Origin Of Vessels Research Articles

To the anatomy and treatment of ectopic pregnancy

Regarding the vessels, my research yielded results similar to those obtained by other researchers. The vessels of the cellular layer are of particular interest, in particular those of them that, having a large caliber, have only an endothelial membrane (capillaries) or even lack any membrane (Blutlacnnen ѵ. Tussenbroek). The opinions of the authors differ as to the origin of these vessels from arteries or veins, due to the loss of the membranes and their expansion. Dobbert recognizes their origin in arteries, similar to the pregnant uterus and tube. Tussenbroek found that the arteries in the decidua retained their structure, and their branches, without loss of muscle membrane and expansion, came close to the surface. Therefore, she considers the veins to be the source of these vessels. As for my case, I found in the cell layer, in addition to capillaries and blood cavities without a trace of membranes, also branches of arteries with an extremely thin connective tissue membrane, which was especially striking when compared with the membranes of the arteries of the glandular layer. Therefore, I am inclined to recognize the origin of these blood vessels from the branches of the arteries, due to the loss of the membranes and their successive expansion. Thus, we find here a process analogous to that which occurs in decidua serotina during normal pregnancy, as proven by Waldeyer's work, Bohr's, Hofteier's, Gottschalk's and others. The presence of such blood cavities, devoid of their own wall, is the second characteristic feature of deciduae uteriuae during ectopic pregnancy.

Perioperative Neurologic Outcomes of Right Versus Left Upper Extremity Access for Fenestrated-Branched Endovascular Aortic Repair

Upper extremity (UE) access is frequently used for fenestrated-branched endovascular aortic repair (F-BEVAR), particularly for complex repairs. Traditionally, left-side UE access has been used to avoid crossing the arch and the origin of the supra-aortic vessels, which could potentially result in cerebral embolization and an increased risk of perioperative cerebrovascular events. More recently, right UE has been more frequently used as it is more convenient and ergonomic. The purpose of this study was to assess the outcomes and cerebrovascular events after F-BEVAR with the use of right versus left-side UE access. During an 8-year period, 453 patients (71% male) underwent F-BEVAR at a single institution. UE access was used in more complex repairs. Left UE access was favored in the past, whereas right UE access is currently the preferred UE access side. Brachial artery cutdown was used in all patients for the placement of a 12F sheath. Outcomes were compared between patients undergoing right versus left UE access. End points included cerebrovascular events, perioperative mortality, technical success, and local access-related complications. UE access was used in 355 (88%) patients. The right-side was used in 232 (65%) and the left-side in 123 (35%) patients for the treatment of 84 (24%) juxtarenal, 135 (38%) suprarenal and 148 (38%) thoracoabdominal aortic aneurysms. Most procedures were elective (94%). Technical success was achieved in 348 patients (98%). In-patient or 30-day mortality was 3%. Five (1.4%) perioperative strokes occurred in patients undergoing right UE access, of which two were ischemic and three were hemorrhagic. No transient ischemic attacks occurred perioperatively. Two hemorrhagic strokes were associated to permissive hypertension to prevent spinal cord ischemia. No perioperative strokes occurred in patients undergoing left UE access (P = .17). Overall, perioperative strokes occurred with similar frequency in patients undergoing UE (5 [1.4%]) and femoral access only (1 [1%]). Arm access related complications occurred in 15 (5%) patients, 11 (3.8%) on the right-side and 4 (6%) on the left-side (P = .5). Right UE access can be used for F-BEVAR with low morbidity and minimal risk of perioperative ischemic stroke or transient ischemic attacks. In general, UE access is not associated with an increased risk of perioperative stroke compared with femoral access only. Tight blood pressure control is, however, critical to avoid intracranial bleeding related to uncontrolled hypertension.

