DOCSLIB.ORG

Preservation of Intercostal Arteries During Thoracoabdominal Aortic Aneurysm Surgery: a Retrospective Study

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Preservation of Intercostal Arteries During Thoracoabdominal Aortic Aneurysm Surgery: a Retrospective Study View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector PRESERVATION OF INTERCOSTAL ARTERIES DURING THORACOABDOMINAL AORTIC ANEURYSM SURGERY: A RETROSPECTIVE STUDY Scott D. Ross, MD Objective: The purpose of this article was to examine the influence of Irving L. Kron, MD reimplantation of patent intercostal and lumbar arteries on the inci- Patrick E. Parrino, MD dence of postoperative paraplegia/paraparesis in patients undergoing Kimberly S. Shockey, MS clamp-and-sew surgical repair of thoracoabdominal aortic aneurysms. John A. Kern, MD Curtis G. Tribble, MD Methods: Data from January 1987 through December 1997 were retro- spectively collected on 132 patients. Ninety-one patients in group I underwent aneurysm repairs before January 1995 and did not undergo intercostal artery reimplantation. Group II included the more recent 41 patients who had vessels between the eighth thoracic intercostal and the second lumbar arteries reimplanted to the graft or preserved at the aor- tic anastomoses. Results: The operative mortality rate was 13.2% (12/91) in group I and 4.9% (2/41) in group II (P = .22). The incidence of post- operative paraplegia was significantly lower in the more recent cohort of patients (8.8% [8/91] in group I vs 0% [0/41] in group II, P = .05). The overall rate of spinal cord dysfunction was lowered from 9.9% (9/91) in group I to 2.4% (1/41) in group II (P = .17). However, a multivariable logistic regression analysis identified only aneurysm extent (Crawford type I and type II) as a predictor of less postoperative spinal cord injury (P = .08). The average aortic crossclamp time in group I was 30.3 ± 11.5 (SD) minutes, and the time of aortic occlusion in group II was not sig- nificantly prolonged, with an average crossclamp time of 31.0 ± 21.0 (SD) minutes (P = .88). Conclusions: An aggressive approach to maintain intercostal artery patency during clamp-and-sew repair of thoracoab- dominal aortic aneurysms may effectively lower the incidence of spinal cord injury without prolonging aortic crossclamp time. (J Thorac Cardiovasc Surg 1999;118:17-25) he surgical repair of aneurysms of the thoracoab- in resection of these aneurysms. The incidence of spinal T dominal aorta has undergone considerable advance- cord dysfunction varies, but the largest series to date ments over the past several decades. Despite many sur- reported the development of postoperative paraplegia or gical successes, the threat of spinal cord ischemia and paraparesis in 16% of their patients.1 Spinal cord injury postoperative paraplegia remains an unsolved problem during the repair of thoracoabdominal aneurysms is the result of ischemia caused by aortic crossclamping and ischemia caused by devascularization from interruption From the Department of Surgery, Division of Thoracic and of the critical blood supply of the spinal cord. However, Cardiovascular Surgery, University of Virginia Health Sciences Center, Charlottesville, Va. owing to the variability and complexity of the blood Read at the Twenty-fourth Annual Meeting of The Western Thoracic supply of the spinal cord, the management of this criti- Surgical Association, Whistler, British Columbia, June 24-27, cal circulation remains controversial. The most impor- 1998. tant artery of the thoracolumbar region of the spinal Received for publication July 15, 1998; revisions requested Sept 4, 1998; revisions received Feb 10, 1999; accepted for publication cord may be the artery of Adamkiewicz, arising most March 8, 1999. commonly in the region from the ninth thoracic inter- Address for reprints: Curtis G. Tribble, MD, Department of Surgery, costal to the first lumbar artery. The reattachment of Division of Thoracic and Cardiovascular Surgery, Box 3111, MR4 these intercostal and lumbar arteries when replacing Building, University of Virginia Health Sciences Center, Charlottesville, VA 22908. thoracoabdominal aneurysms has been postulated to Copyright © 1999 by Mosby, Inc. preserve the artery of Adamkiewicz and play an impor- 0022-5223/99 $8.00 + 0 12/6/98432 tant role in preserving spinal cord function.2-8 However, 17 18 Ross et al The Journal of Thoracic and Cardiovascular Surgery July 1999 Table I. Preoperative patient characteristics arrest were excluded. During the more recent era of the study Group I Group II since January 1995, 6 patients required surgical repair by Characteristic (n = 91) (n = 41) P value means of these various techniques. These techniques were generally applied in cases in which the proximal aorta was Age (y) 60.8 65.5 .29 not able to be clamped or in cases in which there was preop- Male (%) 52/91 (57.1) 27/41 (65.9) .34 erative evidence of severe left ventricular dysfunction. Hypertension (%) 61/91 (67.0) 32/41 (78.0) .20 Medical records of all patients