Subscapular Artery Research Articles

Spontaneous hemopneumothorax causing life-threatening hemorrhage: a case report

BackgroundSpontaneous hemopneumothorax is a rare condition that can be life-threatening if not promptly diagnosed and treated. We report a case of early treatment with transcatheter arterial embolization and video-assisted thoracoscopic surgery.Case presentationA 19-year-old Japanese male was diagnosed with left pneumothorax and underwent chest tube drainage. A total of 10 hours after admission, the patient developed dyspnea, chest pain, and sudden massive bloody effusion. Contrast-enhanced computed tomography revealed contrast extravasation near the left lung apex, and spontaneous hemopneumothorax was diagnosed. Angiography revealed bleeding from a branch of the subscapular artery and transcatheter arterial embolization was performed. The patient underwent video-assisted thoracoscopic surgery and recovered uneventfully.ConclusionsAnesthesiologists involved in urgent surgeries must be aware that a patient with spontaneous pneumothorax can develop a hemopneumothorax, even when full lung expansion has been obtained following chest tube drainage, owing to latent aberrant artery disruption. Interprofessional team engagement is essential for spontaneous hemopneumothorax management.

Unusual Multiple and Bilateral Combinations of Arterial and Neural Variations in the Axillae of Single Cadaver

Nerve During the dissection of the axillae and upper limbs of an 80-year-old male donor, multiple vascular and neural variations were encountered. On the right side, the thoracoacromial artery and the lateral thoracic artery were absent. On the left side the subscapular artery was absent, and the posterior cord of the brachial plexus gave branch to two upper subscapular nerves and then divided into radial nerve and a common stem that branched into thoracodorsal nerve, lower subscapular nerve, nerves to teres major and minor muscles and the axillary nerve. Additionally, in the left arm there was a variant communication between the musculocutaneous nerve and the median nerve. Although the existence of these variations is well documented in the literature as individual entities or few combinations, the occurrence of such multiple variations in a single cadaver in a limited area of the body involving vessel and nerves is not common. A multitude of variations in a small area of the body such as this can be a source of diagnostic and imaging interpretation errors. Unpredictable iatrogenic injuries can also occur during various procedures in the area such as during preparation of muscle flap, mastectomy with axillary lymph node dissection, reconstructive and aesthetic plastic surgery of the breast and other clinical procedures including shoulder arthroplasty.

A Left Axillary Artery Variation: Case Report

Fetal abnormalities can cause axillary artery variations. Recognize and document of these variations are essential for surgeons performing interventional or diagnostic procedures for cardiovascular diseases. During routine dissection of an old female cadaver in the department of anatomy of Islamic Azad University, Tehran of Medical Sciences, we came across a variation in the branching pattern of the left axillary artery. The third part of the left axillary artery gave rise to a common trunk which was divided into the subscapular, lateral thoracic, posterior, and anterior circumflex humeral arteries.

An unusual relationship between the axillary artery and brachial plexus in a cross-breed dog cadaver: a proposal for revising the terminology for nerve loops

In the left axilla of a formalin-embalmed adult female cross-breed dog, an unusual course of the axillary artery in relation to the brachial plexus was noted. A part of the axillary artery after the origin of the subscapular artery coursed through the loop formed by the contributions of the caudal pectoral and lateral thoracic nerves and then between the median and ulnar nerves. Thus, the common trunk for the latter two nerves was missing. Instead, in the proximal brachium, they communicated with each other in both directions. A communicating branch between the cranial and caudal pectoral nerves forming a nerve loop, ansa pectoralis lacked the axillary artery and was instead traversed by the subscapular artery. This is a variation in the relationship between the axillary artery and brachial plexus in the domestic dog and has not been reported in the literature yet. The axillary artery entrapped by the contributions of the caudal and lateral thoracic nerves may be considered as a risk factor for the neuroarterial compressions with non-specific signs and should be taken into account both in surgery and imaging.