Подарок вождю: римская амфора с клеймом Сестия из ГМИИ

The amphorae collection of the Pushkin State Museum of Fine Arts (SMFA) stores the rarest for the Black Sea region sample of Roman amphora of the first half of the 1st century BC with the Latin stamp SES “anchor”. Judging by the presence of traces of marine mollusks on the outer surface, the vessel comes from the sea. Under the act of transfer the amphora was received in the Pushkin State Museum of Fine Arts from the Kremlin Museums in 1965. The stamp makes it possible to confidently define the vessels origin from the workshops of the Roman colony Cosa (modern Tuscany territory), which belonged to the famous plebeian Sestius family, who Cicero corresponded with. Additionally, it has been suggested that the amphora may originate from the famous Grand Congloue shipwreck near Marseille, explored in the post-war period by J.I. Cousteau.

VEGF-B Promotes Endocardium-Derived Coronary Vessel Development and Cardiac Regeneration

Recent discoveries have indicated that, in the developing heart, sinus venosus and endocardium provide major sources of endothelium for coronary vessel growth that supports the expanding myocardium. Here we set out to study the origin of the coronary vessels that develop in response to vascular endothelial growth factor B (VEGF-B) in the heart and the effect of VEGF-B on recovery from myocardial infarction. We used mice and rats expressing a VEGF-B transgene, VEGF-B-gene-deleted mice and rats, apelin-CreERT, and natriuretic peptide receptor 3-CreERT recombinase-mediated genetic cell lineage tracing and viral vector-mediated VEGF-B gene transfer in adult mice. Left anterior descending coronary vessel ligation was performed, and 5-ethynyl-2'-deoxyuridine-mediated proliferating cell cycle labeling; flow cytometry; histological, immunohistochemical, and biochemical methods; single-cell RNA sequencing and subsequent bioinformatic analysis; microcomputed tomography; and fluorescent- and tracer-mediated vascular perfusion imaging analyses were used to study the development and function of the VEGF-B-induced vessels in the heart. We show that cardiomyocyte overexpression of VEGF-B in mice and rats during development promotes the growth of novel vessels that originate directly from the cardiac ventricles and maintain connection with the coronary vessels in subendocardial myocardium. In adult mice, endothelial proliferation induced by VEGF-B gene transfer was located predominantly in the subendocardial coronary vessels. Furthermore, VEGF-B gene transduction before or concomitantly with ligation of the left anterior descending coronary artery promoted endocardium-derived vessel development into the myocardium and improved cardiac tissue remodeling and cardiac function. The myocardial VEGF-B transgene promotes the formation of endocardium-derived coronary vessels during development, endothelial proliferation in subendocardial myocardium in adult mice, and structural and functional rescue of cardiac tissue after myocardial infarction. VEGF-B could provide a new therapeutic strategy for cardiac neovascularization after coronary occlusion to rescue the most vulnerable myocardial tissue.

Centralized power/decentralized production? Angkorian stoneware and the southern production complex of Cheung Ek, Cambodia

In this paper we highlight the potential of compositional characterisation (NAA) of Khmer stonewares for understanding regional economic development in the Angkorian Empire (c. 9 th −15 th c CE). A central feature of the Angkorian economy was the precocious development of sophisticated craft industries. Of the multiple crafts produced in this empire, stoneware production stands out for two reasons: empire transport networks closely articulated with the location of stoneware production complexes best known in central Angkor and on the Khorat plateau northwest of Angkor; and distribution/consumption patterns of Angkorian stoneware map directly onto the empire's geopolitical extent. As part of a larger geochemical provenancing project concerned with Khmer stoneware production and exchange, we present and discuss results for Cheung Ek, a southern Cambodian provincial complex for production of both stoneware and earthenware. The similarities (shared local resources) and differences in the organization of local production are striking between stoneware and earthenware production. Comparison with previously published Khmer stoneware kiln complexes confirms that each has a unique and readily identifiable geochemical profile. By establishing a geochemical baseline this work highlights the potential of stonewares for developing a deeper understanding of Khmer craft production and distribution dynamics in future comparisons between stoneware production, Khmer settlement and ritual contexts. This elemental baseline will also enable future evaluation of the potential discriminating power of other, field deployable but less sensitive non-destructive analytic techniques such as pXRF and pLIBS, particularly in relation to extending this work to checking production origins of complete Khmer stoneware vessels held in museum collections.

