Arterial Anatomy Research Articles

Unilateral linguofacial trunk

The external carotid artery is the main artery of the head and neck region. It has eight branches, and there are various variations in the emergence and distribution of these branches. In particular, frequent changes can be observed in the emergence of facial artery, and lingual artery. Knowledge of the vascular anatomy of the lingual artery and facial artery is important in terms of neck surgery and radical treatments. For this reason, in the present case report we aimed to report a case with linguofacial trunk and its morphometric and morphological features.

Internal vascular anatomy of the human lacrimal gland: A protocol based on cadaver dissection and three-dimensional micro-computed tomography

PurposeTo evaluate the feasibility of studying the vascular supply of the orbital and palpebral lobes of the human lacrimal gland using micro-computed tomography (micro-CT) and microscopic dissection. MethodsThe lacrimal gland artery of a fresh parasagittalized cadaver head (male, aged 76 years) was infused with a lead oxide-latex mixture near the occipital pole of the gland. The entire lacrimal gland was imaged using micro-CT and 3D cinematic rendering (CR) and then dissected under a surgical microscope. ResultsMicro-CT and CR images showed well-demarcated internal vascular branches of the lacrimal artery and their distribution within the orbital and palpebral lobes. The entire course of the artery and its branches could be visualized by CR and microscopic dissection, with the former showing better spatial orientation and finer branching. The main artery runs along the free edge of the aponeurosis of the levator palpebrae superior muscle and lies in the isthmus portion of the gland (between the orbital and palpebral lobes). The branches of the main lacrimal artery include one branch to the orbital adipose tissue just before entering the gland, two branches to the orbital lobe (medial and lateral), and two branches to the palpebral lobe (medial and lateral). The main artery terminates as palpebral and orbital lobe branches in the lateral half of the lacrimal gland. ConclusionLatex and contrast-enhanced micro-CT is very well suited to visualize the vascular anatomy of the lacrimal artery within the gland. A large number of lacrimal gland examinations using the method presented here are required to demonstrate and understand the variability of the vascular anatomy of the human lacrimal gland.

Unique Case of Anomalous Anatomy of the Right Coronary Artery from the Pulmnary Artery

Anomalous origin of the right coronary artery from the pulmonary artery is one of the rare congenital coronary diseases. The percentage of population damage is 0.002 %. In most cases this occurrence is asymptomatic and diagnosed accidentally like our case. Here, we report a 9-month-old female infant who was admitted with a diagnosis multiple muscle ventricular septal defects. For diagnostic we used echocardiogram, as a result an anomalous origin of the right coronary artery from the pulmonary artery was suspected. After that, coronary computed tomography angiography confirmed the diagnosis. The patient underwent surgical correction by redeployment of the coronary artery in aorta. The aim of our report is to describe the successful correction of a potentially fatal disease. Early diagnostic can provide effective treatment.
 
 

Contralateral Snare Cannulation vs. Retrograde Gate Cannulation during Endovascular Aortic Repair in Difficult Iliac Artery Anatomy: A Single Center Experience.

