SEARCH · PubMed Health

Results for “Collateral Circulation”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,585 records · Page 88Linked to original sources

PubMed2002

Haptoglobin phenotype and coronary artery collaterals in diabetic patients.

Cross-cultural epidemiological studies of incident cardiovascular disease in the diabetic patient have demonstrated marked differences in susceptibility that may be due to a genetic factor. The coronary artery collateral circulation is the chief determinant of the size of a myocardial infarction and is highly variable between patients. We recently demonstrated that a functional allelic polymorphism in the haptoglobin gene is correlated with a number of diabetic vascular complications. We thus set out to test the hypothesis that haptoglobin phenotype is associated with collateral formation in the setting of diabetes. We correlated the Hp phenotype (1-1, 2-1 or 2-2) as determined by polyacrylamide electrophoresis with the presence or absence of coronary collaterals by angiography in 82 consecutive diabetic patients and 138 consecutive non-diabetic patients undergoing catheterization. We found that diabetic patients with the Hp phenotype 2-1 were more likely to have collaterals than diabetic patients with the Hp phenotype 2-2 (P=0.007). There was no correlation between Hp phenotypes and the presence of collaterals in non-diabetic patients. Hp phenotype thus appears to be associated with the development of the coronary collateral circulation in diabetic patients with coronary artery disease. Haptoglobin 2-2 may predispose to less compensation for coronary artery stenosis in diabetic patients, and thereby portend a worse prognosis.

Aged↗

PubMed1982

Differential hyperemic responses following femoral arterial and thigh cuff occlusion in the canine hindlimb.

The hyperemic response following arterial reconstruction is variable. To further evaluate this response, arterial blood flows in the canine hindlimb were compared following isolated femoral arterial occlusion and after thigh cuff tourniquet occlusion, which also obstructs collateral circulation. Arterial occlusion and tourniquet occlusion produced significant (P less than 0.05) increases in femoral arterial flow after all intervals of occlusion, except following 30 minutes of isolated arterial occlusion. Isolated arterial occlusion and tourniquet occlusion produced comparable hyperemic responses through five minutes of occlusion. However, tourniquet occlusion produced a significantly greater increase (P less than 0.05) in femoral flow when occlusions exceeded five minutes. These data suggest that the extent of collateralization may moderate the postobstructive hyperemic response following aortic and femoropopliteal reconstruction. The collateral recruitment during isolated arterial occlusion may be responsible for a diminished hyperemic response with time, while obstruction of the collateral circulation during tourniquet occlusion may result in a greater hyperemic response.

Animals↗

PubMed1987

[Follow-up results after STA-MCA anastomosis in cases of middle cerebral artery stenosis].

To elucidate hemodynamic changes and prognosis after STA-MCA anastomosis, thirteen cases with middle cerebral artery stenosis were systematically analyzed from the pre- and postoperative findings of cerebral angiography, CT scan and rCBF. They were followed up about 3 years long on the average postoperatively. Postoperative angiography revealed patent bypass in all cases. No remarkable changes at the site of stenosis were observed in the group A (6 in 13 cases), who had angiographically sufficient inherent collateral circulation. By contrast, group B (7 in 13 cases), who had insufficient inherent collateral circulation, showed remarkable progress in the degree of stenosis and significant changes of flow patterns were observed after operation. However, these postoperative changes did not bring any clinical deterioration. During follow-up period (31.2 months on the average) after operation, no cerebrovascular accident were encountered in all cases and clinically improved. In conclusion, the STA-MCA bypass rendered more beneficial effect to the patient with MCA stenosis when compared with natural histories reported in the literature.

Cerebral Angiography↗

PubMed1995

[Monitoring somatosensory evoked potentials during carotid endarterectomy].