Abstract 15360: Coronary Artery Dominance, Anatomical Variants and Anomalies in African American Population

Introduction: Coronary arterial dominance is defined by the vessel which gives rise to the posterior descending artery (PDA). The prevalence of right dominance is 80- 85%, left dominance is 8% and codominance is 7% among the general population. The coronary dominance in African Americans is not well known. The aim of this study was to investigate the coronary dominance in African Americans. Previous studies showed that left dominance and codominance are associated with increased post-percutaneous coronary intervention (PCI) in-hospital mortality in patients with acute coronary syndrome (ACS). Methods: A retrospective analysis of coronary angiograms performed in our facility was done. A total of 556 cases were reviewed from 2018 to 2019. All the data was collected from the electronic medical records. Patients were categorized by race, gender, age, and comorbidities. Angiograms were reviewed and coronary dominance was determined by the vessel which supplied the PDA. Results: From the 556 charts reviewed, 430(77%) cases were performed in African Americans. Of the 430 patients, 220(51%) were male and 210(49%) were female. Mean age was 62.6 years. 370(86%) patients had hypertension, 171(39.7%) had diabetes, 28(6.5%) had peripheral vascular disease, 149(34.6%) had heart failure, 33(7.6%) had history of stroke. 28(6.5%) were on dialysis, 201(46.7%) had dyslipidemia, 14(3.2%) had HIV, 43 (10%) had atrial arrhythmias, 237(55.1%) had history of tobacco use and 21(4.8%) had history of cocaine use. In 390(90.7%) patients, left main coronary artery bifurcated into left anterior descending coronary artery (LAD) and left circumflex artery (LCX). In 40(9.3%) patients, left main coronary artery trifurcated into LAD, LCX and ramus intermedius artery. Among these patients, 303(70.4%) had right coronary dominance, 38(8.8%) had left coronary dominance and 89(20.7%) had codominance. 7 patients had ectasia of the coronary vessels and 8 patients had anomalous origin of coronary vessels. Conclusions: Our study showed that African Americans have higher prevalence of codominance compared to general population. It is important to identify it at the time of coronary angiogram since it has been associated with increased post PCI in-hospital mortality in patients with ACS.

English

BACKGROUND Variations in origin, course and distribution of renal blood vessels are frequent observations. The aim of this study was to observe the pattern of posterior segmental renal artery by corrosion cast method. METHODS Thirty pairs of kidneys were collected from cadavers in anatomy department of Subharti Medical College, Meerut. Corrosion casts of renal arteries were prepared by infusing cellulose acetate butyrate solution through abdominal aorta. They were macerated in conc. hydrochloric acid. Origin, course and distribution of the posterior segmental artery were studied. RESULTS Renal posterior segmental artery most frequently originated as a continuation of the posterior division (93 %). It has no anastomosis with nearby segmental arteries. CONCLUSIONS Posterior segmental artery supplies posterior segment of kidney and may also frequently give origin to apical segmental artery. This study of origin, course, distribution and variations of renal posterior segmental artery will be useful for surgical and radiological practice. KEYWORDS Kidneys, Renal Artery, Anterior Division, Posterior Division, Posterior Segmental Artery, Abdominal Aorta, Corrosion Casts

Descriptive anatomy of the inferior epigastric, subscapular and internal thoracic vascular pedicles in three domestic mammals: A comparative study

