruction.

Adult↗
PubMed1983

[Role of collateral coronary circulation in the compensation of regional disorders of energy metabolism in the myocardium in experimental myocardial ischemia].

Patterns of glucose, pyruvate and lactate consumption by the ischemized myocardium were studied in dog experiments with reference to the leve of retrograde inflow to the network of the ligated coronary artery. For this purpose, blood samples were taken from distal portion of ligated anterior descending coronary artery and the great cardiac vein accompanying the branches of the former. The increase of the lactate level, "excessive" lactate, the redox potential of the lactate/pyruvate system (E), delta E was shown to be less pronounced in those experiments where collateral coronary flow volumetric rate was above 1.5 ml/min, whereas pH and pO2 values dropped more steeply following coronary ligation in the experiments with small retrograde inflow to the ischemized area. The differences between glucose and pyruvate consumption by the ischemized myocardium were not significant.

Adaptation, Physiological↗
PubMed1998

[Portal hemodynamics, collateral venous circulation and encephalopathy in patients with esophageal and gastric varices in liver cirrhosis].

Complex hemodynamic investigations were conducted in 166 patients with liver cirrhosis and syndrome of portal hypertension. It was established that gastric varicose veins (VV) in 40% of observations are connected with v. renalis sin. by means of gastrorenal shunts (GRS), esophageal VV in 16.9% of observations--with v. renalis sin. Gastric VV frequently are connected with large GRS. More the GRS diameter, the more pronounced lowering of volemic blood flow in portal vein occurs. While gastric VV presence the volemic blood flow value in portal vein significantly lesser than while isolated esophageal VV. Encephalopathy occurs more frequently in patients with GRS, flowing into v. renalis sin. than in patients while other collateral blood flow ways present. Reverse dependence was revealed between GRS diameter and the degree of portal vein pressure lowering.

Blood Flow Velocity↗
PubMed2004

[Combined gene therapy enhances collateral vascularization in coronary artery occlusion swine model].

OBJECTIVE: To investigate the efficacy of combined gene transfer of vascular endothelial growth factor (VEGF) and angiotensin-1 (Ang-1) in swine coronary artery occlusion. METHODS: Swine underwent left thoracotomy followed by ligation of left anterior descending coronary artery. Constructed PCD(2)/VEGF and/or PCD(2)/Ang-1 eukaryotic expression plasmid was directly injected into the swine myocardium. RT-PCR, immunohistochemistry, capillary density and arteriole density were used to detect gene expression and biological effect. Coronary angiography was done to evaluate collateral circulation of the occluded artery. RESULTS: High levels of VEGF and Ang-1 mRNA and protein expression were detected. There was a significant increase in the number of capillaries and arterioles as compared with a control group (P < 0.05). Capillary density and arteriole density of the combination therapy group were higher than those of the swing receiving either therapy alone. Coronary angiography showed better collateral circulation in the combination therapy group. CONCLUSIONS: Direct injection of PCD(2)/VEGF and PCD(2)/Ang-1 can transfect the myocardium and express VEGF and Ang-1 protein. Combined gene transfer of VEGF and Ang-1 can increase capillary and arteriole number and enhance collateral circulation of the occluded coronary artery more effectively.

Angiotensin I↗
PubMed1979

Superficial temporal-middle cerebral artery bypass. A detailed analysis of multiple pre- and postoperative angiograms in 40 consecutive patients.

Pre- and postoperative angiograms on 40 patients undergoing superficial temporal-middle cerebral artery (STA-MCA) bypass surgery have been examined in detail. Multiple postoperative angiograms have been obtained to evaluate the change in both the bypass circuit and the intracranial circulation over time. A reproducible system for evaluating the degree of intracranial vascular filling via the bypass is introduced. The study shows that the STA and its anastomotic branch increase in size over time, measured in months, in the majority of patients. This is paralleled by a progressive increase in the degree of intracranial vascular filling. These changes are proportional to the severity of the vascular disease before surgery. The pattern of preoperative collateral circulation may change over time following the addition of the bypass circuit. The progressive change over time suggests that a static analysis at one time may belie the true effect of the surgery. The change of collateral circulation with augmentation of blood supply to areas of the brain other than those affected by the recent ischemic event, means that a total cerebral evaluation including neuropsychological testing may be necessary for adequate evaluation of the effect of the bypass surgery.

Brain Ischemia↗
PubMed1993

Persistence of systemic and splanchnic hyperkinetic circulation in liver transplant patients.

Portal pressure and portal-systemic collateral circulation after orthotopic liver transplantation have not been investigated. We studied systemic and splanchnic hemodynamics in 17 patients with cirrhosis before and 205 +/- 146 days after orthotopic liver transplantation. Among the 17 orthotopic liver transplantation patients, 12 had undergone hemodynamic study in the 6 mo before orthotopic liver transplantation. Controls were 50 patients with normal liver architecture. Cardiac index remained elevated in orthotopic liver transplantation patients compared with controls (3.6 +/- 0.9 vs 3.1 +/- 0.4 L/min.m2; p < 0.05). Azygos blood flow, which was elevated before orthotopic liver transplantation (585 +/- 402 ml/min), remained elevated after orthotopic liver transplantation (553 +/- 343 ml/min). In transplant patients, hepatic blood flow was higher than it was in controls (2.26 +/- 0.86 vs. 1.38 +/- 0.57 L/min; p < 0.05). Elevated hepatic blood flow correlated with cardiac index (r = 0.647, p < 0.025). In patients with normal graft function, hepatic venous pressure gradient was normal (2 +/- 1 mm Hg). In a patient with acute rejection, a sharp elevation in the hepatic venous pressure gradient was observed; it returned to normal 45 days after treatment. We conclude that despite normal portal pressure, portal-systemic collateral blood flow remains elevated after orthotopic liver transplantation. Possibly because of persistent collateral circulation, which may keep portal tributary blood flow elevated, hepatic blood flow is increased after orthotopic liver transplantation. Elevated splanchnic blood flow, in turn, contributes to the high cardiac index in liver recipients. Finally, a sharp elevation in portal pressure, which may be observed during acute rejection and subsides after treatment, merits further study.

Adult↗