Development Of Collateral Circulation Research Articles

Development of Coronary Collateral Circulation

Collateral coronary arteries provide alternate routes for delivery of blood to myocar­ dium distal to major coronary-artery obstructions. These channels may be extracar­ diac, endomural, or arterioluminal in origin (I). One additional source of collateral myocardial blood flow is from deliberate attempts to surgically augment blood flow to ischemic regions of myocardium. Over the years these have included methods such as promotion of adhesion formation with inflammation and epicardial in­ growth, direct intramyocardial tunneling of bleeding arterial vessels, and, most recently, the construction of aortocoronary interposition saphenous-vein bypass grafts. This review deals primarily with intercoronary collateral vessels, since these constitute the major and best studied class of naturally occurring collateral arteries. These arteries have an anatomic point of origin termed the stem, a mid-zone, and a reentry point. The presence, number, and transmural distribution of coronary collaterals appear to be determined genetically for different species and perhaps differences in collateral density within a given species may also be a hereditary characteristic (2, 3). For example, dogs form extensive epicardial collaterals, while pigs have primarily a dense subendocardial network of collateral arteries. In con­ trast, collateral vessels in man have been demonstrated at every depth of myocar­ dium, but subendocardial connections appear most numerous. Goats, however, do not generally form collateral vessels (4, 5). Gradual closure of a coronary artery in the canine model rarely results in myocardial infarction, but similar preparations in pigs invariably result in some degree of tissue necrosis. The same technique applied to a goat usually results in the death of the animal from massive myocardial necrosis (6). Although man may form abundant collateral channels, it is unpredicta-

Inhibition of feline collateral vessel development following experimental thrombolic occlusion.

We compared development of feline hindlimb collateral circulation after acute occlusion of the terminal aorta by ligation, thrombus formation, and formation of a "closed" aortic loop containing thromboplastin. Collateral circulation development was assessed by aortograms, scintillation scans, neurological signs following occlusion, measurement of hindlimb muscle blood flow, and forelimb and hindlimb temperature. In cats in which aortic occlusion was the result of ligation or thromboplastin in the aortic loop, paralysis was not evident. Aortograms and scintillation scans indicated hindlimb blood flow. Both muscle temperature and blood flow data indicated that the return of blood flow was rapid. The 5th lumbar artery appears to be the origin of the collateral vessels. The mid-zone component is a dorsal and ventral vertebral route and an epaxial muscle route. The reentry components are the 6th or 7th lumbar arteries. The collateral vessels arise from preexisting collateral vessels. Of those cats in which aortic occlusion was the result of a thrombus, all exhibited paralysis. Aortograms, scintillation scans, muscle temperature, and hindlimb blood flow data indicated reduced hindlimb blood flow. The results suggest that the thrombus has an inhibitory effect on the development of collateral circulation.

Intracranial carotid catastrophies encountered by the otolaryngologist

Arteriographic studies are utilized to illustrate the presence and document the results of arterial ligation on three intracranial carotid aneurysms. All three aneurysms resulted from trauma, surgical and otherwise, and all presented as otolaryngologic dilemmas. All were successfully controlled by a combined Otolaryngological and Neurosurgical Team employing varying combinations of intra and extra cranial arterial ligations. None developed significant neurological impairments. The two major indications for common or internal carotid ligation are the resection of neoplasm and the control or prevention of hemorrhage. Sixty percent of patients undergoing elective carotid ligation survive these procedures without evidence of neurological sequelae. This uncompromised survival is based upon the presence or rapid development of collateral circulation to the cerebrovascular bed. Further arteriographic studies are employed to illustrate the development of intra and extra cranial collateralization to the internal carotid artery after surgical interruption of the ipsilateral common carotid. The major collateral circuits demonstrated via a case report are as follows: a. from the vertebral artery to the external carotid and hence to the internal carotid; b. from the posterior communicating artery to the internal carotid; and c. from the ophthalmic artery to the internal carotid.

Case report: An unusual case of portal systemic encephalopathy.

A middle-aged woman with severe obesity, but without any evidence of chronic liver disease, developed episodes of portal systemic encephalopathy following a jejunoileal bypass. High arterial blood ammonia in the face of apparently normal liver morphology indicated the presence of spontaneous portal systemic shunting of blood. This was further supported by an abnormal oral ammonia tolerance test. Selective abdominal angiography revealed occlusion of the portal vein and its tributaries, with development of extensive collateral circulation. It is suggested this unusual complication had developed as a result of previous abdominal surgery.