The tromboembolic and ischemic events during carotid endarterectomy can be avoided or detected with appropriate monitoring. Median nerve somatosensory evoked potentials recorded from the parietal cortex correlate with the blood flow in the middle cerebral artery. The good evoked responses after cross-clamping of the carotid artery indicate a sufficient collateral circulation, enabling a surgery without shunt, thus minimizing the risk of embolisation. Insufficient collateral circulation after cross-camping results in an amplitude reduction of the parietal N20-P25 complex of more than 50%. In this case an ischemic event can be prevented by shunting. As a total 83 carotid endarterectomies were done. In 65 cases (78.3%) the evoked potentials showed no significant alteration, and no postoperative neurological deficit occurred. Seven patients (8.45%) needed to be operated with a shunt, because of cross-clamping ischaemia. One of them presented a transient postoperative hemiparesis, which was predicted by the long-term loss of the SEP-s, and which resolved within 4 hours. Seven further patients (8.45%)--operated primarily with shunt, and 4 patients (4.8%)--monitored with transcranial Doppler sonography, showed no postoperative neurological deficit. We found that median nerve somatosensory evoked potential monitoring during carotid endarterectomy is a simple, sensitive and reliable method.

Arteriovenous Shunt, Surgical↗

PubMed1995

[Angiographic findings in postinfarction cardiac rupture].

The hemodynamic and angiographic findings were examined in 16 patients with myocardial rupture following acute myocardial infarction. The patients (9 men, mean age 55.8 years, and 7 women, mean age 64.0 years) had suffered an extensive transmural infarction, all but 2 cases involved first cardiac events. The diagnosis of myocardial rupture was made on clinical grounds, and confirmed by the results of noninvasive (echocardiography) and invasive (left ventriculography) investigations. The average time from the infarction to the appearance of cardiac rupture was 4.6 days (range: 1 hour to 16 days). The patients receiving thrombolytic therapy mainly suffered an early rupture (less than 72 hours following the infarction), while the group receiving conventional therapy mainly had a late rupture (between 4 and 16 days). 7 patients had single-vessel, 3 two-vessel and 6 three-vessel disease. Examination of the infarct-related vessel revealed a total occlusion in the proximal or medial part of the coronary in 75% of the cases. Angiography demonstrated no manifest collateral circulation to the infarct-related artery in 10 cases, and only limited collateral blood flow in 6 patients. It is concluded that cardiac rupture depends on the management of the myocardial infarction, the abrupt cessation of flow in the infarct-related vessel and the absence of adequate collateral circulation supporting the infarcted zone. 15 patients underwent cardiac surgical correction and in 8 cases additional coronary artery bypass grafting was performed. After the operative intervention, 9 patients exhibited a significant improvement, and there was no sign of cardiac failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2001

Aspects of the spinal cord circulation as assessed by intrathecal oxygen tension monitoring during various arterial interruptions in the pig.

OBJECTIVE: We sought to study the effect of various modes of interruption of the spinal cord blood supply on intrathecal oxygenation. METHODS: In 24 pigs intrathecal PO (2), PCO (2), and pH were continuously monitored with a multiparameter catheter (Paratrend 7, Biomedical Sensors; Diametrics Medical, Inc, St Paul, Minn) during and after aortic crossclamping or selective interruption of segmental arteries and proximal collateral circulation. RESULTS: Proximal aortic clamping (n = 6) produced complete ischemia, whereas a second clamp close to the celiac trunk (n = 4) partly protected against spinal cord ischemia. This is explained by prevention of the steal phenomenon in the excluded part of the aorta. Adding clamps to the subclavian arteries (n = 6) created complete spinal ischemia as the collateral circulation was interrupted. In another group (n = 4) all segmental arteries below T5 were occluded with no reaction in the intrathecal variables. Additional selective clamping of supreme intercostal arteries (n = 4) showed the relative importance of the subclavian and vertebral collateral pathways. CONCLUSIONS: Continuous intrathecal PO (2) was monitored during various modes of interruption of the spinal cord blood supply. This provided insight into the ischemia mechanisms and relative importance of the segmental contribution and proximal collateral pathways of the spinal cord circulation in pigs. A short literature review is given, and aspects of comparative anatomy are discussed.

Animals↗

PubMed1991

[Coronary collateral vessels during the early period of acute myocardial infarction: their development].

