Collateral Branches Research Articles

A Novel Clinically Based Classification System for the Profunda Femoris Artery and the Circumflex Femoral Arteries

The profunda femoris artery (PFA) supplies important collateral branches to both the ipsilateral internal iliac artery and the distal superficial femoral artery (SFA). The size and patency of these collateral pathways can determine the risk of pelvic malperfusion, spinal cord ischemia, and lower extremity limb loss following vascular interventions. Despite its importance, the anatomy of the PFA is rarely characterized in clinical studies involving the pelvic or lower extremity circulation. This discussion may be limited by the lack of a comprehensive classification system. Our objective was to describe the most common PFA anatomic variants and present a classification system based on its branching patterns. We dissected 155 fixed and nonfixed femoral artery systems from 88 cadavers. Seventy-seven female and 78 male femoral exposures were performed. Vessel diameters, branch configurations, and relative distances between the inguinal ligament, PFA, lateral circumflex femoral artery (LCFA), and medial circumflex femoral artery (MCFA) were recorded. The mean diameters of the common femoral artery, SFA, and PFA were 10.3mm, 8.0mm, and 6.9mm in males and 8.9mm, 6.9mm, and 6.1mm in females, respectively (P<0.05). The mean distances from the inguinal ligament for PFA, MCFA, and LCFA were 41mm, 41.7mm, and 52.5mm, respectively. No significant differences were noted relative to laterality or fixation. We developed a clinically applicable classification system based on the orientation of the PFA, LCFA, and MCFA. Six PFA, 5 LCFA, and 5 MCFA variations were identified and ranked by frequency. The 5 most common combinations accounted for 56.1% of our cadaver series. The anatomic orientation of the PFA and its branches is highly variable. We propose a novel classification system of this rich collateral system to facilitate consistent communication in academic and clinical vascular surgery.

Influence of lamina vastoadductoria dissection on the outcomes of femoral artery extensive lesion stenting: A pilot randomised investigation

ObjectiveAim of the study was to improve the immediate and long-term results of stenting of the superficial femoral artery in extended lesions with the changing of the biomechanics of superficial ffemoral artery and of the first portion of the popliteal artery. MethodsPilot randomized prospective single-center study were included 70 patients. Patients were randomized into two groups in 1 × 1 format for 35 people using the envelope method. Self-expanding bare metal stents were used in all cases. At the first group standard revascularization procedures with SFA stenting were performed; in the second group, the superficial femoral artery stenting was supplemented with fasciotomy in the Hunter’s canal with the superficial femoral artery intersection. The total observation period was 2 years. During the observation period an assessment of the clinical symptoms of the lower extremities, measurement of the ankle-brachial index and ultrasound duplex scanning of the operated segment were performed. ResultsAll procedures in both groups were successfully performed. Primary patency through 24 months was 28.5% (10 of 35) in group 1 and 60% (21 of 35) in group 2 (p = 0,015). ConclusionsChanging the biomechanical properties of the distal of the superficial femoral artery segment and of the first portion of the popliteal artery is safe and contributes to the primary patency improvement during the stenting of extended of the superficial femoral artery lesions compared to standard SFA stenting.Dissection of the lamina vastoadductoria with transection of the collateral branches of the knee joint network reduces frequent and severe damages of stents after the stenting of the superficial femoral artery extended lesion.According to the frequency of complications in the early and mid-term postoperative period, limb salvage, mortality and the secondary patency rates, the new method is comparable with standard of the superficial femoral artery stenting.

Comment on Liver Venous Deprivation or Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy?: A Retrospective Multicentric Study.

