A 26-year old female was hit in the cervical region by a large block of ice and admitted with stable vital signs and multiple fractures. Chest radiography demonstrated an enlarged mediastinum, and CT scan revealed a transection of the left common carotid artery at its origin, with a false aneurysm. ...

PURPOSE: To develop a clinically relevant anterior cervical approach (ACA) to the C2-3 level. METHODS: Frequently encountered nerves [hypoglossal (HyN), internal (ISLN) and external superior laryngeal nerves (ESLN)] and vessels [lingual (LiA), superior laryngeal (SLA) and superior thyroid arteries (STA)] in the field of high ACA and the anatomic spatial ...

Plasma hemoglobin (Hb) scavenges endothelium-derived nitric oxide (NO), producing systemic and pulmonary vasoconstriction in many species. We hypothesized that i.v. administration of murine cell-free Hb would produce pulmonary vasoconstriction and enhance hypoxic pulmonary vasoconstriction (HPV) in mice. To assess the impact of plasma Hb on basal pulmonary vascular tone in ...

During treatment of a right internal carotid artery terminus aneurysm, an acute iatrogenic flow limiting dissection was caused in the cervical internal carotid. The true lumen was catheterized using a Mirage 0.008 microwire over an Excelsior SL-10 microcatheter, which was exchanged for a Marksman microcatheter. A 6 mm×30 mm Solitaire ...

A 20-year-old female presented with a pulsatile neck mass. On evaluation, she was found to have right cervical aortic arch, which is a rare anomaly. We highlight the conventional and Computed tomography angiography features of this vascular anomaly.

A 68-year-old man presented with right cervical carotid artery stenosis manifesting as ipsilateral amaurosis fugax. Angiography showed non-bifurcating cervical carotid artery with atherosclerotic stenosis near the branching of the superior thyroid artery. Carotid artery stenting (CAS) was carried out using two balloons for embolic protection of the internal carotid artery ...

Cervical arterial dissection (CAD) is an important cause of childhood arterial ischemic stroke (1). Dissection occurs following a vessel wall tear or rupture of the vasa vasorum with formation of an intramural hematoma. Secondary thromboembolism in the vessel territory can cause an ischemic stroke. Dissections may be traumatic or spontaneous. ...

There are no reliable data from randomised trials to decide whether anticoagulants or antiplatelet agents are better to prevent further thromboembolic events after cervical arterial dissection. Most neurologists favour anticoagulants based on the underlying pathology and the likely course of acute post-dissection thromboembolism.

OBJECTIVE: Stent graft-induced new entry (SINE) has been increasingly observed after thoracic endovascular aortic repair (TEVAR) for aortic dissection. We investigated the mechanism of late distal SINE, prevention strategies, proper size selection of the stent graft, and implantation sequence. METHODS: From November 2006 to May 2011, 99 patients with aortic ...

OBJECTIVES: Stent graft-induced new entry (SINE) has been increasingly observed after thoracic endovascular aortic repair of aortic dissection. We illustrate the possible mechanism by exploring predictive factors of late distal SINE after hybrid arch elephant trunk repair for aortic dissection. METHODS: From November 2006, to May 2011, 20 of 99 ...

The purpose of this study is to elucidate the anatomic relationships between the uncinate process and surrounding neurovascular structures to prevent possible complications in anterior cervical surgery. Twenty-eight formalin-fixed cervical spines were removed from adult cadavers and were studied. The authors investigated the morphometric relationships between the uncinate process, vertebral ...

A propeller flap is useful for coverage of an adjacent skin defect without dissection back to source vessels and harvesting muscle tissues. The thoracoacromial artery is one of the vascular pedicles of the flaps for reconstruction in the cervical region. Use of a propeller flap based on the thoracoacromial artery ...

This report presents a 60-year-old with a large paraclinoid carotid aneurysm associated with cervical interal carotid artery (ICA) dissection (CICAD). She had a fall while riding a bicycle and hit her head on the ground. Computed tomography scan done at another facility showed a round mass lesion near the sella. ...

Aneurysms of the left atrial appendage are extremely rare. Enlargement of the left atrial appendage can be congenital or acquired. Dysplasia of the left atrial muscles leads to congenital left atrial appendage aneurysm and usually presents as atrial tachyarrhythmia or embolic events in the second or third decade of life. ...

During coronary artery bypass graft surgery, various arterial and venous conduits have been used to carry blood flow from the aorta to the coronary vasculature. Arterial conduits provide certain advantages over the saphenous vein, including superior long-term patency, relative resistance to the development of atherosclerosis, and greater endothelium-dependent relaxation. However, ...

Sustained therapeutic hypercapnia prevents pulmonary hypertension in experimental animals, but its rescue effects on established disease have not been studied. Therapies which inhibit Rho-kinase (ROCK) and/or augment nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) signaling can reverse or prevent progression of chronic pulmonary hypertension. Our objective in the present study was ...