The aim of this study was to investigate the incidence and development of coronary collateral circulations in patients with acute myocardial infarction (AMI). We categorized 165 patients with persistent 100% occlusion of the infarct-related artery into 6 groups according to the time from the onset of AMI to angiography. Group I consisted of 55 patients evaluated within 6 hours after the onset of AMI; Group II, 28 patients, between 6 and 12 hours after the onset; Group III, 12 patients, between 12 and 24 hours after the onset; Group IV, 11 patients, between 2 and 13 days after infarction; Group V, 46 patients, between 14 and 44 days after infarction; and Group VI, 13 patients, more than 45 days after infarction. Collateral vessels were applied a numerical score between 0 and 3 according to the degree of opacification of the native vessel distal to the occlusion. In 58%, 79%, 67%, 73%, 89%, and 92%, patients of Groups I to VI had evidence of collateral vessels, respectively. Well-developed collaterals were observed in 24% of Group I compared with 50%, 58%, 55%, 73% and 69% of patients in Groups II to VI, respectively. The mean coronary collateral scores were 0.9 +/- 0.1, 1.4 +/- 0.2, 1.4 +/- 0.3, 1.6 +/- 0.4, 2.0 +/- 0.2 and 2.2 +/- 0.3 for Groups I to VI, respectively. Patients with preinfarction angina had more well-developed collateral circulations than did patients without it, however, there was no significant correlation between the duration of previous angina and extent of coronary collaterals.

Adult↗

PubMed2004

Distinguishing between anterior cerebral artery and middle cerebral artery perfusion by color-coded perfusion direction mapping with arterial spin labeling.

The purpose of this study was to evaluate collateral circulation by describing anterior cerebral artery and middle cerebral artery perfusion areas. Pairs of image sets spin labeled on the medial and lateral side were used. A pixel-by-pixel t test was performed, with blue gradation used to display lateral perfusion (ie, middle cerebral artery) and orange gradation for anterior cerebral artery perfusion. Extensions of anterior cerebral artery perfusion areas in cases of middle cerebral artery stenosis were described. This method may aid in estimation of collateral circulation for stroke treatment.

Cerebral Angiography↗

PubMed1986

[A study of regional cerebral blood flow before and after superficial temporal artery-to-middle cerebral artery anastomosis].

Regional cerebral blood flow (rCBF), using a single photon emission CT with Xe-133 inhalation method, was measured before and after the operation in 30 patients who underwent a superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. The purpose of this study is to assess the effect of STA-MCA anastomosis from the standpoint of hemodynamics and the results obtained were as follows: rCBF at rest increased after the operation, which was approximately 10% alterations and was localized in temporal region of operated hemisphere and frontal region of non-operated hemisphere respectively. rCBF during STA compression test after surgery decreased only in temporal region (anastomotic site) of operated hemisphere. This findings might indicate that blood flow via the bypass artery become to provide mainly to the confined area. CO2 reactivity was disturbed in 6 patients before operation, but it restored in 4 patients after operation. Autoregulation was also abolished in 8 patients before operation, but it restored in 6 patients after operation. In the group of severe degree of ischemia, however, autoregulation did not show the tendency to recover after the operation, whereas CO2 reactivity somewhat recovered. Angiographical retrograde filling which indicates collateral circulation reduced or disappeared in 12 out of 14 patients, in which postoperative rCBF in temporal region increased, in addition autoregulation and CO2 reactivity tended to recover after the bypass operation. These data mentioned above probably indicated the influences of CBF increase via the bypass artery. In summary, it might be concluded that the hemodynamic change such as disappearance of collateral circulation seen on angiography, additionally postoperative rCBF increase in anastomotic site seemed to be related to the restoration of these vascular responses such as CO2 reactivity and autoregulation in ischemic brain.

Adolescent↗

PubMedDate not supplied

Colorectal infarction following resection of abdominal aortic aneurysms.

Infarctions of the colon and rectum (incidences approximately 1 and 0.5 per cent, respectively) are caused by compromised collateral circulation to the colon and rectum, usually as a result of arteriosclerotic disease of the superior and inferior mesenteric arterial systems, as well as the hypogastric arteries. Patients who have colorectal ischemia after operations for abdominal aortic aneurysms have diarrhea (sometimes bloody), abdominal pain, and distention. The diagnosis may be established by sigmoidoscopic examination. Treatment includes surgical removal of the compromised bowel and creation of a temporary or permanent end colostomy. Prevention of this complication is aided by preservation of primary and collateral circulation, avoidance of hypotension, and preoperative bowel preparation.