Endovascular aneurysm repair is well established as the gold standard in treating abdominal aortic aneurysms. Generally, endovascular repair is performed using a bi or trimodular stent graft, requiring placement of a contralateral iliac limb. Deployment of the contralateral iliac limb requires retrograde gate cannulation of the endograft main body contralateral limb. This step represents the crucial point of a standard endovascular repair procedure and can become challenging, especially in the case of high iliac tortuosity. This study compares the procedural times between the retrograde gate cannulation and the contralateral snare cannulation to demonstrate the possibility of directly performing the contralateral snare cannulation in the case of a complex iliac anatomy assessed by the iliac tortuosity index. One hundred and forty-eight patients with infrarenal abdominal aortic aneurysms who underwent endovascular aneurysm repair from 2017 to 2022 were analyzed retrospectively. Cannulation times between retrograde gate cannulation and contralateral snare cannulation were compared for each degree of iliac tortuosity. The degree of iliac tortuosity was assessed through the iliac tortuosity index. Cannulation times were detected from inserting the wire into the introducer to passing through the radio-opaque gate markers. The cannulation times were 2.94 min for the retrograde gate cannulation group and 3.15 min for the contralateral snare cannulation group, respectively, with no statistically significant differences (p = 0.33). Overall cannulation times were 2.98 min. For the iliac tortuosity index grade 0, the cannulation times were 2.71 min for the retrograde gate cannulation group and 3.85 min for the contralateral snare cannulation group, respectively, with a significant difference in favor of the retrograde gate cannulation group (p < 0.0001). For the iliac tortuosity index grade 1, the cannulation times were 2.74 min for the retrograde gate cannulation group and 2.8 min for the contralateral snare cannulation group, respectively, with no statistically significant differences (p = 0.63). Regarding the iliac tortuosity index grades 2 and 3, the cannulation times were 3.01 and 4.93 min for the retrograde gate cannulation group and 2.71 and 3.28 min for the contralateral snare cannulation group, respectively. The first group's times were significantly higher than the second group's (p = 0.01 and p = 0.0001). In patients with infrarenal abdominal aortic aneurysms undergoing endovascular aortic repair, the gate cannulation times were significantly shorter for the contralateral snare cannulation method than the retrograde gate cannulation method in the iliac tortuosity index grades 2 and 3. Therefore, performing the contralateral snare cannulation method would be appropriate.

Diameter and depth of femoral vessels by duplex ultrasound

Background: The anatomy of the femoral artery and vein plays an integral role in vascular access. Both technical feasibility and complication rates are associated with femoral vessel diameter and depth. The goal of this study is to establish normative values for common femoral artery (CFA) and vein (CFV) depth and diameter using a large, diverse patient population. Methods: A retrospective review of all patients undergoing lower extremity venous duplex imaging over a 1 year period were reviewed. Patients with inadequate imaging or with evidence of deep vein thrombosis were excluded. The index image of all studies was a non-compressed view of the common femoral vein at the saphenous-femoral junction. All measurements were taken from this still. Vessel diameters were measured from intima to intima. Depth was measured from skin to intima. BMI and BSA were calculated using standard formulas. Chi square was used for univariate analysis. Linear regression was used to establish correlation. Results: Over the 1 year period, 983 patients met criteria for inclusion. The majority were male (53%) with a mean age of 55. The patients were 47% white and 44% black. The majority had hypertension (53%). The mean BMI and BSA were 29 and 2, respectively. Mean CFA depth was 1.7 cm, while mean CFV depth was 1.8 cm. The mean CFA and CFV diameters were 0.9 and 1.1 cm, respectively. Amongst height, weight, BMI, and BSA, weight correlated best with CFA ( R = 0.548) and CFV ( R = 0.552) depth, while BSA correlated best for diameter for both CFA ( R = 0.390) and CFV ( R = 0.440). Conclusions: This study establishes mean diameters and depths for the common femoral artery and vein using a large, diverse patient group. BSA was most closely associated with vessel diameter, while weight was correlated with depth. This study provides normative diameter and depth values for the common femoral vasculature, which may assist in vascular access planning for providers.

The complete anatomy of the prostatic artery: a meta-analysis based on 7421 arteries with implications for embolization and urological procedures

The complete anatomy of the prostatic artery: a meta-analysis based on 7421 arteries with implications for embolization and urological procedures

Morphological and Topographical Features of the Radial Recurrent Artery and Its Possible Clinical Significance

