Interarterial Anastomoses Research Articles

Prophylaxis of Ischemic Damage to the Ovaries, Taking Into Account Peculiarities of Blood Supply to the Uterus During Endovascular Treatment of Le Yo Fibroids

SUMMARY Uterine arteries embolization (UAE) is one of the modern trends in the treatment of uterine bleeding caused by uterine leiomyomas (UL). However, unfavourable results of this method of treatment are observed in 10–15% of cases. This is primarily concerned with the emerging ischemia of ovarian tissue after embolization.Material and methods Complex examination and treatment was performed in 48 patients admitted with UL complicated by the development of uterine bleeding. Patients with UL were divided into two groups. In the Group I of patients (n=29) standard embolization was performed, while the patients of the Group II (n=19) with diagnosed interarterial utero-ovarian anastomosis underwent separating technique of UA occlusion using different types of emboli.Results and discussion The features of the uterine blood supply in patients with UL were analyzed from the perspective of the effecacy and safety of endovascular intervention. A methodology of staged EUA was developed, which involved the staged aortography of the infrarenal aorta (for visualization of the ovarian arteries); pelvic arteriography (for evaluating the vascular anatomy of the pelvis and identifying utero-ovarian intearterial anastomoses); selective arteriography followed by UAE first with cylindrical emboli, and then with standard emboli in the form of microspheres. The application of the developed technique did not show dysfunction of the ovaries in both the short and long-term follow-up period up to 18 months in the Group II.Conclusion The separating UA occlusion is a safe and effective way of preventing ischemic damage in the presence of signoficant utero-ovarian inter-arterial nastomoses.

Bilateral coagulation of inferior hypophyseal artery and pituitary transposition during endoscopic endonasal interdural posterior clinoidectomy: do they affect pituitary function?

The endoscopic endonasal transcavernous approach with interdural pituitary transposition provides surgical access to the posterior clinoids and interpeduncular cistern. Prior to posterior clinoidectomy, selective coagulation and transection of the inferior hypophyseal artery (IHA) is recommended to prevent uncontrolled tearing of the artery and its avulsion from the wall of the cavernous carotid artery. The authors' preliminary experience has shown that unilateral sacrifice of the IHA caused no permanent endocrine dysfunction. In this study, they investigated the pituitary function in the setting of bilateral sacrifice of IHAs and pituitary transposition. All patients with normal preoperative pituitary function who underwent endoscopic endonasal bilateral posterior clinoidectomy with bilateral IHA sacrifice between March 2010 and December 2016 were included and retrospectively evaluated. All data regarding pituitary function were collected. The degree of pituitary gland manipulation was estimated based on tumor size on preoperative MRI. An angle between a line from the point where the gland meets the floor of the sella to the highest point of the tumor and the horizontal plane of the sellar floor, or access angle, was also measured. Posterior pituitary bright spots on pre- and postoperative T1-weighted MRI were also reported. Twenty patients had bilateral transcavernous posterior clinoidectomies with coagulation of both IHAs. There were 13 chordomas, 3 epidermoid cysts, 2 chondrosarcomas, 1 meningioma, and 1 hemangiopericytoma. The mean follow-up was 19 months (range 13-84 months). Two patients experienced transient diabetes insipidus (DI) requiring desmopressin, which resolved before hospital discharge. One patient (with chordoma) developed delayed permanent DI, and a second patient (with hemangiopericytoma) developed permanent DI and panhypopituitarism. The access angle was higher in the group with pituitary dysfunction (47.25° compared to 33.81°; p = 0.07). Posterior pituitary bright spots were preserved in 75% of cases with normal postoperative endocrine function. The endoscopic endonasal transcavernous approach to the interpeduncular cistern with pituitary transposition and bilateral sacrifice of the IHAs does not cause pituitary dysfunction in a majority of patients. When endocrine deficit occurs, it appears to be more likely to have been caused by surgical manipulation than loss of blood supply. This finding confirms clinically the crucial concept of interarterial anastomosis of pituitary vasculature proposed by anatomists.