Aorta, Abdominal↗

PubMed2003

Echocardiographic features of adult tetralogy of Fallot with natural palliative correction by patent ductus arteriosus.

A thirty-year-old man with the diagnosis of the tetralogy of Fallot and patent ductus arteriosus was admitted to our hospital because of a syncope. He reported no previous symptoms. We diagnosed adult tetralogy of Fallot, which included all four characteristic anomalies: ventricular septal defect, overriding aorta, pulmonary artery stenosis, and right ventricular hypertrophy. The associated persistent ductus arteriosus and the presence of compensatory arteriovenous communications produced a continuous flow load on the left ventricle, which resulted in moderate left ventricular hypertrophy, but without symptoms of pulmonary congestion or cardiac decompensation. Anatomic diagnosis and hemodynamic assessment were established by transthoracic and transesophageal echocardiography, with incidental finding of a quadricuspid aortic valve. To the best of our knowledge, our case of the adult form of Fallot's tetralogy associated with both patent ductus arteriosus and quadricuspid aortic valve is the first one ever described. It is well known that patients with tetralogy of Fallot who do not undergo operation in childhood have short survival, which depends predominantly on the degree of pulmonary artery stenosis and early development of collateral circulation to the lungs. Long-term persistence of natural aortopulmonary anastomosis with systemic collateral circulation to the lungs and remodeling of the heart, with better hemodynamic balance as well as the presence of mild pulmonary artery stenosis probably enhanced the survival of our patient.

Adult↗

PubMed1993

[Behavior of post-occlusion systolic blood pressure after long duration blockade. Effect of induced hypertension].

A suprasystolic blockade (300 mm Hg) was applied for 50 to 60 min to the thigh of the affected leg with a blood pressure cuff in 13 patients with occlusions of the femoral artery. Afterwards, the pre-postocclusive systolic pressure difference was clearly less in most patients than before the compression manoeuvre. This reduction of the systolic pressure gradient, which was greatest in the first hour and slowly decreased in subsequent days, is likely to be based on a dilatation of the collateral arteries. The reaction was especially pronounced in patients with isolated occlusion of the femoral artery. Since the entire collateral circulation is largely in the region of the cuff compression in these cases, the collateral dilatation might arise from the powerful and long lasting pressure. In 9 patients it was investigated whether an increase of systemic blood pressure induced by hypertension can be transduced more effectively to the postocclusive arterial system when the collateral arteries are "paralyzed". The heterogeneous results show that such an effect can evidently only be expected when the collateral circulation is restricted to the thigh. However, such conditions are probably not usual in poorly compensated stage IV following Fontaine, in which a temporary peripheral increase of blood pressure is likely to be reasonable for therapy.

Adult↗

PubMed1997

Significance of negative U waves in the precordial leads during anterior wall acute myocardial infarction.

This study was conducted to clarify the clinical significance of negative U waves in the precordial leads during anterior wall acute myocardial infarction (AMI). In all, 141 patients with first anterior wall AMI (< or = 6 hours) were classified into 2 groups according to the presence (group A, n = 31) or absence (group B, n = 110) of negative U waves in the precordial leads on the admission electrocardiogram (ECG). The number of leads showing ST elevation > or = 1 mm on the admission ECG was smaller in group A than in group B (5.2 +/- 1.3 vs 6.2 +/- 1.7, p < 0.01). Emergent coronary arteriography revealed that group A had a higher incidence of good collateral circulation than group B (39% vs 19%, p < 0.05). Peak creatine kinase activity was lower in group A than in group B (1,708 +/- 1,271 vs 2,735 +/- 1,865 IU/L, p < 0.01). The number of abnormal Q waves on the predischarge ECG was smaller in group A (2.0 +/- 1.5 vs 3.4 +/- 2.0, p < 0.01). Group A had a greater left ventricular ejection fraction and better regional wall motion in the anterobasal, anterolateral, and apical regions in the chronic phase than group B. In conclusion, patients with anterior wall AMI having negative U waves in the precordial leads on admission had a relatively smaller mass of necrotic myocardium than those without the waves. Therefore, negative U waves during anterior wall AMI may be a useful marker for identifying patients with smaller infarction partly due to better collateral circulation.