Objective: The anatomy of the radial recurrent artery (RRA) is very important for interventional procedures. The aim of this study was to investigate the morphological and topographic anatomy of the RRA. Methods: The study was conducted on 20 human cadavers (14 male and 6 female, 40 upper limbs). The RRA was classified into 4 groups as follows according to the observed origin: RRA originated from the radial artery (RA) (Type A), the root of the RA (Type B), the brachial artery (BA) (Type C), and the ulnar artery (UA). The relative positioning of the RRA in relation to the biceps brachii muscle tendon (TBB), in terms of the antero-posterior direction was determined. The vertical distance of the origin point of the RRA to the intercondylar line and the diameters of this artery were determined. Morphometric evaluation was performed with a digital caliper. The obtained data were analyzed using SPSS version 21.00 software. Results: The artery most commonly originated from the RA (Type A 47.5%, 19 extremities). This was followed by RA root (Type B 32.5%, 13 extremities), BA (Type C 17.5%, 7 extremities), and UA (Type D 2.5%, 1 extremity). The RRAs coursed anteriorly to the TBB in 38 extremities (95%) and passed behind the tendon in 2 extremities (5%). The vertical distance of the origin point of the RRA to the intercondylar line was meanly 32.20 ±6.86 mm. The diameter of the artery at its origin point was meanly 2.57 ± 0.58 mm and just after its first branch was meanly 2.05 ± 0.48 mm. Our study documents a rare morphological variation of the RRA originating from the UA (Type D). Conclusion: While many of our findings align with previous studies, this research presents novel anatomical findings and elucidates the superficial course and topographical positioning of the RRA to estimate its origin point.

Coronary anatomy in neotropical carnivores: A comparative analysis.

This study aims to investigate the anatomy of coronary arteries and their primary branches in neotropical carnivores, given the functional significance of coronary circulation and the limited existing descriptions in this order. For this purpose, coronary arteries were dissected, and their branches were counted in 74 hearts from 20 species belonging to five families: Canidae, Mustelidae, Procyonidae, Mephitidae, and Felidae. In all specimens of the suborder Caniformia, the subsinuosal interventricular branch originated at the end of the circumflex branch of the left coronary artery (LCA). In contrast, in all hearts of Felidae specimens, the subsinuosal branch was derived from the right coronary artery. Among the 50 neotropical specimens of the suborder Caniformia, 13.1 ± 5.2 ventricular branches originated from the LCA and only 4.6 ± 1.4 from the right (p < 0.0001), characterizing a consistent left dominance. However, in the 24 specimens of the Felidae family, 10.5 ± 4.0 ventricular branches were found originating from the LCA and 10.4 ± 3.4 from the right, with no difference between the means (p = 0.82), defining a balanced pattern. It is suggested that the type of coronary circulation may correlate with the phylogeny of carnivorans.

Arteria Lusoria: Descriptive Anatomy, Topography and Clinical Implications at the HUBERT KOUTOUKOU MAGA National University Hospital Center (CNHU-HKM)

Background: The presence of a right aberrant subclavian artery, also known as the lusoria artery, is the most frequent anomaly of the aortic arch. The aim of this study was to describe the anatomy of the lusoria artery and its relationships on CT scans in melanoderm subjects at the CNHU-HKM in Benin. Methods: This was a descriptive cross-sectional study with retrospective data collection, conducted from January 2018 to December 2021 at the CNHU-HKM. It focused on thoracic angioscans and thoraco-abdomino-pelvic scans that revealed a lusoria artery in patients referred to the medical imaging department. The sampling was exhaustive. Image analysis was performed using Radiant DICOM Viewer software. Results: A total of 11 cases of lusoria artery were identified among the 732 scans studied, representing a frequency of 1.5%, with a sex ratio of 0.22. The mean age of the patients was 50.81 ± 14.54 years. The discovery of the lusoria artery was incidental in all patients. The lusoria arteries arose from the aortic arch, on average 7.59 mm after the left subclavian artery, with a mean diameter of 14.86 mm at the origin. They all had a retro-esophageal course. The bicarotid trunk was the most frequent associated anatomical variation (90.9%) with a mean length of 11.84 mm. This was followed by Kommerell's diverticulum (18.18%). One case of a common origin of the subclavian arteries and bicarotid trunk associated with the lusoria artery was noted. Conclusion: The lusoria artery is a rare anatomical variation that predominantly affects women. Often discovered incidentally, it arises from the aortic arch and has a retro-esophageal course. It is almost constantly associated with a bicarotid trunk. KEYWORDS: Lusoria artery - bicarotid trunk - CT scan - Kommerell's diverticulum - Benin.