To the Editor: We read with great interest the results of comparing liver venous deprivation (LVD) with associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for compensatory increase rates of future liver remnant (FLR). We wish to congratulate Chebaro et al1 for completing such a pivotal study. As indicated, this first retrospective study demonstrated a faster hypertrophy rate and higher resection rates for ALPPS than for LVD (P < 0.001), whereas 90-day major complication and mortality rates were comparable. However, some issues merit further discussion. First, the authors did not explore the differences in the mechanisms of ALPPS and LVD. While comparing LVD with ALPPS in terms of the efficiency of remnant liver volume (RLV) gain, relative RLV increase was similar between LVD and ALPPS (63% vs 56%, P = 0.727) but with slower kinetic growth rates (KGR) in LVD than in ALPPS (2%/day vs 7%/day, P < 0.001). ALPPS increases FLR volume by an average of 48.6% to 90.0% in 7 to 14 days of ALPPS.2 Guiu et al3 have reported that the percentage of FLR volume increased from 28.2% to 40.9% after 21 days of LVD. ALPPS can increase active proliferation by increasing the hepatic parenchymal partition between the portal and nonportal vein embolic lobes, leading to transection of extensive communicating branches between them.4 Moreover, the increased levels of systemic inflammatory factors and cytokines, such as interleukin 6 and tumor necrosis factors, may have an important effect on the rapid increase in residual liver volume.5 LVD combines embolization of the portal inflow and venous outflow. The main mechanism explaining the effect of LVD involved the reaction of continuous miniportal inflow and a decrease in the portal collateral branches.6 LVD is an interventional procedure that is superior to invasive ALPPS. However, an increase in the KGR of LVD is a critical issue that needs to be solved urgently. Second, although this study reported that the successful resection rate was significantly lower for LVD than for ALPPS (72.6% vs 90.6%, P < 0.001), it did not really reflect the success rate due to different indications. Therefore, it is better to explore successful resection rates aimed at primary liver tumors for LVD and ALPPS. Although ALPPS is mainly indicated for colorectal liver metastases (CRLM), it is also used for primary liver tumors. A single-center study in 2018 selected 45 patients with hepatocellular carcinoma who underwent standard ALPPS. After the first stage of ALPPS, the median increase rate of FLR reached 56.8%. A two-stage hepatectomy was completed in 41 patients (91.1%) in approximately 2 weeks. The 90-day mortality rate was 11.1%, and the 1-year and 3-year overall survival rates were 64.2% and 60.2%, respectively.7 Third, the authors did not report if, and for how long, they followed up these patients to evaluate the prognosis after surgery. Further follow-up (5-year survival) studies are needed to determine the effects of LVD and ALPPS, which will help determine better options in the future. Schnitzbauer et al8 reported that the 3-year overall survival rate of CRLM patients after ALPPS was 50%. Another study showed that the 1-, 3-, and 5-year survival rates of CRLM patients after ALPPS were 76.2%, 57.1%, and 22.9%, respectively.9 Finally, ALPPS did cause direct or indirect squeezing and repeated touching of the liver tumor, which may have resulted in the proliferation or metastasis of tumor cells.10 Postoperative liver tumor markers should be evaluated and compared between the embolized and nonembolized hepatic lobes. Moreover, the number and size of tumors should be compared before and after surgery to assess the degree of progress. In summary, we appreciate the excellent work of Chebaro et al1; however, whether LVD will have a better performance is worthy of more in-depth research.

SARM1 Suppresses Axon Branching Through Attenuation of Axonal Cytoskeletal Dynamics.

Axon branching is a fundamental aspect of neuronal morphogenesis, neuronal circuit formation, and response of the nervous system to injury. Sterile alpha and TIR motif containing 1 (SARM1) was initially identified as promoting Wallerian degeneration of axons. We now report a novel function of SARM1 in postnatal sensory neurons; the suppression of axon branching. Axon collateral branches develop from axonal filopodia precursors through the coordination of the actin and microtubule cytoskeleton. In vitro analysis revealed that cultured P0-2 dorsal root ganglion sensory neurons from a SARM1 knockout (KO) mouse exhibit increased numbers of collateral branches and axonal filopodia relative to wild-type neurons. In SARM1 KO mice, cutaneous sensory endings exhibit increased branching in the skin in vivo with normal density of innervation. Transient axonal actin patches serve as cytoskeletal platforms from which axonal filopodia emerge. Live imaging analysis of axonal actin dynamics showed that SARM1 KO neurons exhibit increased rates of axonal actin patch formation and increased probability that individual patches will give rise to a filopodium before dissipating. SARM1 KO axons contain elevated levels of drebrin and cortactin, two actin regulatory proteins that are positive regulators of actin patches, filopodia formation, and branching. Live imaging of microtubule plus tip dynamics revealed an increase in the rate of formation and velocity of polymerizing tips along the axons of SARM1 KO neurons. Stationary mitochondria define sites along the axon where branches may arise, and the axons of SARM1 KO sensory neurons exhibit an increase in stationary mitochondria. These data reveal SARM1 to be a negative regulator of axonal cytoskeletal dynamics and collateral branching.