Effect of physical training on treadmill exercise capacity, collateral circulation and progression of coronary disease

The increased exercise capacity after physical training in patients with coronary artery disease has been attributed to improved oxygen supply to the myocardium by way of increased collateral circulation or reduction of myocardial oxygen consumption by extracardiac factors, or both. Fourteen patients aged 43 to 61 years (mean 51 years) with 50 percent or greater obstruction in one, two or three vessels (three, six and five patients, respectively) underwent 13 months of physical training. Clinical status was either stable or improved with training. Treadmill exercise capacity, as measured by oxygen consumption, increased 25 percent from 21.9 ± 4.8 (standard deviation) to 27.4 ± 4.1 ml/kg-min at heart rates of 154 ± 17 and 156 ± 12 beats/min, respectively. After training, new collateral vessels, apparently secondary to progression of the disease, were observed in 2 of 21 arteries significantly but not completely obstructed before training. These data are in contrast to those reported for trained dogs with incomplete obstruction. Coronary arterial lesions progressed in only 4 of 14 patients. Coronary arteriographic data from this laboratory do not support the hypothesis that the increased exercise capacity after training in patients with coronary disease can be attributed to the development of collateral circulation. It is possible that physical training may retard the progression of coronary artery disease.

Rhythmic Shoulder Girdle Muscle Contractions as a Complication in Pacemaker Treatment

The correct diagnosis with a good definition of the tumor limits is thus mandatory. Careful study of the clinical picture may be of considerable help in this respect. The symptoms indeed depend upon the level and extension of the mass. The different clinical symptoms are generally related to progressive occlusion of the inferior vena cava followed by development of collateral circulation. In previous reports, when the tumor was located in . the upper third of the inferior vena cava, Chiari's syndrome was observed with hepatomegaly, ascites and jaundice.s*6*7*8*lt-16 The origin of the hepatic vein was invaded by the tumor or occluded by antemortem thrombosis. He~atic failure was sometimes more dramatic when the occlusion of the hepatic vein was abrupt. Tumors located in the middle third of the inferior vena cava give rise to a nephrotic syndrome and renal failure.' Leiomvosarcoma located in the lower third of the inferior Gens cava are extremely difficult to diagnose. Very often, they extend to the peritoneum with no obstruction in the vena cava, but produce severe lumbar pain. It is only when the tumor grows inside the vessel that swelling of the legs may appear with a palpable abdominal mass. Cavography seems to be the most suitable method to reach the diagnosis and to obtain information as regards the tumor extent and location. This technique was used in two previous instances by Roussak and Heppelston6 and Deutsch and colleagues.21 In our patient inferior cavography revealed a defect of filling with many anastomotic vessels. The superior cavography showed extension of the tumor into the right atrium. Filling defects were also observed in peripheral branches of the pulmonary artery. Propagation into the right atrium was found in four cases so far.ls-151lg In all of them, the tumor arose in the upper third of the inferior vena cava. Resection of the tumor was reported in six ~ases.~*'J~-~~ The first operation was carried out by Melchiorl8 in 1921. Three patients survived the surgical procedure and were still alive between nine months and-one year after surgery.34.20

Effect of inflammation on collateral circulation of the gingiva.

The effect of inflammation on collateral circulation of the gingiva and the vasculature of the periodontal ligament was studied in 12 squirrel monkeys. Gingival inflammation was induced by tying silk ligature at the cervical area of mandibular bicuspids and molars to encourage plaque accumulation. At 2, 10 and 26 weeks after ligature placement the animal's vasculature was perfused with India ink and calf serum. Nonligatured bicuspids and molars from the same animals served as controls. At all time points, on all experimental tooth surfaces examined, the vascularity (% grid intersections falling over vessel lumen) of the cervical portion of the periodontal ligament was significantly higher than the controls. The number of vessels connecting vessels of the periodontal ligament with supracrestal vessels was also significantly higher. There was a tendency for the number of vessels perforating either the alveolar bone proper or the alveolar crest to increase when inflammation was induced. The results of this study demonstrate the development of collateral circulation from the periodontal ligament to the gingiva in response to inflammation and help to explain the extension of inflammation into the deeper structures of the periodontium, including the periodontal ligament.

Direct measurement of coronary collateral blood flow in conscious dogs by an electromagnetic flowmeter.

The development of collateral circulation has been indirectly monitored by determining peripheral coronary pressure and 133 Xe clearance. In the present experiments, the development of collateral blood flow following gradual (three dogs) and rapid (three dogs) complete occlusion of the central circumflex branch, during partial central occlusion, and in parallel with a rise in peripheral coronary pressure was directly demonstrated by finding phasic coronary flow patterns in distal branches of the circumflex coronary artery. Collateral blood flow patterns were not consistently observed until a flow of 4-6 ml/ min developed. In five dogs branch flow before central occlusion averaged 20 ml/min, but peak collateral blood flow after occlusion averaged 11.6 ml/min (range 7 to 17 ml/min). To circumvent central occlusion collateral blood flow must enter the circumflex bed retrograde; we proved this fact by finding collateral blood flow patterns that were mirror images of normal antegrade patterns and flow values that were negative with respect to mechanical reference zeros. Unexpectedly, collateral blood flow was antegrade in some branches indicating a redistribution of retrograde collateral blood flow within the circumflex bed. In a terminal open-chest experiment, there was indirect evidence of alternate collateral blood flow opposing measured collateral blood flow; this finding could explain some of the small reactive hyperemias observed after the release of a temporary occlusion of a distal branch. In summary, phasic collateral blood flow patterns in distal epicardial branches that developed rapidly in response to occlusion of the central circumflex branch and in conjunction with a rise in peripheral coronary pressure were demonstrated, and reversal from antegrade to retrograde collateral blood flow was documented.