Modern approaches to endovascular treatment of uterine leiomyoma

Individual features of the blood supply to the uterus and ovaries in 20-25% of cases cause failures in endovascular treatment of patients with uterine leiomyoma (ULM) and are forced to return to traditional surgical methods. The purpose of the study is to assess the possibilities of preventing iatrogenic complications of endovascular treatment of ULM through the use of separating occlusion of the uterine arteries, taking into account the characteristics of the blood supply to the uterus and ovaries. Materials and methods. The work is based on the analysis of the results. X-ray endovascular occlusion of the uterine arteries for ULM performed in 88 women aged 34-46 years (mean age 38.8 ± 2.5 years). The patients were divided into 2 groups: the 1st group comprised 65 patients without visible uterine-ovarian interarterial anastomoses. They performed standard embolization of the uterine arteries (EUA) using spherical PVA microemboli (COOK, USA), Embosphere (Merit Medical, USA) with a diameter of 500-700 microns. The second group consisted of 23 patients in whom utero-ovarian inter-arterial anastomoses were detected. In patients of this group, EUAs were produced with Embox cylindrical emboli (Plastis-M, Russia) with a length of 10 mm and a diameter of 500-700 μm, which occlude only the bed of the uterine arteries and are not capable of to overcome utero-ovarian inter-arterial anastomoses. In the 2nd group of EUA patients wore the character of occlusion, separating the uterine and ovarian arteries. The original EUA protocol was applied, which includes, in addition to the standard stages of selective arteriography of the uterine arteries, performing preliminary abdominal aortography to visualize the ovarian arteries and pelvic arteriography to assess pelvic vascular anatomy and identify utero-ovarian interarterial anastomoses. The results of the study. A total angiographic examination of the ovarian and uterine arteries, including a review angiography of the infrarenal section and bifurcation of the aorta, ileal vessels. In 23 (26.1%) patients with angiographic examination, uterine-ovarian arterio-arterial anastomoses. In 13 patients (56.5% of the detected anastomoses), these were type 1 anastomoses. In 10 patients (43.5% of the detected anastomoses), type 3 anastomoses were detected. Endovascular occlusion of the uterine arteries was performed in all patients. In 5 (7.69%) patients from the 1st group after EUA, amenorrhea occurred. In contrast, in all 23 patients from the 2nd group in the postembolization period, no observation of ovarian function was observed in any of the observations. Conclusion. For endovascular treatment of ULM in the presence of pronounced utero-ovarian interarterial anastomoses, the method of separating uterine artery occlusion is a safe and effective way to prevent ischemic damage to the ovaries.

Proximal clipping of a large fusiform aneurysm of the A2 segment of the left anterior cerebral artery with awakening of the patient (a case report and literature review)

Arterial aneurysms of the A2 segment are very rare (<1%) peripheral aneurysms of the anterior cerebral artery (ACA) territory. Usually, these are saccular aneurysms; there are single reports of fusiform aneurysms of this location. Surgical treatment of these aneurysms involves both microsurgical and endovascular interventions. In the presented case, we used deconstructive surgery (proximal clipping of the aneurysm) with intraoperative awakening of the patient, which verified sufficient collateral blood flow. In the case of focal deficit development, we planned to simultaneously perform an interarterial anastomosis between the A3 segments of the right and left ACAs.

Inter-arterial anastomosis in human spleen – A case report

Inter-arterial anastomosis in human spleen – A case report

Verification of Embolic Channel Causing Blindness Following Filler Injection.

Ocular complications following cosmetic filler injections are serious situations. This study provided scientific evidence that filler in the facial and the superficial temporal arteries could enter into the orbits and the globes on both sides. We demonstrated the existence of an embolic channel connecting the arterial system of the face to the ophthalmic artery. After the removal of the ocular contents from both eyes, liquid dye was injected into the cannulated channel of the superficial temporal artery in six soft embalmed cadavers and different color dye was injected into the facial artery on both sides successively. The interior sclera was monitored for dye oozing from retrograde ophthalmic perfusion. Among all 12 globes, dye injections from the 12 superficial temporal arteries entered ipsilateral globes in three and the contralateral globe in two arteries. Dye from the facial artery was infused into five ipsilateral globes and in three contralateral globes. Dye injections of two facial arteries in the same cadaver resulted in bilateral globe staining but those of the superficial temporal arteries did not. Direct communications between the same and different arteries of the four cannulated arteries were evidenced by dye dripping from the cannulating needle hubs in 14 of 24 injected arteries. Compression of the orbital rim at the superior nasal corner retarded ocular infusion in 11 of 14 arterial injections. Under some specific conditions favoring embolism, persistent interarterial anastomoses between the face and the eye allowed filler emboli to flow into the globe causing ocular complications.