Endovascular treatment of complicated aortic aneurysms using a modified flow-diverting strategy: Mid- to long-term outcome from a multicenter cohort study.

Frequently reported adverse events following flow-diverting stents' treatment of aortic aneurysms indicate further refinements of this technique are required. This study aims at evaluating the clinical efficacy of an improved flow-diverting strategy. A modified flow-diverting procedure was utilized in selected patients, in which stent-grafts were used to cover the non-branched segment of the aneurysmal lesion while flow-diverting multilayered bare metal stents were applied to cover the reno-visceral segment. The safety and efficacy of this joint procedure were assessed by regular follow-up. We screened 497 patients and included 67 cases (mean age: 67.07 ± 12.14 years; 53 males) between February 2012 and March 2018. The median number of stent-grafts and bare metal stents used in the procedure were 1 (range: 1 to 3) and 3 (range: 2 to 4), respectively. During a mean follow-up period of 34.54 ± 20.28 months, aneurysm maximum diameter decreased from 64.79 ± 10.31 to 59.32 ± 10.20 mm (p = 0.002), while sac thrombosis ratio increased from 26.01±10.99% to 98.46±4.84% (p<0.001). Aneurysm-related death or conversion to open repair was documented in three patients. The majority side-branches (198/201) remained patent during follow-up. Overall clinical success rate reached 91.04% (61/67). The joint procedure is characterized by significant aneurysm thrombosis along with high aneurysm stabilization/shrinkage and side-branches' patency rate. It might represent a potential improvement of the flow-diverting strategy in treating complex aortic lesions, yet large-scale, prospective, and randomized trials are anticipated to draw a robust conclusion. The joint procedure could potentially exclude complex aortic aneurysms from circulation while maintaining the collateral branches.

Spindle-Shaped Neurons in the Human Posteromedial (Precuneus) Cortex

The human posteromedial cortex (PMC), which includes the precuneus (PC), represents a multimodal brain area implicated in emotion, conscious awareness, spatial cognition, and social behavior. Here, we describe the presence of Nissl-stained elongated spindle-shaped neurons (suggestive of von Economo neurons, VENs) in the cortical layer V of the anterior and central PC of adult humans. The adapted “single-section” Golgi method for postmortem tissue was used to study these neurons close to pyramidal ones in layer V until merging with layer VI polymorphic cells. From three-dimensional (3D) reconstructed images, we describe the cell body, two main longitudinally oriented ascending and descending dendrites as well as the occurrence of spines from proximal to distal segments. The primary dendritic shafts give rise to thin collateral branches with a radial orientation, and pleomorphic spines were observed with a sparse to moderate density along the dendritic length. Other spindle-shaped cells were observed with straight dendritic shafts and rare branches or with an axon emerging from the soma. We discuss the morphology of these cells and those considered VENs in cortical areas forming integrated brain networks for higher-order activities. The presence of spindle-shaped neurons and the current discussion on the morphology of putative VENs address the need for an in-depth neurochemical and transcriptomic characterization of the PC cytoarchitecture. These findings would include these spindle-shaped cells in the synaptic and information processing by the default mode network and for general intelligence in healthy individuals and in neuropsychiatric disorders involving the PC in the context of the PMC functioning.

Giant ankyrin-B mediates transduction of axon guidance and collateral branch pruning factor sema 3A.