were reviewed and preoper- Myocardial infarction 20/91 (22.0) 12/41 (29.3) .37 ative variables of age, sex, thoracoabdominal aneurysm (%) Prior aortic surgery 26/91 (28.6) 12/41 (29.3) .93 extent, symptomatic status, the presence of dissection, the (%) presence of rupture, history of hypertension, history of Aneurysm extent .80 myocardial infarction or congestive heart failure, and previ- Type I (%) 53/91 (58.2) 21/41 (51.2) ous aortic resection were obtained. Thoracoabdominal Type II (%) 14/91 (15.4) 6/41 (14.6) aneurysm extent was classified according to the scheme pro- Type III (%) 10/91 (11.0) 5/41 (12.2) posed by Crawford: type I, entire descending and upper Type IV (%) 14/91 (15.4) 9/41 (22.0) abdominal aorta; type II, entire descending and abdominal Dissection .47 aorta; type III, variable extents of descending and abdominal Chronic (%) 15/91 (16.5) 5/41 (12.2) aorta; and type IV, entire abdominal aorta with the graft Acute (%) 9/91 (9.9) 2/41 (4.9) extending proximal to the celiac axis. The aortic segment that Rupture (%) 18/91 (19.8) 3/41 (7.3) .07 was resected was used to determine the classification of aneurysm extent. The duration of aortic occlusion was obtained from the operative record for each patient. The post- operative outcomes of death and spinal cord injury manifest- others have questioned the significance of reimplanting ed by paraplegia or paraparesis were determined for each these vessels for spinal protection.9 patient. Operative mortality included deaths within the We10 have previously reported our experience with patients’ entire hospital length of stay or within 30 days after the clamp-and-sew technique for the repair of thora- the operation if they were discharged from the hospital. All coabdominal aortic aneurysms. Recently, we have patients who died after the operation had thorough evalua- modified our technique of these repairs by preserving tions for neurologic injury recorded before death. We defined all patent vessels between the eighth thoracic inter- paraplegia as a permanent neurologic deficit and paraparesis as temporary weakness of a lower extremity. costal and the second lumbar arteries in an effort to The two groups of patients were not significantly different reduce the incidence of spinal cord ischemia. The cur- with respect to a number of preoperative characteristics that rent study examines the addition of intercostal artery are believed to have an impact on outcome in patients with reimplantation to the clamp-and-sew technique and its aneurysmal disease, as shown in Table I. Specifically, the influence on postoperative paraplegia without addition- extent of the aortic lesions did not differ significantly al combinations of adjuvant techniques for spinal cord between the two groups of patients. In particular, 66% of the protection. more recent group and 73% of the earlier group of patients had thoracoabdominal aneurysms classified as Crawford type I and type II aneurysms, indicating that a majority of patients Patients and methods in each group had lesions posing a relatively high risk for Patient population. All patients undergoing clamp-and- paraplegia. In addition, we used a multivariable logistic sew repair of aneurysms of the thoracoabdominal aorta at the regression analysis to create a propensity score for each University of Virginia Health Sciences Center from January patient in the data set. In the analysis, we found the logistic 1987 through December 1997 were included in the study. A models with and without the propensity scores as a covariate total of 132 patients were identified for review. Ninety-one to have almost identical estimates of the baseline characteris- patients in group I underwent aneurysm repairs before tics of the two patient groups. January 1995 and did not undergo intercostal artery reim- Operative technique. All thoracoabdominal repairs were plantation. In these patients, potentially critical intercostal carried out completely retroperitoneally through a thoracoab- vessels were oversewn. Group II included 41 patients who dominal incision. All patients were intubated with a double- underwent aneurysm operations from January 1995 through lumen endotracheal tube that permitted deflation of the left December 1997 and had critical vessels between the eighth lung, facilitating exposure and repair. Intraoperatively, arteri- thoracic intercostal and the second lumbar arteries reimplant- al blood pressure, central venous pressure, pulmonary artery ed to the graft or preserved at the aortic anastomoses. Patients pressure, continuous electrocardiogram, urine output, tem- with isolated aneurysms of the descending thoracic aorta perature, arterial blood gases, electrolytes, and hemoglobin were not
Load more

Recommended publications
  • The Descending Thoracic Aorta Morphological Characteristics