The descriptive anatomy of the inferior epigastric, subscapular and internal thoracic vascular pedicles of domestic animals is not fully known. Improvement of our knowledge in this field could lead to better development of animal models for both pedagogical purposes and surgical experimentation. The objective of this comparative study was to describe the descriptive anatomy of the inferior epigastric, subscapular and internal thoracic pedicles in three domestic mammals commonly used as animal models for experimentation. Our study focuses on the anatomical description of these vascular pedicles in the rat (Rattus norvegicus) (n=1), the rabbit (Oryctolagus cuniculus) (n=1) and the pig (Sus scrofa domesticus) (n=1). A comparative and analytical study of these vessels (origin, path, caliber, termination) with those of humans was carried out. The superficial inferior epigastric vascular pedicles have been identified only in rats and pigs. The deep inferior epigastric, subscapular and internal thoracic pedicles were identified in the three mammals studied. No perforator vessels for the subcutaneous tissue and skin were identify from the deep inferior epigastric pedicles. The anatomical characteristics (origin, path, termination) of these vascular pedicles in rabbits seems to be the closest to that of humans. However the caliber of these vessels is around a millimeter compared to a 2.0-3.0mm in humans. This comparative study allowed us to identify and better characterize the morphological characteristics of these vascular pedicles in three domestic mammals, a step prior improving the development of animal models intended for pedagogical or experimental purposes in the field of microsurgical free flaps.

CME versus D3 Dissection for Colon Cancer.

Over the past 30 years, rectal cancer surgery has been standardized by total mesorectal excision. More recently, some have suggested that colon cancer surgery should be standardized by complete mesocolic excision (CME) with central vascular ligation (CVL), especially in Western countries. Surgeons undertaking CME with CVL report optimal outcomes. Sharp dissection within the embryological plane and high vascular ligation at the vessel origin are essential. In Japan, a similar concept, D3 dissection, has been adopted for decades. Although both surgical procedures are similar, distinct differences exist. Some surgeons are confused about the principles and practice of these two procedures. As well as overviewing the theory behind CME with CVL and D3 dissection, the technical details of both procedures are described.

Characteristics of the Superficial Circumflex Iliac Artery Perforator Flap in a Western Population and a Practice Approach for Free Flap Reconstruction.

There has been increasing interest in the superficial circumflex iliac artery perforator (SCIP) flap as a source of thin, pliable soft tissue combined with a favorable donor site. Despite several clinical series from Asia, barriers to adoption include reluctance to perform submillimeter "supermicrosurgery" and the effect of body habitus on flap feasibility. The purpose of this study is to distinguish vascular anatomic characteristics of the SCIP flap in a North American population. Computed tomography angiography was examined in 84 flaps in healthy prospective renal donor patients from a radiographic database. Descriptive statistics as well as linear regression comparing variables to body mass index (BMI) were performed. Mean BMI was 27.1 ± 3.5 kg/m2, while the mean patient age was 47.8 ± 11.4 years. The superficial circumflex iliac artery (SCIA) originated from the common femoral artery in 92% cases, with remainder originating from the profunda femoris. The mean vessel diameter was 1.85 mm at source vessel origin. Distance from skin to source vessel averaged 30.7 mm. Suprascarpal subcutaneous thickness averaged 16.5 mm. The mean distance from Scarpa's fascia to vessel origin was 14.1 mm. Direct three-dimensional distance from vessel origin to pubic tubercle was 50.2 mm. A medial and lateral perforator split off of the SCIA was observed in 38 cases (45%). Significant differences were shown when comparing BMI to skin to source vessel distance (p < 0.001), suprascarpal subcutaneous fat thickness (p < 0.001), and fascial distance to vessel origin (p < 0.001). BMI did not significantly affect vessel diameter. Despite a significantly higher BMI than many previously published cohorts, the SCIP remains an excellent source of thin and pliable tissue. When dissected closer to the source vessel, a vessel caliber of nearly 2 mm can be achieved, which may obviate the need for "supermicrosurgery" in this population.