Posterior superior alveolar artery – an anatomical and clinical case report

Abstract During a routine dissection of infratemporal fossa on educational purposes abnormality of posterior superior alveolar artery was found. This abnormality stays in relation to atypical anatomy of the facial artery in this cadaver. Such an unusual course of branches may have a profound meaning during surgery in the infratemporal and facial area and might have educational value. A case report was conducted using routine dissection techniques, and the material was accessed through a local informed donation program.

Aortic valve leaflets are asymmetric and correlated with the origin of coronary arteries.

Asymmetry of the aortic valve leaflets has been known since Leonardo Da Vinci, but the relationship between size and shape and origin of the coronary arteries has never been examined. Our aim was to evaluate this anatomy in a population of pediatric patients using a cross-sectional study design. Consecutive pediatric patients with trans-esophageal echocardiography (TEE), with or without trans-thoracic echocardiography (TTE), were included in our study. Exclusion criteria: (I) bicuspid aortic valve; (II) aortic valve stenosis; (III) hypoplasia of aortic valve annulus, or aortic root; (IV) truncal valve; (V) coronary artery atresia; (VI) previous surgery on aortic valve and/or coronary arteries. In pre-operative TTE and intra-operative TEE inter-commissural distance and length of aortic valve leaflets were measured in short axis view in the isovolumic phase of systole. Echocardiography investigations, anonymized and randomly coded, were independently reviewed by at least two readers. Echocardiography, angiography, cardiac computed tomography (CT) scan and magnetic resonance imaging (MRI), and operative notes were reviewed to identify origin of coronary arteries. Two hundred sixty-one pediatric patients were identified, 93 excluded per our criteria, leaving 168 patients, age 2.6±4.3 years, weight 12.87±17.34 kg, 128 (76%) with normal and 40 (24%) with abnormal coronary arteries. In TTE and TEE measurements the non-coronary leaflet had larger area (P<0.001), while the right and left had equal areas, but different shape, with the left leaflet longer (P<0.001) and narrower (P=0.005) than the right. With the major source of blood flow from the right coronary sinus, the non-coronary leaflet was still the longest. However, there was no statically significant difference between the size and shape previously observed between the right and left leaflets. Our study showed asymmetry of size and shape among aortic valve leaflets, and a relationship with coronary artery origin. The complex aortic root anatomy must be approximated to optimize function of any surgical repair. These findings also may prove useful in the pre-operative definition of coronary artery anatomy and in the recognition of coronary artery anomalies.

Alveolar antral artery: cone beam computed tomography study and clinical context.

Anastomosis between posterior superior alveolar artery and infraorbital artery can go through bony canal in the lateral wall of the maxilla. This artery is called alveolar antral artery. It can complicate lateral sinus lift procedure by bleeding and hemosinus formation or bone graft wash out. The artery can also go in soft tissues where is not visible on cone beam computed tomography. In previous studies, the relation of this artery to sinus floor or alveolar process was measured. These structures are highly unstable during lifetime and after tooth loss. The aim of this study is to study presence and relations of bony canal in the lateral maxillary wall, to characterize the group of patients which is more likely to have bone canal in the lateral maxilla. The aim and the novelty of this study is the describing of the relationship of the bony canal to the more stable structure of hard palate and describing the relation of presence of bony canal on width of maxillary sinus, and to facilitate the prediction of presence of the alveolar antral artery. The cone beam computed tomography scans of the patients (251 in number) of the university hospital were examined for presence of alveolar antral artery (148 was fulfilled inclusion criteria), patient were characterized by gender, age, and sinus type (wide, average, narrow). The diameter of the bony canal and its relation to the level of sinus floor and hard palate were measured. The cone beam computed tomography scans of 148 patients, out of it 55 man (37,2%) and 93 women (62,8%). Bony canal containing alveolar anastomosis was found in 69 cases (57,0%). Presence of the bony canal in the lateral wall of maxillae showed statistical probability depending on age with p=0,064 according to Mann-Whitney test. The older patients have more likely the bony canal. The presence of the alveolar antral artery was found more likely in the wide sinuses. The hard palate level can serve as a prediction point of alveolar antral artery only in first molar and second premolar region. In accordance with previous studies the width of bony canal is significantly higher in group of man (p=0,015). There was found a correlation between smaller distance of bony canal from sinus floor in the presence of teeth (p=0,067). After tooth loss the distance between sinus floor and bony canal increases, but the distance of bony canal to hard palate level stays constant. This can be explained hypothetically so that periodontal ligaments and root surface acts as a barrier for sinus pneumatization. Lateral sinus lifting in some cases can be unenviable, the knowledge about alveolar antral artery anatomy can reduce the risk of arterial bleeding. The cone-beam computed tomography is a routine examination prior to augmentation surgery and therefore the data obtained from it has an impact on clinical practice.