The Human Myocardial Stain as Mitigated by Coronary Collaterals

If the human coronary artery tree were an end-arterial system, ie, one without interarterial anastomoses, as stated in 1881 by Cohnheim et al on the basis of canine studies,1 permanent total upstream occlusion of an epicardial branch would invariably result in the necrosis of the downstream myocardium. So far, data from less historical works have, however, indicated an absence of myocardial infarction in 50% of patients with chronic coronary artery occlusion.2 One of the concluding remarks of the study by Choi and coworkers3 published in the present issue of Circulation is that “most patients with chronic coronary artery occlusions show evidence of prior myocardial infarction.” Are we on the way back to Cohnheim’s paradigm? Maybe not, because Choi et al3 reassure the reader that it is the presence of coronary collaterals that mitigates the transmural extent of myocardial scar and regional wall-motion abnormalities (Figure 1). Figure 1. Chronic total occlusion of the proximal left anterior descending coronary artery (LAD; arrow ) with a normal left ventricular angiogram ( upper panels ). Contrast injection into the right coronary artery (RCA) of the same patient shows complete retrograde filling of the LAD via a branch collateral artery ( white arrow ) up to the proximal occlusion site ( lower panel ). Article see p 703 Moliere’s “imaginary invalid” ( Le Malade Imaginaire , 1673, a 3-act comedie-ballet) may challenge psychiatrists, but the gradual extinction of the “imaginary sane” by new “evidence,” that is, increasingly sensitive diagnostic tools, could pose similar problems. “Most” in the above-quoted sentence is equal to not quite the 100% as ordered by Cohnheim but rather to 86%, which could be reasonably translated to “most” only if the study accounted for all patients with chronic coronary artery occlusion. However, the “imaginary sane” with stained myocardium not admitted to a hospital because of well-being …

Assessment of the Human Coronary Collateral Circulation

Cardiovascular disease is the leading cause of death in industrialized countries and may become the most important reason for mortality worldwide.1 In patients suffering from coronary artery disease (CAD), the size of myocardial infarction mainly determines outcome.2 Accordingly, the primary strategy to reduce cardiovascular mortality is by shrinking infarct size (IS) (Figure 1A).3 In the clinical setting of acute myocardial infarction, Antoniucci et al4,5 documented in 1164 patients undergoing primary percutaneous coronary intervention (PCI) that the presence of angiographic collaterals before PCI purported a survival benefit compared with the situation without them (Figure 2). As a surrogate for IS, studies on the effect of myocardial salvage procedures have employed the magnitude of ECG ST-segment elevation during coronary balloon occlusion (Figure 3).6,7 IS, measured as the degree of ECG ST-segment elevation during a 1-minute coronary occlusion, is influenced by the following factors: duration of occlusion, ischemic area at risk for myocardial infarction (AR), collateral blood supply to the ischemic zone, ischemic preconditioning, and myocardial oxygen consumption.8 In the context of a single brief artificial coronary occlusion of uniform duration without preceding bouts of ischemia (Figure 3),6 ECG signs of ischemia are influenced predominantly by the AR and by collateral supply to this region. Furthermore, Figure 1B3 illustrates that AR and collateral supply are inversely related to each other (ie, AR tends to shrink toward zero in the presence of well-functioning collaterals). They are termed sufficient if they prevent an ECG ST-segment elevation of ≥0.1 mV during a 1-minute coronary balloon occlusion; otherwise, they are termed insufficient collaterals. Figure 1. Schematic drawing of the coronary artery circulation without (A) and with interarterial anastomoses (B) between the right coronary artery and the occluded left anterior descending artery (occluded downstream …

Physiological importance of the coronary arterial blood supply to the rattlesnake heart

The reptilian heart consists of a thick inner spongy myocardium that derives its oxygen and nutrient supply directly from the blood within the ventricular cavity, which is surrounded by a thin outer compact layer supplied by coronary arteries. The functional importance of these coronary arteries remains unknown. In the present study we investigate the effects of permanent coronary artery occlusion in the South American rattlesnake (Crotalus durissus) on the ability to maintain heart rate and blood pressure at rest and during short term activity. We used colored silicone rubber (Microfil) to identify the coronary artery distribution and interarterial anastomoses. The coronary circulation was occluded and the snakes were then kept for 4 days at 30 degrees C. Microfil injections verified that virtually all coronary arteries had successfully been occluded, but also made visible an extensive coronary supply to the outer compact layer in untreated snakes. Electrocardiogram (ECG), blood pressure (Psys) and heart rate (fH) were measured at rest and during enforced activity at day 1 and 4. Four days after occlusion of the coronary circulation, the snakes could still maintain a Psys and fH of 5.2+/-0.2 kPa and 58.2+/-2.2 beats min(-1), respectively, during activity and the ECG was not affected. This was not different from sham-operated snakes. Thus, while the outer compact layer of the rattlesnake heart clearly has an extensive coronary supply, rattlesnakes sustain a high blood pressure and heart rate during activity without coronary artery blood supply.

