Axillar Artery Research Articles

Total aortic arch replacement without deep hypothermic circulatory arrest in type A aortic dissection: Left axillar artery for arterial cannulation

ObjectiveTotal aortic arch replacement (TAR) necessitates hypothermic circulatory arrest (CA). The frozen elephant trunk technique (FET) additionally requires commercial hybrid grafts. Herein we describe a novel modified FET technique without CA using standard grafts thanks to left axillary artery (LAxA) cannulation in patients with acute type A aortic dissection. MethodsLAxA anastomosis is made first using a homemade debranching graft, and cardiopulmonary bypass is initiated, followed by anastomoses of left common carotid and innominate arteries. The rest of the operation is performed with complete cerebral perfusion. Following replacement of ascending aorta/root, cardiac reperfusion is started using a root cannula which continues throughout the procedure. Distal arch anastomosis is performed clamp-on, allowing lower body perfusion via left subclavian artery. Lower body perfusion is interrupted for 5 to 8 minutes to deploy an endograft to complete a modified FET. Following cannulation of distal arch graft, perfusion of distal aorta is restarted, and all three grafts are incorporated to construct a neo-ascending aorta and arch. ResultsBetween December 2018 and May 2022, 38 patients underwent TAR without operative mortality. Hospital mortality was %15.7, and spinal cord ischemia and stroke were not encountered in surviving patients. The mean lower body CA time was 7.2 ± 2.8 minutes. ConclusionsTAR using standard endografts without CA is possible with LAxA cannulation. To perform a FET, only a short interruption of lower body circulation is sufficient to deploy an endograft, also improving hemostasis of distal anastomosis. Further studies are required with a higher number of patients to evaluate the efficiency of this novel technique.

Total Aortic Arch Replacement without Total Circulatory Arrest and Deep Hypothermia: A New Modification of Frozen Elephant Trunk Technique Using Left Axillar Artery for Arterial Cannulation

Total Aortic Arch Replacement without Total Circulatory Arrest and Deep Hypothermia: A New Modification of Frozen Elephant Trunk Technique Using Left Axillar Artery for Arterial Cannulation

Triceps and cutaneous radial nerve branches investigated via an axillary anterior arm approach: new findings in a fresh-cadaver anatomical study.

The authors sought to describe the anatomy of the radial nerve and its branches when exposed through an axillary anterior arm approach. Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery. Via the anterior arm approach, all triceps muscle heads could be dissected and individualized. The radial nerve overlaid the latissimus dorsi tendon, bounded by the axillar artery on its superior surface, then passed around the humerus, together with the lower lateral arm and posterior antebrachial cutaneous nerve, between the lateral and medial heads of the triceps. No triceps motor branch accompanied the radial nerve's trajectory. Over the latissimus dorsi tendon, an antero-inferior bundle, containing all radial nerve branches to the triceps, was consistently observed. In the majority of the dissections, a single branch to the long head and dual innervations for the lateral and medial heads were observed. The triceps long and proximal lateral head branches entered the triceps muscle close to the latissimus dorsi tendon. The second branch to the lateral head stemmed from the triceps lower head motor branch. The triceps medial head was innervated by the upper medial head motor branch, which followed the ulnar nerve to enter the medial head on its anterior surface. The distal branch to the triceps medial head also originated near the distal border of the latissimus dorsi tendon. After a short trajectory, a branch went out that penetrated the medial head on its posterior surface. The triceps lower medial head motor branch ended in the anconeus muscle, after traveling inside the triceps medial head. The lower lateral arm and posterior antebrachial cutaneous nerve followed the radial nerve within the torsion canal. The lower lateral brachial cutaneous nerve innervated the skin over the biceps, while the posterior antebrachial cutaneous nerve innervated the skin over the lateral epicondyle and posterior surface of the forearm. The average numbers of myelinated fibers were 926 in the long and 439 in the upper lateral head and 658 in the upper and 1137 in the lower medial head motor branches. The new understanding of radial nerve anatomy delineated in this study should aid surgeons during reconstructive surgery to treat upper-limb paralysis.