    ARS Medica Tomitana - 2016; 3(22): 186 - 191 10.1515/arsm-2016-0031 Malik S., Bordei P., Rusali A., Iliescu D. M. The descending thoracic aorta morphological characteristics Faculty of Medicine, “Ovidius” University, Constanta ABSTRACT Introduction Our study was conducted by consulting angioCT sites made on a CT GE LightSpeed VCT64 Slice CT and a CT GE LightSpeed 16 Slice CT, following the path and relationships of the descending thoracic aorta against the vertebral column, outside diameters thereof at the Descending thoracic aorta extends from the thoracic vertebrae T4, T7, T12 and posterior intercostal aortic arch (which it continues) and aortic hiatus of arteries characteristics. The origin of of the descending the diaphragm at level of T12 vertebra [1,2,3,4,5] thoracic aorta we found most commonly on the left corresponding to the front of T10 [6], level that flank of the lower edge of the vertebral body T4, but continues with the abdominal descending aorta. She I have encountered cases where it had come above the enters the posterior mediastinum at the T4 vertebra and lower edge of T4 on level of intervertebral disc T4-T5 or describes a trajectory which is vertically downward as even at the upper edge of T5 vertebral body. At thoracic a whole, being slightly inferior oblique and to the right, vertebra T4, on a total of 30 cases, the descending thoracic aorta present a diameter of 20.0 to 32.6 mm, then, first at a distance of 2-3 cm midline, progressive values that correspond to male gender and to females approach to become median and prevertebral at the diameter ranging from 25.5 to 27, 4 mm.
    [Show full text]
  • Embolization for Hemoptysis—Angiographic Anatomy of Bronchial and Systemic Arteries
    THIEME 184 Pictorial Essay Embolization for Hemoptysis—Angiographic Anatomy of Bronchial and Systemic Arteries Vikash Srinivasaiah Setty Chennur1 Kumar Kempegowda Shashi1 Stephen Edward Ryan1 1 1 Adnan Hadziomerovic Ashish Gupta 1Division of Angio-Interventional Radiology, Department of Medical Address for correspondence Ashish Gupta, MD, Division of Imaging, University of Ottawa, The Ottawa Hospital, Ottawa, Angio-Interventional Radiology, Department of Medical Imaging, Ontario, Canada University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada (e-mail: [email protected]). J Clin Interv Radiol ISVIR 2018;2:184–190 Abstract Massive hemoptysis is a potentially fatal respiratory emergency. The majority of these patients are referred to interventional radiology for bronchial artery embolization (BAE). Immediate clinical success in stopping hemoptysis ranges from 70 to 99%. However, recurrent hemoptysis after BAE is seen in 10 to 55% patients. One of the main reasons for recurrence is incomplete embolization due to unidentified aberrant Keywords bronchial and/or non-bronchial systemic arterial supply. This pictorial essay aims to ► bronchial describe the normal and variant bronchial arterial anatomy and non-bronchial systemic ► embolization arterial feeders to the lungs on conventional angiography; the knowledge of which is ► hemoptysis critical for interventional radiologists involved in the care of patients with hemoptysis. Introduction Angiographic Anatomy of Bronchial Arteries Massive hemoptysis is a respiratory
    [Show full text]
  • Intercostal Arteries a Single Posterior & Two Anterior Intercostal Arteries
    Intercostal Arteries •Each intercostal space contains: . A single posterior & .Two anterior intercostal arteries •Each artery gives off branches to the muscles, skin, parietal pleura Posterior Intercostal Arteries In the upper two spaces, arise from the superior intercostal artery (a branch of costocervical trunk of the subclavian artery) In the lower nine spaces, arise from the branches of thoracic aorta The course and branching of the intercostal arteries follow the intercostal Posterior intercostal artery Course of intercostal vessels in the posterior thoracic wall Anterior Intercostal Arteries In the upper six spaces, arise from the internal thoracic artery In the lower three spaces arise from the musculophrenic artery (one of the terminal branch of internal thoracic) Form anastomosis with the posterior intercostal arteries Intercostal Veins Accompany intercostal arteries and nerves Each space has posterior & anterior intercostal veins Eleven posterior intercostal and one subcostal vein Lie deepest in the costal grooves Contain valves which direct the blood posteriorly Posterior Intercostal Veins On right side: • The first space drains into the right brachiocephalic vein • Rest of the intercostal spaces drain into the azygos vein On left side: • The upper three spaces drain into the left brachiocephalic vein. • Rest of the intercostal spaces drain into the hemiazygos and accessory hemiazygos veins, which drain into the azygos vein Anterior Intercostal Veins • The lower five spaces drain into the musculophrenic vein (one of the tributary of internal thoracic vein) • The upper six spaces drain into the internal thoracic vein • The internal thoracic vein drains into the subclavian vein. Lymphatics • Anteriorly drain into anterior intercostal nodes that lie along the internal thoracic artery • Posterioly drain into posterior intercostal nodes that lie in the posterior mediastinum .