VP63.23: Endometrial carcinoma in a young female

Endometrial carcinoma (EC) is rare in a young woman with abnormal uterine bleeding. EC is the 3rd most common gynecological cancer and is a disease of postmenopausal women. It is relatively rare in the young reproductive age group (2.1–14.4%). Risk factors are nulliparity, irregular menstruation, diabetes & polycystic ovarian syndrome. A 22-year-old, nulligravid with BMI of 34 kg/m2, consulted due to menorrhagia. Transrectal ultrasound revealed a thickened endometrium (23mm), non-uniform with irregular cystic areas. There was irregular, heterogeneous lesion with largest diameter measuring 3.66cm within the cavity with irregular EMJ with focal disruption at the anterofundal aspect with a colour score of 4 of multifocal origin. A consideration of endometrial pathology was diagnosed with polycystic ovaries. Histopathologic diagnosis revealed endometrial endometrioid adenocarcinoma, FIGO 2. The IETA described endometrioid tumours as having a larger size of tumour, EMJ that is irregular, non-uniform echogenicity and has high colour score with multiple vessels of focal origin. A study of Valentin stated the presence of irregular echogenicity of the endometrium, irregularly branching vessels at power Doppler increases the risk of malignancy. The tumour size appeared to be the single strongest ultrasound predictor of high risk disease. In our case, the sonographic description of the lesion points out to an endometrioid tumour. In a study done by Fischerova, tumours <15mm had regular EMJ (37%) and hyperechoic echogenicity (42%), which are typical features of endometrial hyperplasia. A case of a rare EC in a young: pelvic ultrasound with IETA, has a sensitivity & specificity of 80% & 92% respectively which is significant in detecting endometrial pathologies based on greyscale & colour or power Doppler sonographic findings, hence one should be familiar with its terms and definitions to raise the clinician's awareness toward the appropriate diagnosis and treatment even in young women.

Variations of the Anatomy and Bony Landmarks of Deep Circumflex Iliac Artery in a Select Kenyan Population.

The deep circumflex iliac artery (DCIA) is a large caliber artery which branches laterally from the external iliac artery (EIA), directly opposite the origin of the inferior epigastric artery (IEA). Population variations have been reported in its origin, length, and branching patterns. These may alter its relationship to palpable surgical landmarks such as the anterior superior iliac spine (ASIS) and the pubic tubercle (PT) which are used to locate the artery preoperatively, thus predisposing it iatrogenic injury. Despite this, there is paucity of data from the Kenyan setting. Cross-sectional study design. To determine the variations of the anatomy and bony landmarks of the Deep circumflex iliac artery in a select Kenyan population. A total of 104 DCIA from 52 formalin fixed adult cadavers were dissected to expose the DCIA, following which its vessel of origin and distance from the ASIS and PT, relation to the inguinal ligament (IL), length and branching patterns were noted. The average of the measurements were calculated. All data were collected and analyzed using Microsoft Excel 2007 (Microsoft Corporation, Redmond, WA). Representative photos of the vessel and its variations were taken. The DCIA was found to be present and bilaterally symmetrical in all cadavers. In all cases observed, it originated as a lateral branch from the EIA (100%), opposite the IEA and directly behind the IL in 98% of the cases. Its average distance from the ASIS along the IL was 7.28 ± 0.99, while it was 5.91 ± 1.03 from the pubic tubercle to its origin. Its length ranged from 3.7 cm to 9.5 cm, with an average length of 3.86 cm in the right limb and 3.67 cm in the left limb. As regards its branching patterns, in 78% of the cases, it bifurcated into the horizontal and ascending branches, in 6%, it trifurcated and in 4%, it divided into more than 3, exhibiting a fine tree-like branching (arborization). The DCIA in our setting exhibited variations from other settings and an increase in awareness of these variations will probably reduce future iatrogenic lesions of the DCIA and its major branches in Kenya.

Distribution of Anterolateral Thigh Flap Perforator Vessels and Its Clinical Applications in Malaysian Population

Purpose: Extensive studies regarding vascular anatomy and clinical applications of anterolateral thigh (ALT) flap has been conducted for many years. However, the ALT flap perforator vessels anatomy in the Malaysian population is not well-analyzed. The purpose of this study was to determine the distribution of ALT flap perforator vessels and its clinical applications in reconstructive surgery.Methods: This is a retrospective cross-sectional study conducted in two main centers of reconstructive surgery. A total of 142 cases of ALT flaps that used as an option for soft tissue reconstruction was selected. Vascular anatomy of ALT flaps was studied precisely including the origin of vessels, location of perforators, and types of perforator vessels intraoperatively during the flap harvest.Results: The distribution of ALT flap perforator vessels can be found at three specific locations on the thigh namely perforators A, B, and C. The highest number of cutaneous perforator vessels that supplied the ALT flap was musculocutaneous perforator with 72.3%, and dominantly at perforators B and C. The remaining perforator vessels were septocutaneous perforator with 27.7%, presented mainly at perforator A. A majority of cases involved the reconstruction of wound defects following tumor resection and trauma. The most area of reconstruction was the lower limb with 33.8%.Conclusion: The distribution of ALT flap perforator vessels can be predicted during flap harvest and can be applied in numerous clinical applications for wound defect coverage. The knowledge regarding vascular anatomy of ALT flap perforator vessels can aid plastic surgeons in reconstructive surgery.