Long-Term Complications After Support with Impella 5.0 and 5.5

<h3>Purpose</h3> Impella 5.0 and 5.5 are micro-axial catheter-based left ventricular assist devices (LVAD) that are implanted via a vascular graft sutured to the axillary artery and provide blood flow of up to 5.5 L/min. This study aims to investigate the incidence of long-term complications after circulatory support with Impella 5+. <h3>Methods</h3> Single-center retrospective analysis of 203 consecutive patients treated with a surgically implanted Impella 5.0 or 5.5 between 01/2017 and 09/2021. Patients with access sites other than the right or left axillar artery were excluded. <h3>Results</h3> The mean age at implantation was 58 years. In 75 (36.9%) patients Impella 5+ was implanted for acute myocardial infarction, in 12 (5.9%) for postcardiotomy failure, 75 (36.9%) patients had acute decompensated heart failure on the basis of ischemic (n=41) or dilated (n=34) cardiomyopathy. Implantation of extracorporeal life support (ECLS) before or additionally to Impella support was necessary in 90 (44.3%) patients: in 58 patients as venoarterial ECLS, in 26 patients installed by means of ECMELLA 2.0, and six patients required venovenous ECLS for respiratory support. The median Impella support duration was eight days. Of 203 patients, 74 patients (36.5%) died on Impella support, another four (2.0%) after switching to venoarterial ECLS. Of the remaining 125 patients, 48 were successfully weaned from Impella 5+ and 70 patients were successfully bridged to a durable LVAD. In 119 of these patients, the Impella was explanted and the vascular graft was shortened, ligated and pushed under the pectoralis muscle; in six patients early graft infection prompted complete graft removal during explantation. Further, 13 patients (10.9%) developed a late graft infection after a median of 86 days, requiring complete (n=10) or partial (n=2) explantation of the retained graft. In one patient, the graft infection was successfully treated conservatively in the context of a systemic infection of other origin. Our analysis identified no specific risk factors for graft infections. Of the 203 patients, five (2.5%) developed a brachial plexus injury resulting in neurological dysfunctions. <h3>Conclusion</h3> Long-term complications after circulatory support with Impella 5+ are rare. The low incidence of graft infections related to the retained vascular graft demonstrates that this method is a favorable and safe approach offering the possibility of bedside explantation.

Realignment of Migrated Celiac Stent Graft After Branched Stent Graft Implantation Through Retrograde Cannulation of the Superior Mesenteric Artery Using a Single Vascular Access

Purpose: The purpose of the study was to present an endovascular management of a type IIIc endoleak (EL) in a patient with migration of the bridging stent graft of the celiac trunk (CT) after branched aortic aneurysm repair with retrograde cannulation of the superior mesenteric artery (SMA). Technique: The therapy was applied in a 62-year-old man who underwent a branched EVAR 2 years ago. Meanwhile, the patient was treated due to type Ia EL 6 months ago. The patient suffered in the last days from unclear hemorrhage clinically correlated with weakness. In the computed tomography angiography (CTA), an EL IIIc with a migration of the bridging stent graft from the CT branch was displayed. As vascular access, the left axillar artery was used. Due to the misaligned bridging stent graft, an antegrade cannulation was impossible, so cannulation was performed retrograde through the SMA using pancreaticoduodenal and gastroduodenal arteries. Thereafter, the EL could be repaired with bridging stent grafts. The postinterventional control showed a satisfying reconstruction without EL or embolization. Conclusion: Most of the complications such as type IIIc EL after complex endovascular repair can also be treated endovascularly. This sophisticated treatment requires that necessary materials and experience are available.

In-hospital outcomes of patients with non-iatrogenic civilian vascular trauma.