    [Show full text]
  • Aorta and the Vasculature of the Thorax
    Aorta and the Vasculature of the Thorax Ali Fırat Esmer, MD Ankara University Faculty of Medicine Department of Anatomy THE AORTA After originating from left ventricle, it ascends for a short distance, arches backward and to the left side, descends within the thorax on the left side of the vertebral column It is divided for purposes of The aorta is the main arterial trunk description into: that delivers oxygenated blood from Ascending aorta the left ventricle of the heart to the Arch of the aorta and tissues of the body. Descending aorta (thoracic and abdominal aorta) Ascending Aorta The ascending aorta begins at the base of the left ventricle runs upward and forward at the level of the sternal angle, where it becomes continuous with the arch of the aorta it possesses three bulges, the sinuses of the aorta Branches Right coronary artery Left coronary artery ARCH OF THE AORTA The aortic arch is a continuation of the ascending aorta and begins at the level of the second sternocostal joint. • It arches superiorly, posteriorly and to the left before moving inferiorly. • The aortic arch ends at the level of the T4 vertebra / at level of sternal angle. Branches; Brachiocephalic artery (Innominate artery) Left common carotid artery Left subclavian artery It begins when the ascending aorta emerges from the pericardial sac and courses upward, backward, and to the left as it passes through the superior mediastinum, ending on the left side at vertebral level TIV/V. Extending as high as the midlevel of the manubrium of the sternum, the arch is initially anterior and finally lateral to the trachea.
    [Show full text]
  • Ascending and Descending Thoracic Vertebral Arteries
    CLINICAL REPORT EXTRACRANIAL VASCULAR Ascending and Descending Thoracic Vertebral Arteries X P. Gailloud, X L. Gregg, X M.S. Pearl, and X D. San Millan ABSTRACT SUMMARY: Thoracic vertebral arteries are anastomotic chains similar to cervical vertebral arteries but found at the thoracic level. Descending thoracic vertebral arteries originate from the pretransverse segment of the cervical vertebral artery and curve caudally to pass into the last transverse foramen or the first costotransverse space. Ascending thoracic vertebral arteries originate from the aorta, pass through at least 1 costotransverse space, and continue cranially as the cervical vertebral artery. This report describes the angiographic anatomy and clinical significance of 9 cases of descending and 2 cases of ascending thoracic vertebral arteries. Being located within the upper costotransverse spaces, ascending and descending thoracic vertebral arteries can have important implications during spine inter- ventional or surgical procedures. Because they frequently provide radiculomedullary or bronchial branches, they can also be involved in spinal cord ischemia, supply vascular malformations, or be an elusive source of hemoptysis. ABBREVIATIONS: ISA ϭ intersegmental artery; SIA ϭ supreme intercostal artery; VA ϭ vertebral artery he cervical portion of the vertebral artery (VA) is formed by a bral arteria lusoria8-13 or persistent left seventh cervical ISA of Tseries of anastomoses established between the first 6 cervical aortic origin.14 intersegmental arteries (ISAs) and one of the carotid-vertebral This report discusses 9 angiographic observations of descend- anastomoses, the proatlantal artery.1-3 The VA is labeled a “post- ing thoracic VAs and 2 cases of ascending thoracic VAs. costal” anastomotic chain (ie, located behind the costal process of cervical vertebrae or dorsal to the rib itself at the thoracic level) to CASE SERIES emphasize its location within the transverse foramina.