Entrapment of the Subscapular Artery between the Radial Nerve and the Posterior Wall of the Axilla: An Anatomical Variation with Clinical Significance

Objective. The subscapular artery vascularizes a substantial region of the thoracic wall, and the significance of its distribution is well depicted in the diversity of reconstructive procedures that rely on its blood supply. The aim of this study is to present an uncommon anatomical variation of the artery and discuss the clinical implications of its presence.
 Case Report. This case report depicts a rare variant of compression and the kinking of the subscapular artery by the radial nerve on the posterior wall of the axilla that was encountered during dissection of a male cadaver of Greek origin.
 Conclusion. The use of autologous tissues in the reconstruction of defects and treatment of lymphedema is expanding, so the need to establish safer surgical dissections is also becoming more apparent. The case of entrapment of the subscapular artery by the radial nerve is extremely rare, however, utiliz- ing tissues perfused by this artery for reconstructive purposes could potentially be futile and unsuccessful due to the inadequate blood supply or vessel thrombosis. Hence, the surgeon should adapt the treatment plan according to preoperative findings, as the presence of anatomical variants should always be suspected.

The axillary artery high bifurcation: coexisting variants and clinical significance.

Several branching patterns of the axillary artery (AA) have been described. Unusually, the brachial artery (BA) follows a course in front of the median nerve (MN), the so-called superficial brachial artery (SBA). The SBA may result in MN entrapment. The current cadaveric report highlights a high AA bifurcation, its continuation as SBA and the coexistence of muscular, neural, and vascular asymmetric aberrations. At the right side, the coracobrachialis muscle (CB) had a single head, and the ipsilateral musculocutaneous nerve (MCN) followed a medial course. The AA was highly divided into superficial and deep stems (SAS and DAS), at the 2nd rib lower border. Between two stems, the brachial plexus (BP) lateral and medial cords were identified. The MN originated from the BP lateral cord. The SAS, continued as SBA with a tortuous course. The DAS coursed posterior to the BP medial and lateral cords and gave off the subscapular artery. A bilateral 3rd head of the biceps brachii was identified. The MN atypically originated from the BP lateral cord. At the left side, the two-headed CB was typically penetrated by the MCN. A common trunk of the circumflex humeral arteries was identified in coexistence with an interconnection of the BP lateral cord with the MN medial root. The rare coexistence of muscular, neural, and arterial variants in axillary and brachial region is emphasized, taking into consideration the AA high division and related branching pattern. Documentation of such rare vascular variants is important in aneurysm and trauma surgery, and angiography, where all therapeutic manipulations must be accurately performed due to the possibility of complications.

Prevalence of Axillary Artery Variants and Their Clinical Significance: A Scoping Review.

Axillary artery (AA) variants occurred quite commonly, presenting clinical implications. A literature search yielded 523 resultsfrom which 13 parameters were extracted. Some of the AA variants found were the fusion of two or more branches into common trunks, like the fusion of anterior and posterior circumflex humeral arteries. Moreover, several branches were found to emerge from different points than expected, like the lateral thoracic artery's origin from the subscapular artery instead of the second part of the AA. The importance of the knowledge of the AA variations in clinical practice is undeniable and very useful when planning interventional procedures, as in the case of AA aneurysm treatment or in cases of fracture of the surgical neck of the humerus. The heterogeneity of data limited the possibility of a quantitative summary of data. Therefore, a more systemic study of AA variants based on the origin, course, and branching pattern is suggested. The aim of the current review is to summarize current data literatureregarding the AA typical anatomy and its variants, with a focus on their prevalence and possible clinical implications.

Comparison of artery diameters in the Aachen minipig serving as a human intracranial in vivo model.

Minipigs are used as in vivo endovascular models, particularly in stroke and aneurysm research. However, detailed knowledge of the diameters of forelimb arteries that are commonly used as surrogates for human brain-supplying arteries are lacking. This study aimed to determine the diameters of forelimb and neck arteries in Aachen minipigs and to compare those to the diameters of human cerebral brain-supplying arteries in order to assess the validity of the Aachen minipig as a human intracranial in vivo model. We measured the diameters in the external carotid artery and eight different branches of the subclavian artery in 12 Aachen minipigs using angiographic imaging. Analysed arteries comprised the external carotid artery, axillary artery, brachial artery, subscapular artery first segment, subscapular artery second segment, external thoracic artery, caudal circumflex humeral artery, suprascapular artery and thoracodorsal artery. We compared these diameters to diameters of the following human brain-supplying arteries: terminal internal carotid artery (carotid-T and petrous segment), M1 segment of the middle cerebral artery, M2 segments of the middle cerebral artery, anterior cerebral artery, vertebral artery and basilar artery. Median diameters of porcine forelimb arteries ranged from 1.8 to 4.9 mm, and human brain supplying arteries ranged in diameter from 1.4 to 4.3 mm. Depending on the intended use, this allows porcine forelimb arteries to be selected which are statistically comparable to human brain-supplying vessels. In conclusion, we identified several equivalent arteries of the porcine subclavian branches that are comparable to human brain-supplying arteries. This may help to validate the minipig as a suitable in vivo model for neurovascular experiments.