Background: Morbidity, lesion pattern, management and short-term outcomes of civilian vascular trauma are rarely evaluated. Therefore, analysis of in hospital results in patients with non-iatrogenic vascular trauma in a tertiary referral hospital was performed. Patients and methods: Retrospective evaluation of patients with vascular trauma from 2007-2017 was done. 48 patients (34 male, 14 females, mean age 56years) were included. Excluded were patients with iatrogenic vascular complications. Major cause of vascular trauma were traffic accidents in 43.8%, fall from great heights in 27.1%, sport and home related injuries in 16.8%, suicidal injuries in 4.2% and gunshot wounds in 2.1% (other 6.3%). 60.4% of patients presented with blunt, 39.6% of patients with penetrating vascular trauma. More than half of the cases included polytraumatized patients (54.4%). Results: Most commonly affected were the popliteal (25.0%) and the axillar artery (18.8%). Aortic injuries were present in 14.6% of cases, whereas the femoral and subclavian artery were involved in 12.6% and 10.4%. Vascular reconstruction was performed by interposition graft in 45.9%, direct suture in 18.8%, patchplasty in 10.4%, ligation in 12.4%, and implantation of stentgraft in 12.5%. Postoperative complication rate was 54.2%. Rate of in-hospital major amputation was 14.6% and in-hospital mortality was 14.6% as well. Comparison between blunt and penetrating trauma as to postoperative complication (p=0.322), blood transfusion (p=0.452) and amputation (p=0.304) showed no significant differences, whereas lethality in blunt trauma was 20.6% vs. 5.2% in penetrating trauma. Injury severity score (ISS) was significantly elevated for blunt trauma patients (mean ISS Score blunt 32 vs 21 penetrating, p=0.043). Conclusions: The majority of vascular lesions is caused by blunt trauma. Blunt lesions do also show a severe injury pattern, compared to penetrating trauma, and the complication rate remains high. However, by means of vascular reconstruction, limb salvage is feasible in a high percentage of cases.

Passive Temporary Visceral Shunt from the Axillar Artery as an Adjunct Method during the Open Treatment of Thoracoabdominal Aortic Aneurysm

Distal aortic retrograde perfusion systems like the left heart bypass or femoro-femoral extracorporeal circulation are the methods of reference for organ protection during direct approaches to thoracoabdominal aortic aneurysms. The aim of this work was to evaluate the use of a passive arterial shunt to reduce visceral ischemia during aortic operations when occlusive diseases of the iliac arteries make distal aortic retrograde perfusion inappropriate. Ten patients affected by a Crawford type III thoracoabdominal aneurysm (TAA) were operated on between January 2013 and January 2015 with the use of a temporary shunt inserted onto the left axillar artery that allows visceral perfusion immediately after the aorta is opened. The operation was performed after a single dose of heparin (50 UI/kg). The sera lactate levels were measured 2hr after the last aortic clamp was removed and compared with those obtained from a group of 19 patients operated on for a Crawford type IV TAA during the same period without any arterial shunt. Neither mortality nor paraplegia occurred. The sera lactate levels were lower in the group of patients operated on for a type III TAA (2.57±1) than for a type IV TAA (3.68±1) (P<0.01, Student's t-test). This method was effective for low mesenteric ischemia, easy to perform, and did not require high doses of anticoagulants.

Case of Takayasu syndrome in clinical practice

Aim. Modern data about etiology, pathogenesis, clinical symptom of the Takayasu syndrome are given in the article.Materials and methods. Tomography, sonography has important role in the diagnosis of the nonspecific aortoarteritis. Treatment with medication that inhibits IL-6 receptors and B-cells is discussed. Self data are presented, clinical picture of the Takayasu syndrome in young female is described.Conclusions. Feature of the disease as multifocal stenosis of the aorta, common carotid artery, brachiocephalic artery, subclavian and axillar artery are described.

Utilisation d’un lambeau libre ostéo-musculo-cutané total d’avant-bras

We report the case of a 55-year-old woman suffering from a type I neurofibromatosis (also known as Von Recklinghausen neurofibromatosis) who was diagnosed with a high-grade schwannosarcoma of the median nerve, between the upper third and the medium third of the arm, upon contact with the humerus, invading the humeral vessels. The oncologic treatment of this tumour consisted in the amputation of the arm through the surgical neck of the humerus. In order to create a laterothoracic claw, to bring a partial function of the upper limb back, we decided to realize a free fillet forearm flap. This composite flap was composed of the radius and the ulna, all the forearm muscles and the skin of the anterior side of the forearm. A humeroradial plate osteosynthesis was done and the flap was then harvested with the radial pedicle, and anastomosed to the axillar artery. This procedure gave our patient a functional stump, giving back the arm functionality, especially the claw movement.