Roles of aryl hydrocarbon receptor in endothelial angiogenic responses†.

Aryl hydrocarbon receptor (AhR) is a transcription factor, which can be activated by a plethora of structure-diverse ligands. Historically, AhR is known for its involvements in regulation of metabolism of xenobiotics. However, normal physiological roles of AhR have been defined in other essential biological processes, including vascular growth and function, reproduction, and immunoresponses. In contrast, aberrant expression and activation of the AhR signaling pathway occur in a variety of human diseases, many of which (e.g., preeclampsia, atherosclerosis, and hypertension) could be associated with endothelial dysfunction. Indeed, emerging evidence has shown that either exogenous or endogenous AhR ligands can induce endothelial dysfunction in either an AhR-dependent or AhR-independent manner, possibly reliant on the blood vessel origin (artery and vein) of endothelial cells. Given that the AhR signaling pathway has broad impacts on endothelial and cardiovascular function, AhR ligands, AhR, and their downstream genes could be considered novel therapeutic targets for those endothelial-related diseases. This review will discuss the current knowledge of AhR's mediation on endothelial function and potential mechanisms underlying these actions with a focus on placental endothelial cells.

Illuminating dark fishing fleets in North Korea.

Illegal, unreported, and unregulated fishing threatens resource sustainability and equity. A major challenge with such activity is that most fishing vessels do not broadcast their positions and are "dark" in public monitoring systems. Combining four satellite technologies, we identify widespread illegal fishing by dark fleets in the waters between the Koreas, Japan, and Russia. We find >900 vessels of Chinese origin in 2017 and >700 in 2018 fished illegally in North Korean waters, catching an estimated amount of Todarodes pacificus approximating that of Japan and South Korea combined (>164,000 metric tons worth >$440 million). We further find ~3000 small-scale North Korean vessels fished, mostly illegally, in Russian waters. These results can inform independent oversight of transboundary fisheries and foreshadow a new era in satellite monitoring of fisheries.

Myocardial torsion and cardiac fulcrum

The development of the myocardial band shows that it starts and ends at the origin of the great vessels and that the myocardium joins to these rings but does not inserted into them. We always considered that there should be a fixed end of the muscle band that would allow it a helical rotation to fulfill its fundamental movements of shortening-torsion (systole) and elongation-distortion (suction). Seven young-bovine hearts (800-1000g) and seven human hearts (one embryo, 4g; one 10 years, 250g and five adult, 300g/average) were used for a detailed macrocoscopic and microscopic study. We have found in all the bovine and human hearts studied a nucleus underlying the right trigone, whose osseus, chondroid or tendinous histological structure depends on the specimen analyzed. The microscopic analysis revealed in the hearts a trabecular osteochondral matrix (fulcrum) with segmental lines in bovines and in the ten-year-old human. In the fetus, it was found pre-chondroid areas in a myxoid stroma. In the adult human hearts, the histological analysis revealed a matrix similar to that of a tendon. All the hearts studied presented myocardial attachment to the rigid structure of the fulcrum. Myocardiocytes were not found neither at the left or rigth trigonous nor at the base of the valves. The finding of the fulcrum gives support to the spiral myocardial band being the point of fixation that allows the helicoidal torsion.