Iatrogenic renal hypertension.

Delayed development of renal vascular hypertension secondary to surgical ligation of a major branch of the renal artery occurred. The blood pressure returned to normal levels after surgical removal of the ischemic section of the kidney. This case reiterates the importance of maintaining complete vascular supply to kidneys during renal surgery and suggests the mechanism of development of collateral circulation and subsequent hypertension where renal arterial blood flow is impaired.

Evaluation of ureteral obstruction in the bony pelvis with iliac vein venography.

EVALUATION OF URETERAL OBSTRUCTION IN THE BONY PELVIS WITH ILIAC VEIN VENOGRAPHYTHEODORE R. SMITH, M.D and MORTON A. BOSNIAK, M.D.Audio Available | Share

Inferior vena caval ligation. With special reference to spontaneous resolution of pulmonary emboli and to postligation venous collateral circulation.

During the years 1968–1971, 95 cases of pulmonary embolism were verified at the Department of Surgery, University of Turku; 64% of the patients died. Interruption of the inferior vena cava (IVC) was performed on 24 patients. In 7 cases, IVC ligation was carried out in connection with pulmonary embolectomy. In 10 out of 24 cases the embolism was massive. All these patients were candidates for pulmonary embolectomy, but emergency embolectomy was necessary for 6 patients only and embolectomy for recurrent massive embolism in 1 case.Three patients died postoperatively after embolectomy and one (1/17) after IVC ligation alone. One patient developed phlegmasia coerulea dolens 10 days after IVC ligation. The case was successfully treated by balloon catheter thrombectomy.None of the patients had signs or symptoms of recurrent embolism during the relatively short follow-up period. Sixteen patients underwent follow-up examination on average 11/2 years after IVC interruption. Seven had no stasis of the lower limbs, 7 slight, one moderate and one incapacitating oedema. Lung scanning showed very marked improvement in lung perfusion in 13 out of 15 cases. Successful cavography was performed on 13 patients. The collateral venous drainage passed mainly through the paravertebral plexus and ovarian veins. Especially the ovarian veins were often greatly dilated. The role of spontaneous fibrinolysis and development of venous collateral circulation after IVC ligation was discussed.In our opinion, the complications in this series were minor ones and the favourable experience supports the performance of IVC interruption for prevention of recurrent pulmonary embolism.

Coronary collateral circulation and distal coronary runoff: the key factors in pre-serving myocardial contractility in patients with coronary artery disease.

CORONARY COLLATERAL CIRCULATION AND DISTAL CORONARY RUNOFF: THE KEY FACTORS IN PRESERVING MYOCARDIAL CONTRACTILITY IN PATIENTS WITH CORONARY ARTERY DISEASEDAVID C. LEVIN, M.D., THOMAS A. SOS, M.D., JACK G. LEE, M.D. and HAROLD A. BALTAXE, M.D.Audio Available | Share

POPLITEAL-ARTERY ENTRAPMENT

Diagnosis of popliteal-artery entrapment was aided by the presence of an unusually warm knee. This clinical sign is more likely to be present when the popliteal artery is occluded as a result of the abnormal attachment of the gastrocnemius muscle than in atherosclerotic occlusion, in which the involvement of the calf vessels will limit the development of collateral circulation.

Severe atherosclerosis in the “single coronary artery”: Report of a previously undescribed pattern

A case is presented in which a true single coronary artery of a previously unreported type was found to arise from an unusual position high in the ascending aorta. Atherosclerotic involvement of this vessel was extremely heavy, and there was extensive development of coronary arterial collateral circulation. The problems inherent in attempting to diagnose this type of anomaly are discussed, and the potential impact of abnormal origin and distribution on the development of atherosclerosis in the single coronary vessel is reviewed.

Development of collateral circulation in the hind limb of rats after acute occlusion of the contralateral femoral artery.

On the basis of the described assays on rats after occlusion of the femoral artery (work performance and related changes in blood pressure), it is presumed that the primary factor leading to the development of collateral vessels is of metabolic origin.

Hemodynamic evidence of the development of coronary collateral circulation in conscious dogs.