Preservation of Aortic Arch Branches Using Chimney and Sandwich Stent Grafts

To share our hybrid endovascular experiences using chimney or sandwich stent grafts for acute aortic arch pathologies. Hybrid procedures for a distal aortic arch aneurysm and an ascending anastomotic aortic aneurysm rupture were reported. Right to left common carotid and left axillar artery bypasses were located. Covered stents were inserted into the inominate artery, with the flow-proximal end located in the ascending (standard chimney) or the descending aortic stent graft (retrograde sandwich). Both cases had no signs of brain ischemia. Aneurysms are decreasing in size. Chimney and sandwich techniques were technically feasible in the complex and acute situations.

The arteries originating from the aortic arch and the patterns of their branches in ground squirrels (Spermophilus citellus)

&amp;nbsp; &amp;nbsp;In this study, the aim was to investigate the anatomy of the aortic arch in ground squirrels (Spermophilus citellus). Five ground squirrels were investigated. The materials were carefully dissected and the arterial patterns of arteries originating from the aortic arch were examined. The brachiocephalic trunk and the left subclavian artery were separated from the aortic arch. The brachiocephalic trunk first gave the left common carotid artery, and then the right subclavian and common carotid artery detached from it. In all the animals examined, at the cranial thoracic entrance and after leaving from this entrance, similar branches arising from the left and right subclavian arteries were the common branch of the internal thoracic artery and the intercostal suprema artery, separate branches as the vertebral and descending scapular arteries and a common branch of the cervical superficial, the cervical profund, the suprascapular arteries and the spinal ramus. After separation of these branches, the continuation of the artery gave the external thoracic artery on the external face of the thoracic cavity and then formed the axillar artery. The axillary artery separated into the subscapular and the brachial arteries. In conclusion, the pattern of arteries originating from the aortic arch and the branches of these arteries were partially similar to what has been observed in red squirrels, and thus differ from other rodents and domestic mammals. &amp;nbsp;

The arteries originating from the aortic arch and the branches of these arteries in red squirrels (Sciurus vulgaris)

This study had the aim of investigating the anatomy of the aortic arch in squirrels (Sciurus vulgaris). Ten squirrels were studied. The materials were carefully dissected and the arterial patterns of arteries originating from the aortic arch were examined. The brachiocephalic trunk and the left subclavian artery were detached from the aortic arch. The brachiocephalic trunk first gave the left common carotid artery, and then detached to the right subclavian and common carotid artery. In all the examined materials, the left and right subclavian arteries gave branches that were similar after leaving the thoracic cavity from the cranial thoracic entrance. But while the whole branches of the the right subclavian artery were arising from almost the same point the left subclavian artery gave these branches in a definite order, and the branches that separated were the following: the internal thoracic artery, the intercostal suprema artery, the ramus spinalis, the vertebral artery and the descending scapular artery. It also gave the common branch formed by the junction of three of the cervical superficial, the cevical profund and the suprascapular arteries. After the separation of these branches, continuation of the artery gave the external thoracic artery on the external face of the thoracic cavity and then formed the axillar artery. The axillary artery separated into the subscapular and the brachial arteries. Thus, the arteries originating from the aortic arch and the branches of these arteries are different from other rodents and from domestic mammals.

Subgross and Macroscopic Investigation of Blood Vessels Originating from Aortic Arch in the Chinchilla (Chinchilla lanigera)

A total of 10 adult, healthy, male chinchilla (Chinchilla lanigera) were used to investigate the vessels originating from aortic arch. Coloured latex was injected into the carotid arteries following conventional anatomical applications in all the chinchillas examined. The brachiocephalic trunk and the left subclavian artery arose from the aortic arch at the level of the second intercostal region in the thoracic cavity. The right and left subclavian arteries detached branches at the level of first intercostal region and divided into the following vessels: internal thoracic artery, dorsal scapular artery, vertebral artery, superficial cervical artery and axillar artery. The vessels originating from the aortic arch displayed some significant differences in chinchillas compared to rats, guinea pigs, rabbits, porcupines and other laboratory rodents.