Variants in the high confident autism spectrum disorder (ASD) gene ANK2 target both ubiquitously expressed 220 kDa ankyrin-B and neurospecific 440 kDa ankyrin-B (AnkB440) isoforms. Previous work showed that knock-in mice expressing an ASD-linked Ank2 variant yielding a truncated AnkB440 product exhibit ectopic brain connectivity and behavioral abnormalities. Expression of this variant or loss of AnkB440 caused axonal hyperbranching in vitro, which implicated AnkB440 microtubule bundling activity in suppressing collateral branch formation. Leveraging multiple mouse models, cellular assays, and live microscopy, we show that AnkB440 also modulates axon collateral branching stochastically by reducing the number of F-actin-rich branch initiation points. Additionally, we show that AnkB440 enables growth cone (GC) collapse in response to chemorepellent factor semaphorin 3 A (Sema 3 A) by stabilizing its receptor complex L1 cell adhesion molecule/neuropilin-1. ASD-linked ANK2 variants failed to rescue Sema 3A-induced GC collapse. We propose that impaired response to repellent cues due to AnkB440 deficits leads to axonal targeting and branch pruning defects and may contribute to the pathogenicity of ANK2 variants.

Contained Rupture of a Large Colic Aneurysm

<h3>Introduction and Objective</h3> Visceral artery aneurysms are infrequently encountered with a reported incidence of 0.1-1% in the general population. Despite their rarity, they can pose a significant threat to those afflicted; available literature suggests a 25-70% mortality rate with rupture. They predominantly occur in the splenic and hepatic arteries. However, colic aneurysms are exceptionally unusual, and their etiology is not completely understood. Genetic disorders and systemic conditions including polyarteritis nodosa, fibromuscular dysplasia, and infection have all been implicated. We present a case of a large colic aneurysm rupture as the first manifestation in an otherwise healthy patient with suspected rheumatological origin. <h3>Case Report</h3> A retrospective chart review was performed on a single patient in a tertiary care institution. A 54-year-old female was transferred to our facility with one week of progressively worsening abdominal pain, malaise and bilious emesis. She presented with tachycardia in the 110s and newly discovered hypertension at 176/104 requiring nicardipine titration. Her hemoglobin was stable at 10.4 g/dL with a normal vascular exam. Her abdomen was mildly distended but otherwise unremarkable. The patient did not take any medications, denied any smoking history or illicit drug use, and her only past surgery was a caesarean section. She underwent a computed tomographic angiography (CTA) scan of the abdomen significant for a large 7.7 cm aneurysm of the right colic artery with a collateral branch from an Arc of Buhler variant. Other aneurysms included a 1.2 cm celiac trunk aneurysm and a 4 mm left colic artery aneurysm. Additional vascular findings included beaded appearance of mesenteric vessels, pulmonary arteriovenous malformations, and a portovenous fistula. Due to the hemoperitoneum, symptomatic presentation, and large size, the patient underwent emergent embolization of her right colic aneurysm. Coil embolization was successfully performed as well to the Arc of Buhler. The patient's symptoms resolved, and she was discharged home after 4 days. <h3>Discussion</h3> Large colic aneurysms are extremely rare, and a presentation of rupture in the context of several other vascular aneurysms and malformations has not yet been described. Though most visceral aneurysms are discovered when symptomatic, their rupture can be life-threatening and the need for expeditious recognition and treatment is critical. CTA of the abdomen is invaluable, and most patients can be treated with coil embolization. Etiological workup can be performed when patients are stable and may involve a multidisciplinary approach.

Diffusion tensor tractography characteristics of axonal injury in concussion/mild traumatic brain injury.

The main advantage of diffusion tensor tractography is that it allows the entire neural tract to be evaluated. In addition, configurational analysis of reconstructed neural tracts can indicate abnormalities such as tearing, narrowing, or discontinuations, which have been used to identify axonal injury of neural tracts in concussion patients. This review focuses on the characteristic features of axonal injury in concussion or mild traumatic brain injury (mTBI) patients through the use of diffusion tensor tractography. Axonal injury in concussion (mTBI) patients is characterized by their occurrence in long neural tracts and multiple injuries, and these characteristics are common in patients with diffuse axonal injury and in concussion (mTBI) patients with axonal injury. However, the discontinuation of the corticospinal tract is mostly observed in diffuse axonal injury, and partial tearing and narrowing in the subcortical white matter are frequently observed in concussion (mTBI) patients with axonal injury. This difference appears to be attributed to the observation that axonal injury in concussion (mTBI) patients is the result of weaker forces than those producing diffuse axonal injuries. In addition, regarding the fornix, in diffuse axonal injury, discontinuation of the fornical crus has been frequently reported, but in concussion (mTBI) patients, many collateral branches form in the fornix in addition to these findings in many case studies. It is presumed that the impact on the brain in TBI is relatively weaker than that in diffuse axonal injury, and that the formation of collateral branches occurs during the fornix recovery process. Although the occurrence of axonal injury in multiple areas of the brain is an important feature of diffuse axonal injury, case studies in concussion (mTBI) have shown that axonal injury occurs in multiple neural tracts. Because axonal injury lesions in mTBI patients may persist for approximately 10 years after injury onset, the characteristics of axonal injury in concussion (mTBI) patients, which are reviewed and categorized in this review, are expected to serve as useful supplementary information in the diagnosis of axonal injury in concussion (mTBI) patients.