Angioplasty, Balloon, Coronary↗

PubMed1990

Role of previous angina pectoris and collateral flow to preserve left ventricular function in the presence or absence of myocardial infarction in isolated total occlusion of the left anterior descending coronary artery.

The aim of this study was to determine whether previous angina pectoris and collateral circulation influenced myocardial function after isolated coronary occlusion. In 58 consecutive patients, coronary angiography showed a complete isolated occlusion of the left anterior descending coronary artery; 43 patients (74%) had previous myocardial infarction. Duration of previous angina pectoris was defined as the time from the first ischemic symptom to the date of myocardial infarction or of coronary angiography in the absence of myocardial infarction. Left ventricular ejection fraction was measured on the 30 degrees right anterior oblique projection of the left ventricular angiogram. Collateral circulation was graded as follows: none or filling limited to side branches (group 1) and partial or complete filling of the epicardial arterial segment (group 2). Group 2 (40 patients) had higher ejection fraction (57 vs 38%; p less than 0.0001) and longer duration of previous angina pectoris (11 vs 0.1 months; p less than 0.002) than group 1 (18 patients). A longer duration of previous angina pectoris probably allows collateral development before coronary occlusion in 1-vessel coronary artery disease, thereby limiting myocardial damage.

Angina Pectoris↗

PubMed1996

Expression of vascular endothelial growth factor in human myocardial infarction.

To define mechanisms that may influence collateral circulation and angiogenesis, we investigated vascular endothelial growth factor (VEGF) mRNA expression in human hearts. In non-ischemic human hearts, VEGF mRNA was not detected in vessels, but was found in cardiomyocytes. In hearts with myocardial infarction, the intensity of the VEGF signal was much higher in smooth muscle cells of arterioles adjacent to necrosis and in infiltrating macrophages than in myocytes around the site of the necrosis. This study suggests that levels of VEGF expression are high in smooth muscle cells and macrophages around infarcted areas after myocardial infarction and that VEGF may play a role in promoting collateral circulation and angiogenesis in human ischemic hearts.

Aged↗

PubMed1991

Reperfusion injury in dog hearts with permanent occlusion of a coronary artery, probably due to reperfusion via collateral vessels.

To clarify whether or not reperfusion injury occurs in the permanent occlusion of a coronary artery, we analyzed quantitatively contraction band necrosis as an indicator of early recanalization, coagulation necrosis, infarct size and measured regional blood flow in dog hearts with collateral circulation. Fifty mongrel dogs were divided into four groups: 15 dogs with a 24-hour occlusion of the left anterior descending coronary artery just distal to the first diagonal branch (permanent occlusion group): 15 dogs a with 3-hour occlusion followed by 24-hour recanalization (recanalization group); 10 dogs with a 2-hour occlusion without recanalization (transient occlusion group); 10 dogs with a 4-hour occlusion without recanalization (transient occlusion group). The regional blood flow in the subepicardium and subendocardium determined by the generated hydrogen gas clearance method was greatly decreased 30 minutes after occlusion (14 + 8%/12 +/- 9%) and was relatively restored from 180 minutes (31 +/- 21%/21 +/- 14%) to 24 hours later (41 + 19%/26 + 16%) in spite of complete occlusion of the coronary artery. The percentage infarct area in the risk area was significantly greater in the permanent occlusion group (60 +/- 26%) than in the recanalization group (35 +/- 31%). Although most of the infarct was occupied by contraction band necrosis in the recanalization group (86 +/- 12%), contraction band necrosis was diffusely seen even in the permanent occlusion group (54 +/- 27%). In both the permanent and recanalization groups, contraction band necrosis was the main histological feature of small infarcts occupying less than 30% of the risk area, while coagulation necrosis was the main feature in very large infarcts occupying more than 80% of the risk area. In the occlusion groups without recanalization, the percentage area of contraction band necrosis in the risk area was 6 +/- 8% after the 2-hour occlusion, 23 +/- 17% after the 4-hour occlusion and 31 +/- 21% after permanent occlusion; the difference between the 4-hour and permanent occlusion groups was not significant. In the permanent occlusion group, the percentage infarct area in the risk area was inversely correlated with regional blood flow during occlusion, an indicator of collateral flow. It was concluded that reperfusion injury occurs even in hearts without recanalization. The pathogenesis may involve reperfusion in the risk area via collateral circulation. Protection against reperfusion injury is important to minimize the infarct size even in hearts with permanent occlusion, although the presence of collateral flow is an important factor in limiting infarct size.