Anatomic Risks of Shoulder Arthroscopy Portals: Anatomic Cadaveric Study of 12 Portals

The purpose of this anatomic cadaveric study was to determine with trocars in situ the relationships of 12 shoulder arthroscopic portals frequently used with the adjacent musculotendinous and neurovascular structures. Twelve shoulders of embalmed cadavers installed in a beach-chair position were dissected. Twelve different portals were established by using their authors' description: posterior "soft point," central posterior, anterior central, anterior inferior, anterior superior, 5 o'clock portal, Neviaser, superolateral, transrotator cuff approach, Port of Wilmington, anterolateral, and posterolateral. Six of these portals were placed on each shoulder so that each portal was studied 6 times. Dissections were conduced with trocars in situ to take into account their volume. The distance to the adjacent relevant neurovascular structures at risk (axillar and suprascapular nerves, axillar and suprascapular arteries, and cephalic vein) were measured, arm at side, by using a calliper. Musculotendinous structures crossed by portals were noticed. The cephalic vein was injured twice by anterior portals. The 5 o'clock portal is at most risk of neurovascular injury. It is located at mean distances to the axillar artery and nerve of 13 and 15 mm, respectively. Other anterior, posterior, superior, and lateral portals are safe with mean distances higher than 20 mm. No musculotendinous rupture nor large injury occurred. The present study shows that the trocars placement of the studied portals did not create, except for the cephalic vein, any lesion of the neurovascular adjacent structures. This study suggests, except for the 5 o'clock portal, the safety of the shoulder arthroscopic portals tested regarding to the neurovascular adjacent structures.

Cyclic Decrease in Mixed Venous Oxygen Saturation for the Early Diagnosis of Seizure Complications After Cardiac Surgery

Cyclic Decrease in Mixed Venous Oxygen Saturation for the Early Diagnosis of Seizure Complications After Cardiac Surgery

自家静脈移植によるえきか動脈損傷の治療経験２例

We experienced two patients who had the injury of the axillar artery caused by blunt trauma. They had no fracture but contusion in the injured region. Physical examination of them revealed the pulselessness of the radial artery and the swelling of the injured extremity. The arteriography of them confirmed the occlusion of the axillar artery. Surgical exploration of them revealed the complete occlusion by contusion and thrombosis in the axillar artery.The thrombosed segment were resected and the great saphenous vein were grafted in the resected part of the artery. The pulses of the radial artery were felt after the operation. The arteriography of them after the operation revealed that the axillar artery was patent but in one case had 50% stenosis at the distal anastomosed part and in another case had the moderate stenosis. Because the collateral circulation develops in the upper extremity, it is not so easy to diagnose the injury of the artery when blunt trauma caused it and the ischemic symptoms are moderate.

Multiple Hemangioblastomas occurring in Cerebellum, Spinal Cord, and Undersurface of the Occipital Lobe

Supratentorial hemangioblastoma is encountered very rarely. About 60 cases in all have been reported. The authors present a case of supratentorial hemangioblastoma and cerebellar hemangioblastoma occurring 7 years after surgery for spinal hemangioblastoma. A 23-year-old male was admitted with severe headache and vomiting. Neurological examination showed paraplegia, left cerebellar disturbance, and horizontal nystagmus on lateral gaze to the left. Computerized tomography scans and bilateral axillar artery angiograms showed a left cerebellar cystic mass with two mural nodules. In consequent operations, two hemangioblastomas were found; one in the left cerebellar hemisphere and the other attached to the cerebellar tentorium under the left occipital lobe. The histology of these tumors revealed the well-differentiated morphology of hemangioblastomas. The authors discuss some clinical aspects of the supratentorial hemangioblastoma associated with infratentorial or spinal hemangioblastoma, and also the differential diagnosis between angioblastic meningioma and hemangioblastoma.