Vascularização arterial da região do nó sinoatrial em corações suínos: origem, distribuição e quantificação

O nó sinoatrial, por se encontrar topograficamente instalado como componente inicial do sistema de condução, é responsável pela geração dos impulsos nervosos determinantes da contração cardíaca. Estudos relacionados à morfologia do nó, visando conhecer a origem, trajeto e distribuição dos vasos neste tecido são conhecidos, contudo, no que diz respeito a estes aspectos e aos dados quantitativos da irrigação nodal, no que se refere ao comportamento vascular arterial e a densidade vascular arterial desta região, a literatura é escassa. Com este objetivo foram utilizados 30 corações de suínos SRD, sendo 27 injetados com resina vinílica corada, para análise da origem e trajeto da ANSA (artéria do nó sinoatrial) e 3 corações injetados com solução aquosa de carvão coloidal (tinta nanquim) para proceder à análise estereológica. As artérias atriais originaram-se tanto da artéria coronária direita quanto da esquerda, com predominância da primeira (66,66% e 33,33%, respectivamente). Quando originada da coronária direita, a irrigação ocorreu pelo ramo AADAM (artéria atrial direita cranial medial) em 14 casos e pelos ramos AADAI (artéria atrial direita cranial medial) em 2 casos e AADAL (artéria atrial direita cranial lateral) em 2 casos. Em 9 casos (33,33%) originou-se pela artéria coronária esquerda: quatro pelo ramo AASPL (artéria atrial esquerda caudal lateral), dois pelo ramo AASAI (artéria atrial esquerda cranial intermédia) e três pelo ramo AASAM (artéria atrial esquerda cranial medial). Anastomoses interarteriais, com participação dos vasos responsáveis pela irrigação do território do nó sinoatrial foram observadas na maioria dos casos (25 corações). O Volume do órgão ou Volume Referência (V(ref)) foi de 35,32x10(4)µm³. Para as variáveis estereológicas analisadas, a estimação da densidade de comprimento do vaso (Lv) foi de 766; o comprimento do vaso (L) - mm - foi de 27,06x10(5)µm; a densidade de superfície de área (Sv) foi de 182 e a superfície de área (S) - mm² - foi de 64,3x10(6)µm². A estimação da densidade numérica vascular (Nv(vasc)), quantidade de vasos por unidade de volume (cm³), foi de 2,19 10-5 e o número total de vasos no órgão (N(vasc)), estimado pelo método dissector físico em combinação com a estimativa do número de Euler (Xv), foi de 773,6832 x10-2. A elevada densidade vascular e do número total de vasos na região do nó sinoatrial de suínos sugere a existência de uma complexa e densa rede vascular perinodal, ratificando a importância deste marca-passo pelo seu suprimento sangüíneo.

Use of corrosion casting techniques to evaluate coronary collateral vessels and anastomoses in hearts of canine cadavers

To study and investigate branching patterns of the canine coronary arteries and collateral circulation by use of corrosion casting techniques. 31 hearts obtained from cadavers of clinically normal dogs of various ages and breeds and of either sex. 3-dimensional reproduction of coronary arteries was achieved by postmortem injection and perfusion with casting materials into the aortic sinus via the ascending aorta. Perfused hearts were macerated and carefully irrigated; the air-dried specimens were examined macroscopically and with a magnifying headset. Collateral arteries and inter- and intra-arterial anastomoses were successfully detected in 8 corrosion cast specimens. In total, 9 coronary collateral arteries and 3 interarterial anastomoses were found. Our finding of coronary collateral arteries in canine hearts is in agreement with recent findings in coronary flow study. On the basis of our results, vasodilation treatment to improve collateral vessel remodeling in dogs with myocardial dysfunction may be warranted.