Arterial supply to the rat colon.

Rats are often used as animal models in studies such as on intestinal transplantation and anastomosis healing, which require colectomy. Although detailed information regarding arterial supply is important to establish accurate and reproducible experimental procedures, this has not been studied in the rat colon. Therefore, we analysed the detailed arterial distribution pattern and its individual variations in the colon of 34 rats. The rat colon received colic branches of the ileocolic artery, and the right, middle and left colic arteries. The single left colic artery constantly arose from the caudal mesenteric artery and was distributed to the descending colon, whereas the others showed variations in number and distribution. The ileocolic artery gave rise to one (12%) or two (88%) colic branches supplying the proximal ascending colon, and these branches formed rich, mesh-like anastomoses along the initial portion of the ascending colon. One (74%) or two (26%) right colic arteries originated from the cranial mesenteric artery and supplied the ascending colon and right colic flexure. Moreover, one (38%), two (56%) or three (6%) middle colic arteries emerged from the cranial mesenteric artery and were distributed to the transverse colon, left colic flexure and proximal descending colon. In total, we categorized the individual variations in arterial branching and anastomosis into 11 patterns. Arterial supply to the rat colon showed a specific pattern and frequent individual variations. These findings thus provide essential information for establishing reproducible models of rat colic surgery.

An eighth note.

Venous stenosis is the most common cause of arteriovenous fistula (AVF) failure in hemodialysis patients. For patients with AVF stenosis, the pressure over the antecedent part of the AVF stenotic lesion will increase if arterial inflow is sufficient. We report a chronic hemodialysis patient who received an angiographic examination for the juxta-anastomosis stenosis of his AVF. A unique feature of a collateral venous branch antecedent to the stenotic lesion was noted, resembling a musical sign as the "eighth note." After percutaneous transluminal angioplasty, the eighth note attenuated markedly at once. Of note, the eighth note sign is not seen frequently, and thus we postulate that the formation of an eighth note sign on the radiocephalic fistula should fulfill the following requirements, including a sufficient arterial inflow, an adjacent collateral branch close enough to the arteriovenous anastomosis, a severe juxta-anastomotic stenotic lesion, and an intact ulnar venous drainage system.

A voluminous portal cavernoma of the hepatic pedicle with severe portal hypertension

Portal cavernoma is the cavernous transformation of the portal vein. It is the consequence of chronic portal vein thrombosis and occurs when collateral branches develop to bypass the portal occlusion. The clinical presentation includes hematemesis due to variceal bleeding, ascites or anemia, and splenomegaly. Herein we present images of a 37-year-old male patient received in our department for abdominal ultrasound, following 2 episodes of hematemesis. This case illustrates the ultrasound aspect of a voluminous portal cavernoma with portal hypertension signs.

Complex Syndrome of the Complete Occlusion of the End of the Superior Mesenteric Vein, Opposed with the Stable Gastric Pentadecapeptide BPC 157 in Rats.