Anatomical characterization of pulmonary artery and implications to pulmonary artery pressure monitor implantation

In patients with heart failure, guideline directed medical therapy improves outcomes and requires close patient monitoring. Pulmonary artery pressure monitors permit remote assessment of cardiopulmonary haemodynamics and facilitate early intervention that has been shown to decrease heart failure hospitalization. Pressure sensors implanted in the pulmonary vasculature are stabilized through passive or active interaction with the anatomy and communicate with an external reader to relay invasively measured pressure by radiofrequency. A body mass index > 35 kg/m2 and chest circumference > 165 cm prevent use due to poor communication. Pulmonary vasculature anatomy is variable between patients and the pulmonary artery size, angulation of vessels and depth of sensor location from the chest wall in heart failure patients who may be candidates for pressure sensors remains largely unexamined. The present study analyses the size, angulation, and depth of the pulmonary artery at the position of implantation of two pulmonary artery pressure sensors: the CardioMEMS sensor typically implanted in the left pulmonary artery and the Cordella sensor implanted in the right pulmonary artery. Thirty-four computed tomography pulmonary angiograms from patients with heart failure were analysed using the MIMICS software. Distance from the bifurcation of the pulmonary artery to the implant site was shorter for the right pulmonary artery (4.55 ± 0.64 cm vs. 7.4 ± 1.3 cm) and vessel diameter at the implant site was larger (17.15 ± 2.87 mm vs. 11.83 ± 2.30 mm). Link distance (length of the communication path between sensor and reader) was shorter for the left pulmonary artery (9.40 ± 1.43 mm vs. 12.54 ± 1.37 mm). Therefore, the detailed analysis of pulmonary arterial anatomy using computed tomography pulmonary angiograms may alter the choice of implant location to reduce the risk of sensor migration and improve readability by minimizing sensor-to-reader link distance.

Review of the Renal Artery Anatomy: In Chronic Kidney Disease and Healthy Individuals

Objective: The purpose of this study was to evaluate renal arteries and aorta anatomy in patients with chronic kidney disease (CKD) and compare them with a control group. Methods: Computed tomography images of 800 individuals (551 of that were with CKD and 249 of them were completely healthy in terms of urinary system) were evaluated retrospectively. Age range of the individuals 19 - 91 years (mean 61.15 ± 12.58). The differences between the renal arteries diameters, diameters of aorta, courses of the renal arteries, their separation levels from the aorta was investigated between the control group and patients with CKD. Results: Diameters of aorta and renal arteries are statistically significantly larger in CKD patients than healthy individuals and there was a negative correlation between the diameters of aorta with glomerular filtration rate. No statistically significant difference was observed between CKD patients and healthy individuals in terms of renal artery course. No statistically significant difference was detected between CKD patients and healthy individuals in terms of the branching level of the renal arteries from the aorta. Conclusion: Our study is one of the first studies which these measurements were made in individuals with CKD, according to the available literature. This study is important in that it reveals that the diameters of the renal arteries and aorta is statistically significantly larger in patients with CKD than in healthy individuals. These data may be important for the surgeons in interventional applications.