Branchial vascular pathways in two species of Tetraodontiformes and the concept of secondary vessels and nutrient arteries

The vascular organisation of the branchial basket was examined in two Tetraodontiform fishes; the three-barred porcupinefish, Dicotylichthys punctulatus and the banded toadfish, Marylina pleurosticta by scanning electron microscopy of vascular casts and standard histological approaches. In D. punctulatus, interarterial anastomoses (iaas) originated at high densities from the efferent filamental and branchial arteries, subsequently re-anastomosing to form progressively larger secondary vessels. Small branches of this system entered the filament body, where it was interspersed between the intrafilamental vessels. Large-bore secondary vessels ran parallel with the efferent branchial arteries, and were found to constitute an additional arterio–arterial pathway, in that these vessels exited the branchial basket in company with the mandibular, the carotid and the afferent and efferent branchial arteries, from where they gave rise to capillary beds after exit. Secondary vessels were not found to supply filament muscle; rather these tissues were supplied by single specialised vessels running in parallel between the efferent and afferent branchial arteries in both species examined. Although the branchial vascular anatomy was generally fairly similar for the two species examined, iaas were not found to originate from any branchial component in the banded toadfish, M. pleurosticta, which instead showed a moderate frequency of iaas on other vessels in the cephalic region. It is proposed that four independent vascular pathways may be present within the teleostean gill filament, the conventional arterio–arterial pathway across the respiratory lamellae; an arterio–arterial system of secondary vessels supplying the filament and non-branchial tissues; a system of vessels supplying the filament musculature; and the intrafilamental vessels (central venous sinus). The present study demonstrates that phylogenetic differences in the arrangement of the branchial vascular system occur between species of the same taxon.

The secondary vascular system of Actinopterygii: interspecific variation in origins and investment

Vascular casts of 3 species of Chondrichthyes, 1 of Dipnoi, 1 of Chondrostei and 14 species of the Teleostei were examined by light and scanning electron microscopy in order to give a qualitative and quantitative analysis of interarterial anastomoses (iaas) that indicate the presence (or absence) of a secondary vascular system (SVS). Anastomoses were found to originate from a variety of different primary blood vessels, many of which have not been previously identified as giving rise to secondary vessels. Segmental arteries derived from the dorsal aorta and supplying body musculature were major sites of origin of the SVS, although there was considerable variation in where, in the hierarchy of arterial branching, the anastomoses occurred. The degree of investment in a SVS was species specific, with more active species having a higher degree of secondary vascularisation. This difference was quantified using an absolute count of iaas between Anguilla reinhardtii and Trachinotus baillonii. A range of general features of the SVS is also described. No evidence of iaas was found on the coeliac, mesenteric or renal circulation in any species. Evidence of iaas was lacking in the dipnoan and chondrichthyan species examined, suggesting that a SVS is restricted to Actinopterygii. The presence and distribution of a SVS does not appear to be exclusively linked to phylogenetic position, but rather to the physiological adaptation of the species.

Arterial and venous vasculature of the heart of the beluga whale (Delphinapterus leucas).

The arteries and veins of the heart of the beluga whale (Delphinapterus leucas) are described from the dissection of nine specimens. The arterial distribution is composed of the basic mammalian pattern of two major vessels, the left and right coronary arteries, which supply the cardiac tissue. The venous drainage is provided by three major systems which are the great, middle, and small cardiac veins. The vascular characteristics of the heart of the beluga whale are the marked sinuosity of both coronary arteries and their main branches, the numerous large interarterial anastomoses between major vessels, and the duplication of vessels in parallel branches. These characteristics are discussed in functional terms and correlated with the diving ability of the species.

Intrarenal localized renorenal collaterals in dogs after ligation of the principal arterial branch

In 7 kidneys of 6 dogs one of the main stem of the renal artery was ligated. The development of the renorenal collaterals could be followed in 5, as two dogs died after the operation. In all cases intrarenal collaterals could be demonstrated, even in the postoperative dead dogs. The vessels responsible for the collateral circulation are performed interarterial anastomoses, belonging to the extra-glomerular arterial system. From the results of these and former experimental studies it can be concluded, that the renal artery of the dog when entering the renal sinus cannot be regarded as an anatomic, but at most as a functional end artery.

The microsurgical anterior interhemispheric approach suitably applied to ruptured aneurysms of the anterior communicating artery in the acute stage.