Background. Gastric pentadecapeptide BPC 157 therapy in rats compensated irremovable occlusion of various vessels and counteracted the consequent multiorgan dysfunction syndromes by activation of the corresponding collateral bypassing loops. Thus, we used BPC 157 therapy against the irremovable occlusion of the end of the superior mesenteric vein. Methods. Assessments, for 30 min (gross recording, venography, ECG, pressure, microscopy, biochemistry, and oxidative stress) include the portal and caval hypertension, aortal hypotension, and centrally, the superior sagittal sinus hypertension, systemic arterial and venous thrombosis, ECG disturbances, MDA-tissue increase, and heart, lung, liver, kidney and gastrointestinal tract, in particular, and brain (cortex (cerebral, cerebellar), hypothalamus/thalamus, hippocampus) lesions. Rats received BPC 157 medication (10 µg/kg, 10 ng/kg) intraperitoneally at 1 or 15 min ligation time. Results. BPC 157 rapidly activated the superior mesenteric vein–inferior anterior pancreati-coduodenal vein–superior anterior pancreaticoduodenal vein–pyloric vein–portal vein pathway, reestablished superior mesenteric vein and portal vein connection and reestablished blood flow. Simultaneously, toward inferior caval vein, an additional pathway appears via the inferior mesenteric vein united with the middle colic vein, throughout its left colic branch to ascertain alternative bypassing blood flow. Consequently, BPC 157 acts peripherally and centrally, and counteracted the intracranial (superior sagittal sinus), portal and caval hypertension, aortal hypotension, ECG disturbances attenuated, abolished progressing venous and arterial thrombosis. Additionally, BPC 157 counteracted multiorgan dysfunction syndrome, heart, lung, liver, kidney and gastrointestinal tract, and brain lesions, and oxidative stress in tissues. Conclusion. BPC 157 therapy may be specific management also for the superior mesenteric vein injuries.

Fitting Splines to Axonal Arbors Quantifies Relationship Between Branch Order and Geometry.

Neuromorphology is crucial to identifying neuronal subtypes and understanding learning. It is also implicated in neurological disease. However, standard morphological analysis focuses on macroscopic features such as branching frequency and connectivity between regions, and often neglects the internal geometry of neurons. In this work, we treat neuron trace points as a sampling of differentiable curves and fit them with a set of branching B-splines. We designed our representation with the Frenet-Serret formulas from differential geometry in mind. The Frenet-Serret formulas completely characterize smooth curves, and involve two parameters, curvature and torsion. Our representation makes it possible to compute these parameters from neuron traces in closed form. These parameters are defined continuously along the curve, in contrast to other parameters like tortuosity which depend on start and end points. We applied our method to a dataset of cortical projection neurons traced in two mouse brains, and found that the parameters are distributed differently between primary, collateral, and terminal axon branches, thus quantifying geometric differences between different components of an axonal arbor. The results agreed in both brains, further validating our representation. The code used in this work can be readily applied to neuron traces in SWC format and is available in our open-source Python package brainlit: http://brainlit.neurodata.io/.

Laparoscopic low anterior resection for rectal cancer wherein the inferior mesenteric artery arose from the superior mesenteric artery: a case report

BackgroundFew cases have been reported of colorectal cancer with inferior mesenteric artery (IMA) branching abnormalities; therefore, the lymphatic flow in such cases remains unknown. We report the first case of locally advanced rectal cancer in which the IMA arose from the superior mesenteric artery (SMA) in which we achieved to visualize the lymphatic flow.Case presentationA 65-year-old woman complaining of bloody stools was investigated in our hospital and suspected with rectal cancer. Colonoscopy and abdominal enhanced computed tomography (CT) revealed a circumscribed, localized ulcerative tumor in the rectum. 3-Dimensional contrast-enhanced computed tomography (3D-CT) showed that the IMA arose from the SMA. The patient was diagnosed with rectal cancer (cT3N0M0, cStage IIa) and laparoscopic low anterior resection was performed. The sigmoid colon was resected using the medial approach. Only the plexus of the colic branch of the lumbar splanchnic nerve was observed at the site where the root of the IMA usually exists and showed interruption of the indocyanine green (ICG) fluorescence-illuminated lymphatics. The root of the IMA was ligated, and Japanese D3 lymphadenectomy was performed, preserving the accessory middle colic artery. All fluorescent lymph nodes were resected. The pathological diagnosis was pT4aN1aM0 stage IIIb. The patient’s postoperative course was uneventful. Adjuvant chemotherapy was administered, and the patient was recurrence-free at 1.5 years after surgery.ConclusionsWe were able to perform safe and appropriate surgery oncologically, despite abnormal vascular anatomy, due to preoperative identification using 3D-CT and intraoperative navigation using ICG administration.