CT-based comparison of porcine, ovine, and human pulmonary arterial morphometry

To facilitate pre-clinical animal and in-silico clinical trials for implantable pulmonary artery pressure sensors, understanding the respective species pulmonary arteries (PA) anatomy is important. Thus, morphological parameters describing PA of pigs and sheep, which are common animal models, were compared with humans. Retrospective computed tomography data of 41 domestic pigs (82.6 ± 18.8 kg), 14 sheep (49.1 ± 6.9 kg), and 49 patients (76.8 ± 18.2 kg) were used for reconstruction of the subject-specific PA anatomy. 3D surface geometries including main, left, and right PA as well as LPA and RPA side branches were manually reconstructed. Then, specific geometric parameters (length, diameters, taper, bifurcation angle, curvature, and cross-section enlargement) affecting device implantation and post-interventional device effect and efficacy were automatically calculated. For both animal models, significant differences to the human anatomy for most geometric parameters were found, even though the respective parameters’ distributions also featured relevant overlap. Out of the two animal models, sheep seem to be better suitable for a preclinical study when considering only PA morphology. Reconstructed geometries are provided as open data for future studies. These findings support planning of preclinical studies and will help to evaluate the results of animal trials.

Clarifying the Pulmonary Arterial Morphology and Pulmonary Blood Supply in Patients with Tetralogy of Fallot and Pulmonary Atresia on Computed Tomography Angiography

Aim. The present study sought to characterize the pulmonary arterial morphology and pulmonary blood supply in patients of tetralogy of Fallot and pulmonary atresia (TOF-PA) on CT angiography. Materials and Methods. We retrospectively reviewed our departmental database to identify patients with TOF-PA evaluated using CT angiography. The images were analysed to detect the presence of main and branch pulmonary arteries and pulmonary arterial confluence, presence of major aortopulmonary collateral arteries (MAPCAs), laterality and relation with pulmonary arterial morphology, and presence of patent arterial duct and associated intra- and extracardiac anomalies. Results. TOF-PA was identified in 177 patients (114 (64.4%) males; median age: 9 months). Pulmonary arteries were confluent in 142/177 (80.2%) patients. According to Somerville classification, type II pulmonary atresia was the most frequent pattern seen in 127/177 (71.8%). Based on McGoon’s ratio, pulmonary arteries were adequate for surgery in 123/177 (69.5%) patients. Patent arterial duct was present in 84/177 (47.5%) patients while MAPCAs were present in 124 (70.1%) patients, of which 72/124 (58.1%) patients had at least 1 essential MAPCA supplying either lung. According to Congenital Heart Surgeons’ Society classification, type B pulmonary arterial anatomy was the most prevalent, seen in 103/177 (57.6%) patients. Conclusion. TOF-PA is associated with marked morphologic variability in the pulmonary arterial arborization to supply the lungs. Cardiac CT angiography can accurately delineate the pulmonary arterial morphology, sources of pulmonary blood supply, and associated cardiovascular anomalies in patients with TOF-PA which aids in planning appropriate surgical management including decisions regarding the need for unifocalization of MAPCAs.

Comprehensive anatomical study of meningeal arteries in dromedaries

This study provides a detailed, in-depth analysis of the anatomy, topography, and branching patterns of the meningeal arteries in dromedary camels, a subject that has not previously been thoroughly studied in animals, providing insight into the intricate biological adaptations that allow them to survive in harsh environments. By precisely examining 20 heads obtained from freshly slaughtered dromedaries, we revealed the origins and topologies of the rostral, middle, and caudal meningeal arteries using advanced casting techniques for precise rendering. Our findings indicate that the rostral meningeal artery derives from the external ethmoidal artery and primarily supplies the rostrodorsal region of the frontal lobe. The middle meningeal artery provides blood to approximately two-thirds of the brain meninges. The caudal meningeal artery is derived from the occipital artery and supplies the meninges covering the cerebellum, caudal part of the falx cerebri, and tentorium cerebelli. Significantly, our study revealed the presence of accessory branches originating from the rostral epidural rete mirabile, a finding not previously described in the existing literature. These branches supply the meninges of the frontal and lateral regions of the frontal lobes. This novel study advances our understanding of the meningeal arteries in dromedaries and has significant implications for advancements in veterinary neuroscience.

Cadaveric and Computed Tomography Analysis of the Anterior Ethmoidal Artery Flap.