Since 1964, we have addressed ourselves to the problem of the rate of development of collateral circulation following coronary occlusion in the conscious dog preparation. Four different experimental approaches have been used, all of which have essentially involved the effects of gradual circumflex branch occlusion on collateral development. An attempt will be made to summarize the earlier experiments and to give in more detail the salient features of more recent experiments.KeywordsCoronary OcclusionReactive HyperemiaCollateral Blood FlowElectromagnetic FlowmeterCoronary PressureThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Weitere Untersuchungen zum Nachweis der Bedeutung von Metaboliten des Muskels bei der Entwicklung des Kollateralkreislaufes

It has been shown that during work performance metabolites are liberated from the muscle into the blood vessels and thus act on the entire vascular system. From these, and earlier studies, we conclude that the primary factor responsible for the development of collateral circulation is metabolic and that the metabolites produce secondary hemodynamic changes.

The effects of chronic unilateral renal artery constriction on blood pressure, separate renal function, and the development of collateral circulation in the dog.

In 10 dogs in each of which one kidney was left intact, unilateral renal artery constriction (R.A.C.) resulted in an increase in aortic pressure (PA) for as long as 13 months. When PA had stabilized at 156 ± 14 mm Hg compared with a baseline of 128 ± 13 mm Hg (p < 0.001) urine flow rate (V), sodium excretion (UNaV), and chloride excretion (UClV) decreased in the constricted kidney (E), while creatinine clearance (CCr) and para-aminohippurate clearance (CPAH) did not change significantly. In the contralateral control kidney (C) V, UNaV, and UClV increased, in association with increases in CCr and CPAH, but without changes in filtration fraction or renal vascular resistance. Although E/C creatinine concentration (UCr) increased as E/C V fell, E/C urine sodium concentration remained unchanged. However, when differences in V, UNaV, UClV, CCr, CPAH, and UCr between C and E were enhanced in relation to a transient exaggerated increase in PA in the acute phase following R.A.C., E/C UNa appeared to decrease slightly. When collateral circulation which had developed to E was stripped, enhanced differences in separate renal function recurred in association with a further increase in PA. Thus, chronic R.A.C. leads to the development of collateral renal circulation which appears responsible for improvement in function in E, and decrease in PA. These effects are associated with decrease in function on the control side, thereby leading to a reduction in differences in function between the two sides.

Quantitative segmental pulse volume recorder: a clinical tool.

A quantitative segmental pulse volume recorder (PVR) has been described which is (1) simple, reliable, and reproducible, (2) capable of standardization, (3) easily employed by paramedical personnel, and (4) adaptable to measurements taken after exercise. The components of the electronic package have been tested in terms of frequency response, linearity, and calibration. It has been used in over 300 patients during the past two years to measure pulse volume amplitudes, pulse contours, and limb pressures. Preoperatively, the PVR provided a measure of the functional severity of the occlusive disease as well as an objective base line for later comparisons. Operative mbnitoring with the PVR can be easily carried out and was particularly valuable in patients undergoing proximal arterial reconstructions in the presence of distal occlusive disease. With this method, early postoperative limb monitoring in patients without palpable pulses can be carried out in the recovery area by nursing personnel. The PVR has contributed to the long-term follow-up study of patients with vascular disease by documenting the adequacy of arterial reconstructions, the progression of underlying disease, or the development of collateral circulation.

In vivo microscopic observations of the pathogenesis and pathophysiology of hepatosplenic schistosomiasis in the mouse liver.

Abstract In vivo microscopic observations have elucidated the pathophysiology of hepatosplenic schistosomiasis mansoni in the mouse. Numerous schistosome eggs trapped in the interlobular portal venules partially or completely obstruct flow. Each egg is capable of obstructing blood flow to about 10 functional hepatic units (defined in text). In mice with severe hepatosplenic disease and portal hypertension, egg loads may reach 10,000 per gram of liver, but they block blood flow to only 6% of the total number of functional units. The host's granulomatous and fibrotic reaction to the eggs, which more than doubles the weight of the liver, imposes an extensive presinusoidal block to liver blood flow. Neovascular formation occurs in the scar tissue and provides a bridge between the presinusoidal vasculature and the sinusoids. The rapidity of the blood flow in these new vessels suggested that they were arterial; this was confirmed when ligation of the hepatic artery resulted in cessation of blood flow not only in the scar tissue but also in the adjacent sinusoids and central venules. On the basis of these studies, the pathophysiology of hepatosplenic schistosomiasis mansoni may be summed up as follows: schistosome eggs and the granulomatous inflammation and scar tissue around them gradually shut down portal venous flow. This results in portal hypertension, congestive splenomegaly, and the development of portal-systemic collateral circulation. Compensatory arterialization occurs through neovascular formation and this maintains sinusoidal perfusion and liver function within relatively normal limits.