Anatomic mapping of the collateral branches of the external carotid artery with regard to daily clinical practice

BackgroundTo identify the anatomical variations of the main branches of the external carotid artery (lingual, facial, occipital, ascending pharyngeal and sternocleidomastoid), giving information about the calibers and origins with the aim of creating a new classification useful in clinical practice. Material and methods193 human embalmed body-donors were dissected. The data collected were analyzed using the Chi² test. The results of previous studies were reviewed. ResultsThe majority of the anterior arterial branches (superior thyroid, facial and lingual artery) were observed with an independent origin, respectively, classified as pattern I (80.83%, 156/193). In 17.62% (34/193) a linguofacial trunk, pattern II, has been observed, only in 1,04% (2/193) a thyrolingual trunk, pattern III, has been found and in one case (1/193, 0.52%) one thyrolinguofacial trunk, pattern IV, was found. Depending on the posterior branches (occipital and ascending pharyngeal), four different types could be determined: type a, the posterior arteries originated independently, type b, the posterior arteries originated in a common trunk, type c, the ascending pharyngeal artery was absent, type d, the occipital artery was absent. ConclusionAnatomical variations in these arteries are relevant in daily clinical practice due to growing applications, e.g., in Interventional Radiology techniques. Knowledge of these anatomical references could help clinicians in the interpretation of the carotid system.

Controlling the arterial supply into the pancreatic head region as a whole peripancreatic arterial arcade via a mesenteric approach during isolated pancreatoduodenectomy.

The peripancreatic arterial system forms various arterial arcades and collateral branches; therefore, it stands to reason that the arterial supply into the pancreatic head region should be controlled as a whole peripancreatic arterial arcade rather than as the three major supplying arteries during isolated pancreatoduodenectomy (PD). We investigated the clinical importance of early control of the whole peripancreatic arterial arcade during PD. The subjects of this retrospective study were 63 consecutive patients who underwent PD via a mesenteric approach at our hospital between October, 2014 and February, 2017. The patients were divided into an early control group (n = 27) and a late control group (n = 36) for comparative analysis. The peripancreatic arterial arcades and collateral branches were seen on preoperative multidetector row computed tomography (CT) images and during PD in all 63 patients. The early control group had significantly less intraoperative blood loss than the late control group. Early control of the whole peripancreatic arterial arcade was an independent factor associated with lower intraoperative blood loss in the multivariable analysis (P = 0.012). The arterial supply into the pancreatic head region should be controlled as a whole peripancreatic arterial arcade rather than as the three major supplying arteries during isolated PD.

English

BACKGROUND Superior Mesenteric Artery (SMA) is one of the anterior branches of the abdominal aorta. It originates from abdominal aorta at the level of lower border of first lumbar vertebra, one centimeter below the coeliac trunk. It gives the first branch inferior pancreaticoduodenal artery (IPDA), The colic branches arise from concave right side of the superior mesenteric artery, these are middle colic artery (MCA), right colic artery (RCA), ileo colic artery (ICA). Jejunal and ileal branches arise from left side of the SMA. Superior mesenteric artery supplies derivatives of midgut. Knowledge of branching pattern of the SMA is clinically important to gastroenterologists operating on gut and neighboring structures like pancreas, duodenum, and liver. We wanted to study the variations in the branches of superior mesenteric artery. METHODS This is a descriptive study conducted on 50 adult embalmed human cadavers by conventional dissection method, the findings were noted and tabulated. RESULTS Present study shows that inferior pancreatic duodenal artery orginated from SMA in 47 (94 %) specimens. IPDA was absent in 3 (6 %) specimens. Middle colic artery was found to arise from SMA in 48 (94 %) and MCA was absent in 2 (4 %) specimens. Right colic artery was found to arise from SMA in 47 (94 %) specimens and it was absent in 3 (6 %) specimens. Ileo-colic artery was found to arise from SMA in all 50 (100 %) specimens. CONCLUSIONS Awareness of these complex variations may prevent devastating complications during colonic surgeries. Variations in the branching pattern of superior mesenteric artery is essential for surgeons operating on derivatives of midgut, liver, pancreas. KEY WORDS Branches, Colic, Superior Mesenteric Artery, Variations