Collateral Artery from the 1st Part of the Axillary Artery: A Case Report

During radiological studies and surgeries, the branch architecture of the Axillary artery (AA) is crucial. Variations can complicate the interpretation of radiological data and cause unanticipated surgical complications. In the present situation, an uncommon collateral artery arose from the 1st part of the AA and gave rise to the lateral thoracic artery (LTA) and subscapular artery (SSA) before becoming the posterior circumflex humeral artery (PCHA). The SSA additionally gave rise to the thoracodorsal (TDA) and circumflex scapular arteries (CSA). For safe and effective surgical treatments and to prevent technical failures during catheterization and interventional procedures, it is essential to be aware of these anatomical differences.

Routine Contrasted Chest CT Accurately Identifies Anatomic Variations of the Proximal Subscapular System.

The vascular anatomy of the proximal subscapular artery has been previously classified into 2 major types depending on the presence of a common subscapular trunk. The purpose of this study was to determine the utility, reliability, and cost of routine chest imaging to identify these anatomical variations. Data were collected retrospectively at a tertiary medical center for patients who were undergoing CT chest for various indications between October 2019 and October 2020. Two independent and blinded readers interpreted CT chest with contrast of 52 patients for a total 104 sides. The proximal branching pattern of the subscapular system was identified to have a common trunk in 99 (95%) sides. The remaining five sides (5%) demonstrated two arterial pedicles; with one patient exhibiting the variant anatomy bilaterally. Preoperative CT chest with contrast can accurately identify anatomic variation of the subscapular vascular system. For complex reconstruction requiring a single anastomosis in the vessel depleted neck, preoperative imaging can assure selection of a type I vascular anatomy of the proximal subscapular system. Preoperative imaging with contrasted CT has value in assessing this anatomy when planning for chimeric flaps involving circumflex scapular and thoracodorsal arteries. 3 Laryngoscope, 134:684-687, 2024.

Comments on "Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review".

The circumflex scapular artery is a branch of the subscapular artery originating from the axillary artery. It gives two different branches, transverse and vertical, on the posterior aspect of the trunk. A parascapular flap can be designed over the branches given by the circumflex scapular artery. The pedicle length of this flap is approximately 3 to 7 cm. The flap can be designed as a pedicled flap or it can be used as a free flap.[1]

Topographical Variations of Nutrient Foramina in the Dry Adult Scapula: A Cross-sectional Study

Introduction: The scapula is the shoulder girdle bone. Vascularity of this bone may arise from the subscapular and circumflex scapular arteries (on the lateral border), supra-scapular artery (on the superior border), deep branch of the transverse cervical artery (on the medial border), or a branch from the axillary artery (on the costal surface). Nutrient arteries associated with flat bones like the scapula have not received significant research in the past. Aim: To determine the number and location of nutrient foramina on the human dry scapula. Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Anatomy of RG KAR Medical College, Kolkata, West Bengal, India.. The sample was gathered from August 2022 to January 2023. A total of 122 dry adult scapulae were studied (69 right and 53 left), irrespective of age and sex. The data obtained after thorough inspection was tabulated to obtain the results. The International Business Management(IBM) Statistical Package for Social Sciences(SPSS) software tool was used for statistical analysis, and inferences were drawn from the results. Results: The average number of nutrient foramina per scapula was five (ranging from 2 to 10). The most common location of the supraspinous fossa was 30.97%. On the costal surface, most of the nutrient foramina were found directly inferior to the suprascapular notch (30%), and on the dorsal surface, nutrient foramina were identified under the spine of the scapula (23.75%). Nutrient foramina were least present in the peri- glenoid area (15.28%). The Analysis of Variance(ANOVA) test showed homologous subsets between and within the different types of fossae. Conclusion: To maintain the health of the scapula, the nutrient artery must be preserved. Most scapulae had more than one nutrient foramina, located in specific areas on both the dorsal and costal surfaces of the shoulder blade. As a result, orthopaedic surgeons performing scapular surgery place great significance on their topographic understanding of the nutrient foramina. A knowledge of these variations aids surgeons in minimising blood loss during surgical implications around the pectoral girdle or scapular area in living patients.