Branch Vessel Patency after Thoracic Endovascular Aortic Repair for Type B Aortic Dissection

Thoracic endovascular aortic repair (TEVAR) for type B aortic dissections is used to promote false lumen (FL) thrombosis and favorable aortic remodeling, but its impact on occlusion of FL origin branch vessels has not been widely described. We compare FL versus true lumen (TL) branch vessel patency after TEVAR. Patients treated by TEVAR for type B aortic dissection in zones 2-5 in the Vascular Quality Initiative from 2009 to 2018 were evaluated. The primary outcome was postoperative branch patency. Secondary outcomes were need for branch vessel intervention, preoperative origin, and postoperative patency of individual branch vessels (celiac, superior mesenteric artery, renal arteries, and iliac arteries). A subset analysis was performed comparing acute and chronic dissections. Of 11,774 patients, 1,484 met criteria for analysis. The left renal was the most common to have FL origin (21.6%), whereas right and left common iliac arteries were the most likely to originate off both lumens (BLs; 22% and 24%). Branch vessels that originated from the TL, FL, BLs, or were obstructed had postoperative patency rates of 99%, 99%, 99%, and 87% (P<0.0001). Branch vessel treatment was performed in 5% of patients. The right (2.5%) and left (2.8%) renal arteries were the most frequently obstructed branches postoperatively. On multivariate analysis, preoperatively obstructed branches (odds ratio 0.03, P<0.0001) were negatively associated with postoperative branch patency and branch vessel treatment (odds ratio 3.8, P=0.004) was positively associated with postoperative patency. FL or BL origin, number of zones covered by TEVAR, urgency, dissection chronicity (acute versus chronic), and demographics were not independently associated with patency. These findings remained unchanged in the subset analysis of only acute dissections. Branch vessel patency rates after TEVAR for a type B aortic dissection are high and are not significantly different for FL or BL origin vessels compared with TL vessels. Branches that are patent before TEVAR almost always remain patent after TEVAR, but branch vessel stenting may be required in less than 5%.

Acute Blindness In An Athlete

TITLE: Acute Blindness in an Athlete PRESENTER: Sarah Abdellatif, DO HISTORY: A 24 yo weightlifter with a past medical history of mitral valve prolapse and Raynaud’s syndrome experienced sudden right eye blindness about one month ago after training at the gym. She finished her session at the gym that day with no issues. Once patient returned home, she decided to sit down and read for a bit when she suddenly lost vision of her right eye. She had no precipitating symptoms. Patient took an aspirin and her vision returned in about thirty minutes. She states that the image was slightly pixelated when it returned. Patient had never had anything like this happen before and had not happened again after that episode. PHYSICAL EXAMINATION: Height- 66 inches Weight- 112 pounds Blood Pressure- 132/76HEENT- Extraocular movements intact. Pupils equal and reactive to light.Neck- JVP normal, carotid pulses are full and equal bilaterally without bruitsCardiac- Regular rhythm and rate, S1 normal, S2 normal, so S3 or S4, no murmurs, no gallops, no rubs detectedPeripheral Pulses- Femoral, popliteal, dorsalis pedis, and posterior tibial pulses are full and equal bilaterally with no bruits auscultated.Neuro- Cranial nerves 2-12 intact. DIFFERENTIAL DIAGNOSIS: 1. Patent Foramen Ovale 2. Central Retinal Artery Occlusion 3. Carotid Stenosis 4. Hemiplegic Migraine 5. Multiple Sclerosis TEST AND RESULTS: Complete 2D Echocardiogram-- The left ventricular systolic function is normal with an estimated EF 60-64%.- Patent foramen ovale is seen with left to right shunting.- Qp:Qs ratio is 0.72.- There are no hemodynamically significant valvular abnormalities or insufficiencies noted on this study. FINAL/WORKING DIAGNOSIS: Large bidirectional shunting via patent foramen ovale with possible aborted central retinal artery occlusion stroke TREATMENT AND OUTCOMES: 1. Start aspirin and Plavix daily. 2. TEE and a cardiac CTA to include origin of great vessels and carotid arteries. 3. Check a seven day cardiac monitor. 4. Schedule for PFO closure once results return. Risks and benefits discussed, given patient’s level of activity. 5. Refer to stroke neurologist for multidisciplinary evaluation.