    [Show full text]
  • The Surgical Anatomy of the Mammary Gland. Vascularisation, Innervation, Lymphatic Drainage, the Structure of the Axillary Fossa (Part 2.)
    NOWOTWORY Journal of Oncology 2021, volume 71, number 1, 62–69 DOI: 10.5603/NJO.2021.0011 © Polskie Towarzystwo Onkologiczne ISSN 0029–540X Varia www.nowotwory.edu.pl The surgical anatomy of the mammary gland. Vascularisation, innervation, lymphatic drainage, the structure of the axillary fossa (part 2.) Sławomir Cieśla1, Mateusz Wichtowski1, 2, Róża Poźniak-Balicka3, 4, Dawid Murawa1, 2 1Department of General and Oncological Surgery, K. Marcinkowski University Hospital, Zielona Gora, Poland 2Department of Surgery and Oncology, Collegium Medicum, University of Zielona Gora, Poland 3Department of Radiotherapy, K. Marcinkowski University Hospital, Zielona Gora, Poland 4Department of Urology and Oncological Urology, Collegium Medicum, University of Zielona Gora, Poland Dynamically developing oncoplasty, i.e. the application of plastic surgery methods in oncological breast surgeries, requires excellent knowledge of mammary gland anatomy. This article presents the details of arterial blood supply and venous blood outflow as well as breast innervation with a special focus on the nipple-areolar complex, and the lymphatic system with lymphatic outflow routes. Additionally, it provides an extensive description of the axillary fossa anatomy. Key words: anatomy of the mammary gland The large-scale introduction of oncoplasty to everyday on- axillary artery subclavian artery cological surgery practice of partial mammary gland resec- internal thoracic artery thoracic-acromial artery tions, partial or total breast reconstructions with the use of branches to the mammary gland the patient’s own tissue as well as an artificial material such as implants has significantly changed the paradigm of surgi- cal procedures. A thorough knowledge of mammary gland lateral thoracic artery superficial anatomy has taken on a new meaning.
    [Show full text]
  • Anatomy of Esophagus Anatomy of Esophagus
    DOI: 10.5772/intechopen.69583 Provisional chapter Chapter 1 Anatomy of Esophagus Anatomy of Esophagus Murat Ferhat Ferhatoglu and Taner Kıvılcım Murat Ferhat Ferhatoglu and Taner Kıvılcım Additional information is available at the end of the chapter Additional information is available at the end of the chapter http://dx.doi.org/10.5772/intechopen.69583 Abstract Anatomy knowledge is the basic stone of healing diseases. Arteries, veins, wall structure, nerves, narrowing, curves, relations with other organs are very important to understand eso- phagial diseases. In this chapter we aimed to explain anatomical fundementals of oesophagus. Keywords: anatomy, esophagus, parts of esophagus, blood supply of esophagus, innervation of esophagus 1. Introduction Esophagus is a muscular tube-like organ that originates from endodermal primitive gut, 25–28 cm long, approximately 2 cm in diameter, located between lower border of laryngeal part of pharynx (Figure 1) and cardia of stomach. Start and end points of esophagus correspond to 6th cervi- cal vertebra and 11th thoracic vertebra topographically, and the gastroesophageal junction cor- responds to xiphoid process of sternum. Five cm of esophagus is in the neck, and it descends over superior mediastinum and posterior mediastinum approximately 17–18 cm, continues for 1–1.5 cm in diaphragm, ending with 2–3 cm of esophagus in abdomen (Figure 2) [1, 2]. Sex, age, physi- cal condition, and gender affect the length of esophagus. A newborn’s esophagus is 18 cm long, and it begins and ends one or two vertebra higher than in adult. Esophagus lengthens to 22 cm long by age 3 years and to 27 cm by age 10 years [3, 4].