Topographical, anatomical and neurosurgical aspects of "end-to-side" nerve repair

The article presents the results of a comprehensive anatomical and experimental study of individual variability in the structure and topography of motor branches of peripheral nerves in relation to the justification of methods for selective reinnervation of tissues by the "end-to-side" neurorrhaphy. It was found that relatively longer branches of peripheral nerves with a small number of connecting inter-arm collaterals characteristic of narrow and long limbs create conditions for less traumatic mobilization of motor branches. In cases with relatively wide and short extremities mobilization of peripheral nerves is complicated by the presence of a large number of collateral branches and intra-trunk connections, which are often damaged when separate bundles that make up the mobilized branches of the donor or recipient nerve are isolated from the main nerve trunk. It has been shown that potential recipient nerves should be motor branches of peripheral nerves, the preservation of which is of fundamental importance for the function of the corresponding segment of the limb. To create conditions conducive to selective reinnervation of functionally significant muscle groups of the upper limb, we have developed, justified from anatomical positions, and tested in an experiment on anatomical material methods for connecting the distal motor branches of peripheral nerves by the "end-to-side" neurorrhaphy. The main idea of accelerated recovery of the thumb opposition in injuries of the median nerve is to reinnervate the muscles of the elevation of the I finger due to nerve fibers that are part of the deep branch of the ulnar nerve. For this purpose, surgical techniques have been developed for connecting the recurrent motor branch of the damaged median nerve mobilized at the level of the wrist with the edges of a surgically formed perineurium defect on the lateral surface of the bundles that make up the deep branch of the ulnar nerve. In another clinical situation, in patients with radial nerve injuries, for the muscle reinnervation, а method is proposed for neurotisation of the deep motor branch of the radial nerve by the end-to-side suture to the lateral surface of the median nerve. We assume that performing the "end-to-side" nerve suture at the level of the base of the hand in the cases of proximal damage to the median nerve will reduce the time of reinnervation of the muscles of the thumb elevation by 400450 days. Transposition of the deep branch of the damaged at the proximal level radial nerve with "end-to-side" neurorrhaphy to the median nerve by 250300 days (based on the total length of the shoulder and forearm, which is about 50 cm and the rate of regeneration of nerve fibers 1 mm per day). Accordingly, with higher injuries (brachial plexus), the gain in the time of reinnervation of the distal segments will be even greater. In our opinion, the results can be used as a basis for further clinical research on the development of methods for selective tissue reinnervation in cases with isolated injuries of the peripheral nerves.

Use of Head and Neck Magnetic Resonance Angiography to Explore Neurological Function Recovery and Impact of Rehabilitation Nursing on Patients with Acute Stroke

To analyze neurological function recovery and the impact of rehabilitation nursing in patients with cerebral stroke after treatment to aid clinical diagnosis and treatment of cerebral stroke. The study comprised 140 patients who were hospitalized in the neurology department for magnetic resonance angiography examination. Patients were divided into a treatment group (70 patients) and a control group (70 patients) based on treatment plan. Digital subtraction angiography was regarded as the gold standard diagnostic examination. In patients in both groups, magnetic resonance angiography features of the M1 segment of the middle cerebral artery and diagnostic specificity and sensitivity were recorded. An activities of daily living score was used to assess neurological function of patients before and after rehabilitation. The activities of daily living scores of patients in both groups increased significantly after treatment (P<0.05); the scores of patients in the treatment group increased more significantly (P < 0.05). The total effective rate was 89% in the treatment group and 60% in the control group. The difference between the 2 groups was statistically significant (P < 0.05). After treatment, the degree of M1 segment stenosis in both groups was better than before treatment, and the number of collateral circulation branches was increased; the improvements in the treatment group were more significant (P < 0.05). Rehabilitation nursing could greatly improve the stenosis of blood vessels in patients with acute cerebral stroke and promote the establishment of collateral circulation, thereby effectively enhancing the recovery of neurological function and strengthening the ability of patients to perform activities of daily living.