Nitric oxide (NO) is an important vascular modulator in the development of pulmonary hypertension. NO exerts its regulatory effect mainly by activating soluble guanylate cyclase (sGC) to synthesize cyclic guanosine monophosphate (cGMP). Exposure to hypoxia causes pulmonary hypertension. But in lung disease, hypoxia is commonly accompanied by hypercapnia. The aim ...

Our previous work has demonstrated that the cellular phenotype changes of human pulmonary artery smooth muscle cells (PASMCs) play an important role during pulmonary vascular remodelling. However, little is known about the role of PASMCs phenotype modulation in the course of hypoxia-induced migration and its behind molecular mechanisms. In this ...

During treatment of a right internal carotid artery terminus aneurysm, an acute iatrogenic flow limiting dissection was caused in the cervical internal carotid. The true lumen was catheterized using a Mirage 0.008 microwire over an Excelsior SL-10 microcatheter, which was exchanged for a Marksman microcatheter. A 6 mm×30 mm Solitaire ...

The recent escalation in lower extremity revascularization procedures suggests a concomitant increase in peripheral arterial disease (PAD) screening. We hypothesized that self-referring physicians would show the greatest growth in noninvasive physiologic testing for PAD and similar trends for revascularization procedures. We compared utilization rates for self-referring specialties (vascular surgery, interventional ...

Background There is debate concerning whether an aneurysmal ascending aorta should be replaced when associated with a dysfunctioning aortic valve that is to be replaced. To examine this issue, we divided the patients by type of aortic valve dysfunction-either aortic stenosis (AS) or pure aortic regurgitation (AR)-something not previously undertaken. ...

Internal thoracic artery (ITA) is an established arterial graft for the coronary artery by-pass surgery. Special micro-anatomical features of the ITA wall may protect it from age related pathological changes. One of the complications seen after coronary artery bypass grafting is vasospasm. Sympathetic nerves may be involved in vasospasm. To ...

Dynamic analysis of an axially stretched arterial wall with collagen fibers distributed in two preferred directions under a suddenly applied constant internal pressure along with the possibility of the formation and rupture of aneurysm are examined within the framework of nonlinear dynamics. A two layer tube model with the fiber-reinforced ...

Although internal mammary artery pseudoaneurysms are a rare vascular abnormality, they are sometimes seen after sternotomy, diagnostic and therapeutic vascular access or penetrating chest trauma. To our knowledge, internal mammary artery pseudoaneurysm caused by pulmonary actinomycosis has not been reported previously. We report a case of pseudoaneurysm of the left ...

We report on a rare occurrence of an acquired fistula between the left internal mammary artery and the pulmonary artery following coronary artery bypass grafting. Endovascular repair was employed using two polytetrafluoroethylene graft stents for sealing the communication sites, with good results after two years of follow-up.

To assess the current status of the prevalence and variability of internal mammary graft use in contemporary multivessel coronary artery bypass graft (CABG). The internal mammary artery (IMA) is considered the gold-standard conduit in coronary artery bypass graft (CABG) surgery. There is universal agreement that the IMA graft is associated ...

Ventricular fibrillation is a common arrhythmia encountered after the termination of cardiopulmonary bypass. Risk is augmented in patients who are undergoing repeat cardiac procedures with most documented complications occurring during repeat sternotomy. Aortic valve surgery is more complex after coronary artery bypass grafting using internal mammary arteries, and it compounds ...

BACKGROUND: The Michigan Society of Thoracic and Cardiovascular Surgeons (MSTCVS) Quality Collaborative is a voluntary, surgeon-directed quality initiative involving all cardiac surgery programs in Michigan. Understanding that internal mammary artery (IMA) use during coronary artery bypass grafting is an important process measure associated with improved outcomes, this analysis reviews our ...

A 73-year-old patient, who underwent triple bypass surgery in another hospital in 1991 after suffering an acute myocardial infarction, was admitted to our institution after an episode of unstable angina. Evidence of a left internal mammary artery grafted to the great cardiac anterior interventricular vein (GCV), with Qp:Qs > 1.5:1, ...

Performing cardiac surgery on HIV positive patients represents a significant risk of occupational exposure to surgeons and their support staff. In addition, the immunocompromized state of these patients may be a factor which could adversely influence the results. Totally endoscopic coronary artery bypass grafting (TECAB) in HIV patients has not ...

In patients with known coronary artery disease and/or a history of revascularization, angina pectoris or unstable coronary syndromes are usually attributed to the progression of atherosclerotic lesions rather than an unrecognized great vessel disease. However, for patients with a previous coronary artery bypass graft operation (CABG), during which a left ...

We present our reproducible technique of achieving two bypasses from selected pedicled internal thoracic arteries. We feel that awareness of this technical modification is to the benefit of patients.