A case series: 3-dimensional computed tomographic study of the superior orbital vessels: Superior orbital arcades and their relationships with the supratrochlear artery and supraorbital artery

Vascularcomplications from periorbital intravascular filler injection are major safety concerns. To thoroughly describe the superior orbital vessels near the orbital rim and propose considerations for upper eyelid and forehead injections. Fifty-one cadaver heads were infused with lead oxide contrast media through the external carotid artery, internal carotid artery, and facial and superficial temporal arteries. Computed tomography (CT) images were obtained after contrast agent injection, and 3-dimensional CT scans were reconstructed by using a validated algorithm. Eighty-six qualified hemifaces clearly showed the origin, depth, and anastomoses of the superior orbital vessels, which consistently deployed 2 distinctive layers: deep and superficial. Of all hemifaces, 59.3% had deep superior orbital vessels near the orbital rim, including 44.2% with deep superior orbital arcades and 15.1% with deep superior orbital arteries, which originated from the ophthalmic artery. Additionally, 97.7% of the hemifaces had superficial superior orbital arcades, for which 4 origins were identified: ophthalmic artery, superior medial palpebral artery, angular artery, and anastomosis between the angular and ophthalmic arteries. The arterial depth estimated from 3-dimensional CT needs to be confirmed by standard cadaver dissection. This study elucidated novel arterial systems and proposed considerations for upper eyelid and forehead injections.

Laparoscopic Left Gastric Artery-Preserving Subtotal Gastrectomy with D2 Lymphadenectomy in a Patient with Gastric Cancer and a Replaced Left Hepatic Artery

Introduction: An aberrant left hepatic artery (aLHA) may be seen in 8%–15% of cases1,2 and a replaced LHA (rLHA) may be seen in ~2%–11% of cases.1,3 An aLHA and a rLHA assume significant importance during gastric resections. A preoperative assessment of this anatomy is particularly important in laparoscopic surgery because of loss of tactile feedback of the arterial pulsation within the lesser omentum. When present, the artery of origin should be preserved. This video demonstrates a gastric resection for cancer where a diligent review of imaging identified a rLHA arising from the left gastric artery (LGA). An LGA preserving radical gastrectomy, without compromising oncologic principles, was performed. Methods: A 54-year-old male patient presented with melena and he underwent an upper endoscopy and was found to have an antropyloric lesion. Biopsy showed adenocarcinoma. A contrast-enhanced CT scan showed the tumor, perigastric lymph nodes, and a rLHA arising from the LGA—Michel's Type 2 anatomy.4 A laparoscopic LGA preserving subtotal gastrectomy with D2 lymphadenectomy was planned. The patient was operated in the French position with five ports, which included a 10-mm umbilical camera port, and 5- and 12-mm left and right working ports, respectively, in the midclavicular line. Standard steps of a subtotal gastrectomy with D2 lymphadenectomy were followed with modification to preserve the LGA. After dividing the greater omentum from the transverse colon, all the tissues around the left and right gastroepiploic, common hepatic, right gastric, proper hepatic, celiac axis, and proximal splenic arteries were meticulously cleared to remove all the lymph nodes en bloc. The lesser omentum was incised and the rLHA was identified along with the LGA. The LGA was circumferentially cleared and the gastric branches divided to complete the en bloc lymphadenectomy. Results: The patient had an uneventful recovery. He was tolerating solids by postoperative day 5. His postoperative liver function tests were normal. He was discharged on the eighth postoperative day. The histopathology was moderately differentiated adenocarcinoma pT1bN0 with 0/32 lymph nodes positive. Conclusion: During a laparoscopic gastric resection, it is pertinent to look for vascular anomalies, including a rLHA in the preoperative imaging to prevent accidental injury. When present, the vessel of origin should be preserved. A laparoscopic LGA sparing radical gastrectomy is feasible without compromising the oncologic safety. No competing financial interests exist. Runtime of video: 9 mins 51 secs