    [Show full text]
  • An Aberrant Right Lateral Branch from Right Internal Thoracic Artery
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Directory of Open Access Journals eISSN 1308-4038 International Journal of Anatomical Variations (2010) 3: 114–116 Case Report An aberrant right lateral branch from right internal thoracic artery Published online August 10th, 2010 © http://www.ijav.org Vishal Manoharrao SALVE ABSTRACT Challa RATNAPRABHA The internal thoracic artery is the largest artery of the thoracic wall. The internal thoracic artery is often mobilized for coronary artery bypass grafting. During routine dissection (MBBS Batch 2009-2010) of a middle aged male cadaver at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Gannavaram, (INDIA); an aberrant right lateral branch from right internal thoracic artery was found. It arose Department of Anatomy, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences from right internal thoracic artery behind right first rib. It ran downward for first four intercostal spaces & Research Foundation, Chinnaoutpalli, Gannavaram Mandal, Krishna District (AP), about 1 cm away from the mid-axillary line. It terminated into two intercostal arteries on either side in the INDIA. 4th intercostal space. The rare and unexpected occurrence of variation of the internal thoracic artery such as the one reported here may complicate the entire procedure of coronary artery by-pass grafting. Thus this rare variant of the internal thoracic artery is of great concern during any surgical procedure that involves this artery. © IJAV. 2010; 3: 114–116. Vishal Manoharrao Salve, MBBS, MS Assistant Professor Department of Anatomy Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation Chinnaoutpalli, Gannavaram Mandal Krishna District (AP), 521286, INDIA.
    [Show full text]
  • Bilateral Lateral Costal Branches of the Internal Thoracic Arteries: a Case Report
    This is “Advance Publication Article” Kurume Medical Journal, 65, 00-00, 2018 Case Report Bilateral Lateral Costal Branches of the Internal Thoracic Arteries: A Case Report YUI ODO, JOE IWANAGA*, **, †, YOKO TABIRA**, KOICHI WATANABE**, TSUYOSHI SAGA**, R. SHANE TUBBS*, ‡, YOSHIKO FUJISHIMA AND KOH-ICHI YAMAKI** Kurume University School of Medicine, Kurume 830-0011, Japan, *Seattle Science Foundation, Seattle, WA 98122, USA, **Department of Anatomy, Kurume University School of Medicine, †Dental and Oral Medical Center, Kurume University School of Medicine, Kurume 830-0011, Japan, ‡Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada Received 4 October 2017, accepted 13 September 2018 J-STAGE advance publication 9 August 2019 Edited by HIROYUKI TANAKA Summary: We report a case of bilateral lateral costal branches (LCB) of the internal thoracic artery (ITA). On the left side, the ITA branched from the subclavian artery as a common trunk with the thyrocervical trunk. The left LCB flew into the collateral branch of the fifth intercostal artery after reaching the upper end of the sixth rib and after exiting the left ITA at the upper part of the first rib. The left ITA was disconnected near the second rib because it had been used for coronary artery bypass surgery. The right ITA arose from the anterior surface of the right subclavian artery just after the right ITA diverged from the brachiocephalic artery. The right LCB reached the upper end of the fifth rib and flew into the collateral branch of the fourth intercostal artery. The right ITA descended along the back of the costal cartilages as usual.
    [Show full text]
  • The Right Bronchial Artery Anatomical Considerations and Surgical Approach
    Thorax: first published as 10.1136/thx.25.3.328 on 1 May 1970. Downloaded from Thorax (1970), 25, 328. The right bronchial artery Anatomical considerations and surgical approach HILEL NATHAN, RUBEN ORDA, and MICHEL BARKAY Departmellt of Aitatomy anid Anithropology, Tel-Aviv University Medical School, Tel-Hashomer Government Hospital, Israel The precise course and relations of the right bronchial artery are presented with an emphasis on the characteristic parallelism between the arches of this artery and the azygos vein. The technique for an easy surgical approach to the bronchial artery is described. Various pathological conditions involving this artery are discussed in relation to possible surgical applications. In spite of the fact that bronchial arteries have systemic blood supply of the lungs. The anterior been known for a long time, their real function arteries, on the other hand, are generally small in pulmonary physiology is still under discussion. and inconsistent. A complete description of these The participation of these arteries in many patho- vessels and their variations in humans was given logical conditions of the lungs was the subject of by Cauldwell et al. (1948) and in dogs by numerous clinical (Cockett and Vass, 1950; Cud- Notkovichl (1957). kowicz and Armstrong, 1951 ; Cudkowicz, 1952; During the course of hundreds of dissections Liebow, Hales, and Lindskog, 1949; Liebow, we noticed that the right bronchial artery was Hales, Harrison, Bloomer, and Lindskog, 1950); nearly always present and that its course and re- and experimental (Mathes, Holman, and Reichert, lations were consistent. In the present report a 1932; Cockett and Vass, 1951) studies.