Animals↗

PubMed1993

Thallium reinjection demonstrates viable myocardium in regions with reverse redistribution.

BACKGROUND: The clinical significance and pathophysiological mechanisms of reverse redistribution on stress-redistribution thallium-201 myocardial scintigraphy in patients with chronic coronary artery disease are unclear. Recent studies have shown that thallium-201 reinjection is a useful technique for the detection of myocardial viability in chronic coronary artery disease. In this investigation we determined whether thallium reinjection distinguishes viable from nonviable myocardium in regions with reverse redistribution. METHODS AND RESULTS: We studied 39 patients with chronic stable coronary artery disease (age, 60 +/- 10 years), all of whom demonstrated reverse redistribution on standard exercise-redistribution thallium single-photon emission computed tomography (SPECT). Reverse redistribution was defined as > or = 10% decrease in relative thallium-201 activity between stress and redistribution images and included either the worsening of a perfusion defect apparent on post-stress images or the appearance of a new defect on the redistribution images. Thallium reinjection was performed immediately after the 3- to 4-hour redistribution study. Of 39 regions with reverse redistribution, 32 (82%) showed enhanced thallium-201 activity (> or = 10% increase) after reinjection. In the other 7 regions (18%), the scintigraphic defect persisted after reinjection. Abnormal Q waves were present in only 8 of 32 (25%) regions with enhanced thallium-201 uptake after reinjection compared with 5 of 7 (71%) regions not responding to reinjection (P < .05). Akinetic or dyskinetic wall motion was present in 3 of 32 (9%) regions showing enhanced uptake after reinjection, in contrast with 5 of 7 (71%) regions not responding to reinjection (P < .01). Critically stenosed or totally occluded coronary arteries supplied 24 of 29 (83%) regions with enhanced thallium-201 uptake after reinjection but only 2 of 7 (28%) regions not showing a positive response to reinjection (P < .05). Collateral circulation was detected in 23 of 29 (79%) regions with a positive thallium reinjection effect but in only 1 of the other 7 regions (P < .01). Sixteen of the 39 patients also underwent positron emission tomography using 18F-fluorodeoxyglucose (FDG) to assess glucose utilization and H2(15)O to assess regional blood flow. The 14 regions with reverse redistribution that responded to reinjection with enhanced thallium uptake all showed either normal patterns of FDG uptake and flow or an ischemic pattern with increased FDG uptake relative to flow. Reduced FDG uptake and reduced flow values were seen in the two regions not responding to thallium reinjection. CONCLUSIONS: These observations indicate that reverse redistribution in chronic coronary artery disease usually reflects viable myocardium, critically dependent upon collateral circulation.

Cardiac Catheterization↗

PubMed1977

Effect of partial portal vein ligation on immune glomerular deposits in Schistosoma mansoni-infected mice.

Portosystemic collateral circulation was induced in mice infected or not with Schistosoma mansoni by partial ligation of the portal vein. The effects on immune glomerular deposits were assessed and compared to findings in unoperated infected, sham-operated and normal animals. Mesangial immune deposits of IgM, IgA, IgG and C3 were found by immunofluorescence significantly more frequently in operated than in unoperated infected mice. Schistosomal antigen was demonstrated in 5 animals out of 38 infected ones, 4 of the 5 having been operated. The results suggest that portosystemic collateral circulation might be an important factor in the genesis of schistosomal glomerulopathy, perhaps by diversion of antigens or complexes from the Kupffer cells. The high percentage of glomerular immune deposits found in uninfected ligated animals (71-4%) suggests furthermore that non-specific immune factors possibly of intestinal origin could be involved.

Animals↗