89. A proposed algorithm for free flap reconstruction of osseous defects in the head and neck: The Guys Hospital experience

Traditionally, fibular free flaps (FFF) have been shown to be the gold standard for osseous head and neck reconstruction. Head and neck cancer patients often exhibit risk factors for atherosclerosis. In some cases a FFF cannot be used as its harvest risks precipitating limb ischaema. Scapular free flap (SFF) reconstruction allows for bony reconstruction as well as having the option of incorporating other flaps based on the subscapular artery system.

Anatomy of Profunda Brachial Artery in the Axilla and Its Relationship With the Radial Nerve: Fresh-Cadaver Anatomical Study and Clinical Observations

Dissection of the radial nerve in the axilla and upper portion of and posterior aspect of arm may be necessary for brachial plexus reconstruction, in axillary nerve paralysis, and in radial nerve injuries. The radial nerve is in intimate contact with the profunda brachial artery (PBA). The authors sought to describe the relationship of the PBA with the radial nerve. We dissected the PBA and the radial nerve bilaterally in 20 upper limbs from 10 fresh cadavers after subclavian artery injection with green latex. We studied the relationship of the PBA with the radial nerve, its branching patterns, and its diameters. In addition, we performed surgery on 5 patients with brachial plexus, radial, or axillary nerve injury in whom we dissected the PBA. The PBA was present in all dissections, originating from the brachial artery (n= 19 specimens) close to the latissimus dorsi tendon or from the subscapular artery (n= 1 specimen). In 15 dissections, the PBA bifurcated into an anterior (AB) and a posterior (PB) branch. In one dissection, the AB was absent. The AB traveled toward the triceps medial head. The PB flanked the radial nerve posteriorly and traveled around the humerus, with the radial nerve passing between the medial and the lateral head of the triceps. The AB and PB were longer than the PBA and measured on average 53 mm (SD ± 33 mm) and 39 mm (SD ± 26 mm), respectively. Intraoperatively, the radial nerve could be exposed in the upper arm by pulling the triceps medial head anteriorly together with the AB. The PB was lateral to the radial nerve in the posterior arm approach. In the upper arm, the radial nerve was not flanked by a single branch as postulated in anatomical textbooks but by 2 branches resulting from the bifurcation of the PBA. Awareness of PBA anatomy is essential during radial nerve dissection from the anterior or posterior arm approach.

Surgical technique for preservation of extrathoracic collateral networks in thoracoabdominal aortic surgery.

Surgical technique for preservation of extrathoracic collateral networks in thoracoabdominal aortic surgery.

Comparison of porcine and human vascular diameters for the optimization of interventional stroke training and research.

The branches of the porcine subclavian artery are frequently used in endovascular stroke training and research. This study aimed to determine a porcine weight group, in which the arterial diameters most closely match human cerebral artery diameters, and thus optimize the porcine in-vivo model for neuroendovascular purposes. A group of 42 German Landrace swine (45–74 kg) was divided into four subgroups according to their weight. Angiographic images of the swine were used to determine the arterial diameter of the main branches of the subclavian artery: axillary artery, brachial artery, external thoracic artery, subscapular artery (at two different segments), suprascapular artery, caudal circumflex humeral artery, thoracodorsal artery, and circumflex scapular artery. The porcine arterial diameters were correlated with animal weight and compared to luminal diameters of human arteries which are commonly involved in stroke: internal carotid artery, basilar artery, vertebral artery, middle cerebral artery and M2 branches of the middle cerebral artery. Swine weight was positively correlated with porcine arterial diameter. The most conformity with human arterial diameters was found within the two heavier porcine groups (55–74 kg). We suggest the use of swine with a weight between 55–59.7 kg, as lighter animals show less similarity with human arterial diameters and heavier animals could cause more problems with manipulation and handling.