    [Show full text]
  • Original Article ANATOMIC VARIATIONS in the SURGICAL ANATOMY of the THORACIC ESOPHAGUS and ITS SURROUNDING STRUCTURES
    ABCDDV/913 ABCD Arq Bras Cir Dig Artigo Original 2013;26(2):101-106 VARIAÇÕES ANATÔMICAS NA ANATOMIA CIRÚRGICA DO ESÔFAGO TORÁCICO E SUAS ESTRUTURAS CIRCUNDANTES Anatomic variations in the surgical anatomy of the thoracic esophagus and its surrounding structures Guilherme F. TAKASSI1, Fernando A. M. HERBELLA1, Marco G. PATTI2 Trabalho realizado no 1Departamento RESUMO – Racional: A esofagectomia é procedimento difícil, devido a: a) ser operação de Cirurgia, Escola Paulista de Medicina, complexa; b) apresentar alta morbidade e mortalidade; c) a anatomia cirúrgica do esôfago Universidade Federal de São Paulo, São é muito peculiar. As variações anatômicas que podem ser encontradas inesperadamente 2 Paulo, SP, Brasil e Department of Surgery, durante uma operação podem causar complicações e influenciar os resultados.Objetivo : Pritzker School of Medicine, University of Chicago, Chicago,IL, USA Revisar a base anatômica para esofagectomia destacando as variações encontradas nas estruturas mediastinais através de revisão de literatura e dissecção de cadáveres. Métodos: A literatura relacionada com a anatomia cirúrgica das estruturas esôfago e mediastino foi revista. Além disso, um total de 20 cadáveres humanos frescos (não embalsamados, não preservados e com tempo de morte com menos de 12 h) foram dissecados. Dezesseis eram do sexo masculino com idade média de 53±23 anos. Resultados: Variações anatômicas de aorta, sistema ázigos, pleura, nervo vago, linfonodos e ducto torácico foram documentadas. Conclusões: Os órgãos e estruturas do mediastino podem, frequentemente, apresentar variações anatômicas. Algumas delas podem ser clinicamente significativas durante esofagectomia. Devido a que apenas uma parte dessas variações DESCRITORES - Esôfago. Nervo vago. são identificadas antes da operação com os meios de imagens atuais, os cirurgiões devem Ducto torácico.
    [Show full text]
  • Transcatheter Arterial Embolization for Intercostal Arterio-Esophageal
    Tajima et al. Surgical Case Reports (2017) 3:70 DOI 10.1186/s40792-017-0345-8 CASE REPORT Open Access Transcatheter arterial embolization for intercostal arterio-esophageal fistula in esophageal cancer Tetsuya Tajima1*, Shigeo Haruki1, Shinsuke Usui1, Koji Ito1, Akiyo Matsumoto1, Akiyuki Matsuhisa2 and Noriaki Takiguchi1 Abstract Background: While esophageal fistula formation in the adjacent organs is associated with high rates of morbidity and mortality, the management of non-aortic arterio-esophageal fistula has not been frequently reported. Case presentation: A 69-year-old Japanese man who had undergone definitive chemoradiotherapy for esophageal cancer was admitted to our hospital with hematemesis. He was diagnosed with mediastinal abscess caused by esophageal perforation, and esophageal bypass surgery was performed. After 3 days, he presented with fatal hemoptysis. As angiography revealed an intercostal artery pseudoaneurysm, transcatheter arterial embolization was performed. Conclusions: When patients with esophageal cancer, especially those with a history of radiotherapy and/or mediastinitis, present with hematemesis and/or hemoptysis, the possibility of non-aortic arterio-esophageal fistula should be considered. Transcatheter arterial embolization is an effective treatment for non-aortic arterio-esophageal fistula. Keywords: Esophageal cancer, Arterio-esophageal fistula, Intercostal artery, Transcatheter arterial embolization Background Case presentation Esophageal fistula formation in the adjacent organs is A 69-year-old Japanese man was admitted to our hospital associated with high rates of morbidity and mortality with hematemesis. Five months earlier, the patient had [1]. Although patients with esophageal cancer may suf- been diagnosed with Stage IIIA (cT3N1M0) thoracic fer lethal bleeding due to aortic arterio-esophageal fis- esophageal squamous cell carcinoma according to the tula (AEF), the management of non-aortic AEF has not Union for International Cancer Control, seventh edition, at been frequently reported.
    [Show full text]