The anterior ethmoidal artery (AEA) flap has been successful in repairing anterior nasal septal perforations and has been presumed to be axially based on AEA branches coursing through or around the cribriform plate (CP). However, limited evidence supports the flap's axial supply. The purposes of this cadaveric and computed tomography (CT) study were to assess the arterial anatomy from the CP to the septum, and to determine AEA flap length to predict ideal flap base width. Ten fresh latex-injected cadavers were utilized for endoscopic dissection to identify arteries traversing the CPs on each side. First, arterial trajectories along the dorsal septum were recorded. Measurements were then made bilaterally along the septum from the middle turbinate (MT) axilla to the nasal branch of the AEA (NBAEA) traversing the CP. Additionally, 100 sinus CTs were reviewed to measure AEA flap lengths bilaterally. From 10 cadavers, 20 sides were utilized for measurements. In all cadavers, the AEA septal branches coursed diagonally or horizontally along the dorsal septum, and never directly vertically. The mean distance from the MT axilla to the NBAEA was 1.24 ± 1.93 cm (range = 1-1.5 cm). Based on CTs, the mean AEA flap length was 6.40 ± 0.60 cm. Based on the non-vertical courses of AEA septal branches, the AEA flap is more likely a random transposition flap than an axial flap. Average AEA flap length ranged from 6.0 to 7.0 cm. Assuming 3:1 length:width ratios, AEA flap base widths should be about 2.0-2.3 cm. NA Laryngoscope, 134:2100-2104, 2024.

Functional Syntax score based on quantitative flow ratio vs. anatomical Syntax score

Abstract Background/Introduction Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score takes into consideration only the anatomy of the coronary network, while the Functional Syntax Score based on Quantitative Flow Ratio (FSSQFR) combines all the information derived from both anatomy and physiology of coronary arteries. Purpose To investigate the level of agreement between anatomical SYNTAX Score I (SS) and FSSQFR and its possible impact on risk re-stratification of patients and on revascularization options. Methods We performed an offline QFR analysis in consecutive patients who underwent coronary angiography in a single Greek center. A total of 410 patients with accountable FSSQFR were included. The latter was counted by summing the individual points only of physiologically significant lesions (vessel QFR ≤0.8). Patients were divided into low-, intermediate- and high risk according to SS and FSS with the same cutoff. The primary endpoint was the estimation of the predictive value of FSSQFR for the composite outcome of cardiovascular death, myocardial infarction and ischemia-driven revascularization at follow-up. Results FSSQFR and SS were estimated for all patients. After calculating the FSSQFR, 12% (48/410) of study patients changed the risk group. Most of them moved from higher-risk group by SS to lower-risk group and only three of them presented the opposite movement. Moreover, 5.9% (24/410) of patients, for whom coronary artery bypass grafting would be recommended according to SS, converted to favor percutaneous coronary intervention after FSSQFR calculation. After a median 30.2 (25.7-33.7) months follow-up period, the cumulative incidence of a composite of cardiac death, myocardial infarction or ischemia-driven revascularization was 4.6%, 10.7%, and 24.1%, in the low, intermediate, and high FSSQFR group correspondingly (log-rank P&amp;lt;0.001) (Figure 1). After multivariate regression analysis, FSSQFR was an independent predictor of the primary endpoint after adjustment for age, gender, smoking, and hypertension (adjusted OR: 1.08 [95% CI, 1.05–1.12]; P&amp;lt;0.001). The area under the curve for FSSQFR to predict the 2-year composite endpoint was higher than that of the classic anatomic SYNTAX score (0.711 vs. 0.706; p&amp;lt;0.001) (Figure 2). Conclusions In our study, FSSQFR found to be an independent predictor of higher cardiovascular adverse events. Also, compared with SS, FSSQFR significantly improved risk classification of patients with coronary disease widening the possible therapeutic options.

The topographical anatomy of the posterior auricular artery: a computed tomography angiography analysis with implications for reconstructive surgery

The topographical anatomy of the posterior auricular artery: a computed tomography angiography analysis with implications for reconstructive surgery