Surgical Implications in Multiple Variants in the Axillary Artery

The third segment of the axillary artery (TSAA) contributes crucial irrigation to muscles in mostly all compartments of the upper limb. Numerous studies have reported atypical branching patterns of the TSAA, which creates obstacles in operative assessments involving structures irrigated by this segment of the artery. In our current study, we observed three atypical branching patterns in the TSAA in which the subscapular artery gave rise to the posterior humeral circumflex artery and a second subscapular artery. In addition, a variant was found in the origin of the thoracodorsal artery; two collateral horizontal arteries irrigating the deep medial surface of the latissimus dorsi. Anatomical variants, not only in the axillary artery but in the whole body, have a remarkable importance in surgery as a whole and are a cause of the continuous adjustment of surgical standards and patient management. In this case report, we aim to evaluate these variants from a clinical perspective for the proper management of axillary traumas and pathologies.

Treatment of massive hemoptysis after thoracic aortic aneurysm repair

BackgroundMassive hemoptysis after thoracic aortic aneurysm (TAA) repair is a rare but potentially lethal condition. Endovascular management is a challenging treatment option due to the complexity of culprit vessel access.Case presentationAn 81-year-old woman was referred to our hospital with massive hemoptysis. She had a history of graft replacement and thoracic endovascular aortic repair (TEVAR) for dissecting TAA. Computed tomography (CT) showed massive atelectasis with hematoma in the left lower lung lobe adjacent to the descending aortic aneurysm treated with TEVAR. Contrast-enhanced CT revealed a pseudoaneurysm and proliferation of abnormal vessels at the peripheral side of the left pulmonary ligament artery (PLA) in the atelectasis. The PLA continued to the right subscapular artery via a complex collateral pathway. Diagnostic angiography of the right subcapsular artery revealed a pseudoaneurysm and abnormal vessels at the peripheral side of the left PLA with a systemic-pulmonary artery shunt. Transcatheter arterial embolization (TAE) for the left PLA via the collateral pathway with N-butyl cyanoacrylate achieved complete embolization. The patient’s hemoptysis was controlled and she was discharged.ConclusionsHere we presented a case of massive hemoptysis due to PLA disruption that occurred after TAA repair. TAE via a complex collateral pathway is a feasible and effective treatment for hemoptysis, even in patients who have undergone surgical or endovascular TAA repair.

MORPHOLOGICAL VARIATION IN BRANCHING COURSE AND DISTRIBUTION OF AXILLARY ARTERY IN NORTH INDIAN POPULATION

Anomalous arterial pattern are having significant importance for anatomist, vascular reconstruction surgeons and radiologists. The present study was conducted on 22 formalin fixed cadavers. Out of which 4 cadavers showed variation in the course and branching pattern of superior thoracic artery. In 2 male cadavers, superior thoracic artery showed unusual course and other 2 cadavers showed variations in the branching pattern of lateral thoracic and subscapular arteries. Knowledge of these arterial patterns is useful in determining pathology of arteries, their proper surgical procedures and proper diagnostic interpretation.

Anatomic variants of the subscapular-thoracodorsal arterial system: A radiologic analysis of 200 arterial systems

BackgroundComposite flaps based on the subscapular arterial system are excellent choices for complex defects, including those of the head and neck, though rates of anatomic variants are not well described. ObjectiveCharacterize subscapular-thoracodorsal arterial system in a large cohort of patients using CT chest angiography. MethodsCTA chest studies from 100 adult patients were analyzed to characterize the bilateral subscapular-thoracodorsal arterial systems. ResultsOut of 200 arterial systems, 25 (12.5%) were lacking a subscapular artery, with the thoracodoral and circumflex scapular arteries arising independently off of the axillary (or other nearby vessels). Strikingly, the subscapular artery was absent bilaterally in 5 patients and absent unilaterally in 15 patients, meaning that one in five patients harbored abnormal anatomy on at least one side. There was no radiographic evidence of atherosclerosis in the studied vessels in any patient, including smokers and patients with atherosclerosis in other vessels. ConclusionVariations in the subscapular-thoracodorsal arterial system appear more frequent than previously described. For select patients requiring complex reconstruction using the scapular system, CTA chest may aide surgical planning.