From 1973 to 1980, 177 cases with ruptured aneurysms of the anterior communicating artery (Aco) have been operated on using various microsurgical procedures. Since 1974, 136 cases were directly operated on using the microsurgical anterior interhemispheric (AIH) approach: a modification of Lougheed's approach. The overall mortality was 5%. The early operations, within 1 week of onset of subarachnoid haemorrhage had a 3% mortality in grade 1 and 2 patients; a 16% mortality in grade 3 and 4 and a 25% mortality in grade 5 patients. The rate of cases in which the patient was independent following surgery was 92% in grade 1 and 2 patients, 47% in grade 3 and 4, and 25% in grade 5 in the same group. The AIH approach for severe cases in the acute stage has the following benefits: 1. The retraction pressure on the brain in the AIH approach is half as much as that in Yaşargil's approach. The aneurysms can be operated on with less retraction of the brain and thus without damaging the brain, olfactory nerves, bridging veins, hypothalamic arteries and other perforating arteries. 2. Various types of aneurysms, whatever their position, especially those located high and in a posterior direction, can be easily clipped. 3. Adequate removal of clots can be achieved from the interhemispheric fissure, the chiasmatic and the prepontine cisterns and the frontal lobe. 4. Interarterial anastomosis between both anterior cerebral arteries can be applied if necessary to allow easy clipping on unusual aneurysms. 5. Temporary occlusion of A1's and A2's and external decompression can be easily done if necessary.

Fluorescein angiography of the choroid with elevated intraocular pressure (author's transl)

Artificially induced increases in intraocular pressure slow the influx of dye during fluorescein angiography sufficiently to permit a sparation in time of the filling of the retina and the choroidea. During the filling of the choroidea segmental filling patterns appear in the form of lobules: the size of these wes determined. Interarterial anastomoses between ciliar arteries were also demonstrated. The clarity of the photographs was enhanced by computer-assisted image evaluation.

The coronary collateral circulation: Determinants and functional significance in ischemic heart disease

Richard Lower is given credit for having first postulated the existence of coronary collaterals or coronary interarterial anastomoses in 1869. Long after, the work of Spalteholz (1907), Gross (1921), James (1961), and Fulton (1965) combined to confirm their existence.’ Since then, a great deal has been thought, spoken, and published about coronary collaterals, but significantly less has been incontrovertibly demonstrated or proven. This presentation considers what is currently known and what is postulated with respect to the coronary collateral circulation. The specific questions addressed include: (1) the mode of growth and development and the anatomic distribution of coronary collaterals (when and where they are present and absent); (2) the role of physical exercise in the development of coronary collateralization; (3) functional efficacy of coronary collaterals (with respect to relief of myocardial ischemia, frequency of left ventricular (LV) dysfunction, myocardial infarction (MI), cardiac arrhythmias, and both sudden and nonsudden coronary death; (4) the relationship between nature’s coronary bypasses (collaterals) and man-made coronary bypasses (surgical grafts)-which are more effective? Do the former obviate the latter? What is the fate of the former following placement of the latter? and; (5) the question of our ability to pharmacologically or mechanically influence the function of coronary collaterals.

Superficial anastomoses of blood vessels in the human heart

We investigated superficial interarterial, intra-arterial, arterio-venous and veno-venous anastomoses in 100 hearts from men and women taken at random who died at 20-85 years of age. By means of careful dissection and injection into the blood vessels of a differently stained 12% solution of vinilit in acetone, we studied the number and localization of the anastomoses and their appearance. Interarterial anastomoses, i.e. anastomoses between the ramification of the left and the right coronary artery, were detected in 33 hearts. Intra-arterial anastomoses, i.e. anastomoses between the ramifications of one and the same artery, were seen in 5 hearts. Arterio-venous anastomoses were found in 39 hearts. Veno-venous anostomoses were found in 49 hearts. The veno-venous anastomoses display a great many variations, being commonly the regular finding in human veins.

Ipsi-and contralateral anastomosis of the uterine arteries.

&lt;i&gt;In vitro &lt;/i&gt;perfusion technique and plastic cast injection methods were utilized to study the ipsi- and contralateral anastomosis of the human uterine arteries. The perfusion method repeatedly illustrated the abundant contralateral communications around the cervical region of the uterus. Superficial contralateral anastomosis within the peritoneal coverings was observed in the fundic region of the uterus. Any other myometrial midline crossing of vessels was not reproducible probably due to the specific distortion caused by the leiomyomas of these operatively excised specimens. The plastic cast technique succeeded in mapping out the three-dimensional arterial tree of the uterus. With simultaneous injection into the right and left uterine arteries, and using differently colored plastic on each side, the two-color plastic junction points appeared in the midsagittal plane, and the interarterial anastomosis was clearly visible throughout the entire length of the uterus. This technique exhibited many arterioles traversing into the contralateral side. Furthermore, an extremely dense capillary network with contralateral anastomosis was apparent and distributed according to the multiple-layer organization of the myometrium. Postmenopausal uteri elicited a paramedial arteriole zigzagging across the midline of the posterior wall of the uterus. This type of arteriole was not observed in this study in any of the uteri of females of childbearing age.