Pediatric coronary artery bypass is performed for ischemic complications of Kawasaki disease, congenital coronary anomalies, and iatrogenic pediatric coronary artery problems. We performed myocardial revascularization using the internal mammary artery in 6 children. A review of outcomes is presented here. Patient ages ranged from 7 days to 10 years. There ...

Observational data suggest that the use of bilateral internal mammary arteries (BIMA) during coronary artery bypass graft surgery provides superior revascularization to a single internal mammary artery (SIMA), but concerns about safety have prevented the widespread use of BIMA. The Arterial Revascularisation Trial (ART) is a randomized trial of BIMA ...

We discuss an interesting case of a right internal mammary artery pseudoaneurysm discovered after an attempted right internal jugular venous catheter placement. Such injury to the internal mammary artery is a rare complication of traumatic injuries to the chest, sternotomies, and central venous catheter placements. It has been reported after ...

The internal thoracic artery (ITA) has been universally accepted as a superior conduit for patients undergoing coronary artery bypass operations. The harvesting of the ITA is a routine procedure. Rarely, one encounters an ITA densely adherent to the overlying periosteum. We describe a technique of safely harvesting such an ITA ...

We report the case of an 80-year-old male with severe aortic valve stenosis previously submitted to surgical myocardial revascularization with patent mammary graft treated by TAVI through left-transaxillary approach because of unsuitable transfemoral and transapical approaches.

Embolization during diagnostic catheterization is rare. When it occurs, angiographers need to recognize and treat it immediately. Mechanical removal of the embolized material may help restore flow promptly and salvage myocardium. We describe two cases of iatrogenic embolization into the internal mammary artery grafts resulting in left anterior descending artery ...

Robotic skeletonizing and harvesting of the internal thoracic artery, using the da Vinci surgical system, has a number of advantages over robotic pediculed ITA harvesting. The advantages include greater blood flow, a longer conduit, and less bleeding. The technique is facilitated by use of the EndoWrist spatula cautery and fine ...

Aortic valve surgery with a patent left internal mammary artery (LIMA) on the left anterior descending (LAD) coronary artery is challenging in terms of myocardial protection and graft injury. Minimally invasive techniques may require minimal dissection of adhesions and may eventually decrease the risk of injuries. Since 1997, more than ...

We report a case of a patient who had a type A aortic dissection after previous coronary bypass grafting. The in-situ right mammary artery had been anastomosed with the left anterior descending artery, the left mammary artery had been anastomosed to the obtuse marginal, and a vein graft had been ...

Attempts to wire and stent a native coronary artery lesion through a tortuous internal mammary graft can result in graft occlusion, ischemia, and inability to visualize the distal lesion. We report three cases in which treatment of such lesions was successfully completed using two guiding catheters, one of which was ...

Myocardial protection is compromised in patients with a patent internal mammary artery (IMA) graft. We assessed the advantages of systemic hyperkalemia with mild hypothermia for valve surgery in patients with a patent IMA graft. Nine patients (mean age 71.5+/-7.0 years) with a patent IMA graft underwent valve surgery from May ...

The authors present a case of left internal mammary artery graft anastomosis to the anterior interventricular vein leading to congestive heart failure. The patient underwent successful left main stenting using an Impella left ventricular assist device and left internal mammary graft occlusion using two Amplatzer vascular plugs.

Coronary artery bypass surgery is beneficial in patients with complex coronary artery disease. The longevity of the left internal mammary artery (LIMA) placed to the left anterior descending (LAD) artery (LIMA-LAD) is between 92-99% at 15 years, and contributes substantially to the survival advantage in patients treated with surgical revascularization. ...

BACKGROUND: Composite Y-grafts, using the left internal thoracic artery as the inflow, allow a more efficient use of conduits without the need to touch a diseased ascending aorta. Among other conduits, the saphenous vein graft may be an alternative to the radial artery in elderly patients. PATIENTS AND METHODS: We ...

A simple, inexpensive, and easy-to-use method for exposure of the left internal mammary artery is described. Two blades of the conventional four-blade sternal spreader hooking the Adson forceps, which passes through the loops of sternal wires, provides excellent exposure of the IMA. The same retractor is used for the rest ...

In cases where conventional aortocoronary grafts cannot be used, No-React bovine internal mammary artery is a possible alternative. The aim of this study was to assess the patency and clinical performance of bovine internal mammary artery as a coronary bypass conduit, using 64-slice computed tomography coronary angiography. Eleven patients (mean ...

Use of the internal thoracic artery in coronary revascularization confers excellent benefit. We assessed the impact of skeletonization on the incidence of postoperative sternal wound infection in patients undergoing coronary artery bypass grafting. We also investigated whether there is an advantage in using this technique when harvesting both internal thoracic ...

We describe the technical details and the preliminary results of a new surgical approach for multivessel disease that involves using a lower T sternotomy, grafting of the left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD) and use of the right internal mammary artery (RIMA) as ...