When collateral vessels matter: asymptomatic Leriche syndrome

We describe a case of aortic coarctation at the level of the infrarenal abdominal aorta which is encountered in less than six individuals in one million. In contrast to aortic narrowing above or including the renal arteries, this seems to be a relatively benign anomaly without systemic hypertension or impaired renal function. For the first time in this type of anomaly, contrast-enhanced MR angiography (ce-MRA) on a multi-receiver channel MR system, with an 8-channel phased array coil and parallel imaging was used. Ce-MRA displayed a tortuous, narrowed aortic segment that was found to be associated with mesenteric artery stenosis and compression of the orthotopic left renal vein, also known as the nutcracker phenomenon. All major aortic branches could be depicted using 3D surface-shaded displays and subvolume maximum intensity projections (MIPs). Collateral vessels of the abdominal wall were identified using whole-volume MIPs. Since the majority of aortic malformations are diagnosed at a younger age, and many suffer from renal insufficiency, we conclude that ce-MRA will eventually place conventional DSA as the modality of choice in malformations of the abdominal aorta.

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Nonsurgical treatment of patients with leriche syndrome

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0029-1191512 ◽

2009 ◽

Vol 56 (S 01) ◽

Author(s):

H Krankenberg ◽

H Reichenspurner ◽

M Ismail ◽

T Tübler

Keyword(s):

Nonsurgical Treatment ◽

Leriche Syndrome

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Preinfarction Angina and Improved Reperfusion of the Infarct-related Artery

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615557 ◽

1999 ◽

Vol 82 (S 01) ◽

pp. 68-72 ◽

Cited By ~ 2

Author(s):

Alessandro Sciahbasi ◽

Eugenia De Marco ◽

Attilio Maseri ◽

Felicita Andreotti

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Infarct Size ◽

Ischemic Preconditioning ◽

Early Reperfusion ◽

Vast Number ◽

Beneficial Effects ◽

Infarct Related Artery ◽

Cardioprotective Effects ◽

Collateral Vessels

SummaryPreinfarction angina and early reperfusion of the infarct-related artery are major determinants of reduced infarct-size in patients with acute myocardial infarction. The beneficial effects of preinfarction angina on infarct size have been attributed to the development of collateral vessels and/or to post-ischemic myocardial protection. However, recently, a relation has been found between prodromal angina, faster coronary recanalization, and smaller infarcts in patients treated with rt-PA: those with preinfarction angina showed earlier reperfusion (p = 0.006) and a 50% reduction of CKMB-estimated infarct-size (p = 0.009) compared to patients without preinfarction angina. This intriguing observation is consistent with a subsequent observation of higher coronary recanalization rates following thrombolysis in patients with prodromal preinfarction angina compared to patients without antecedent angina. Recent findings in dogs show an enhanced spontaneous lysis of plateletrich coronary thrombi with ischemic preconditioning, which is prevented by adenosine blockade, suggesting an antithrom-botic effect of ischemic metabolites. Understanding the mechanisms responsible for earlier and enhanced coronary recanalization in patients with preinfarction angina may open the way to new reperfusion strategies.A vast number of studies, globally involving ≈17,000 patients with acute myocardial infarction, have unequivocally shown that an infarction preceded by angina evolves into a smaller area of necrosis compared to an infarct not preceded by angina (Table 1) (1). So far, preinfarction angina has been thought to have cardioprotective effects mainly through two mechanisms: collateral perfusion of the infarctzone (2-4), and ischemic preconditioning of the myocardium (5-7). Here we discuss a further mechanism of protection represented by improved reperfusion of the infarct-related artery.

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Depression of Collateral Blood Flow Following Arterial Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651903 ◽

1977 ◽

Vol 38 (04) ◽

pp. 0850-0862 ◽

Cited By ~ 1

Author(s):

Robert G. Schaub ◽

Ronald Sande ◽

Kenneth M. Meyers

Keyword(s):

Blood Flow ◽

Arterial Thrombosis ◽

Hind Limb ◽

Therapeutic Interventions ◽

Collateral Blood Flow ◽

Serotonin Antagonist ◽

Limb Perfusion ◽

Clinical Consequences ◽

Collateral Vessels ◽

Iliac Bifurcation

SummaryPermanent ligation of the feline aorta at the iliac bifurcation is followed by rapid opening of pre-existing collateral blood vessels. However, if ligation is combined with formation of a clot, these protective collateral vessels do not function. This study was undertaken to determine if drugs which alter serotonin function can improve collateral blood flow after arterial thrombosis. Permanent ligations were placed at the iliac bifurcation, circumflex iliac and sixth lumbar arteries in all cats. A clot was produced in the aorta of 27 cats by injection of 0.1 ml of thromboplastin. Ligated clot-occluded cats were untreated (10); had blood serotonin depleted using a single dose of reserpine (0.1 mg/kg i. m.) followed by para-chlorophenylanine (p-CPA) (100 mg/kg orally) every 3 days (9) ; or were treated prior to surgery with a serotonin antagonist cinanserin HC1 (4 mg/kg i. v.) (8). Control cats (18) were acutely ligated. 9 of these cats were untreated, 5 were cinanserin HC1-treated, and 4 were reserpine/p-CPA-treated. Extent of collateral development was assessed by aortograms 3 days after occlusion and by neurologic rating. Aortograms of acutely ligated cats indicated a significant collateral blood flow around the segment of ligated aorta, while ligated clot-occluded cats had a severely depressed hind-limb perfusion. Reserpine/p-CPA-treated ligation clot-occluded cats had aortograms similar to acutely ligated cats. The cinanserin HC1-treated ligation clot-occluded cats had aortograms which indicated hind-limb perfusion was not as adequate as the acutely ligated cats. However, the perfusion of these animals was improved over untreated ligation clot-occluded cats. Neurologic rating correlated with aortograms. These results suggest: 1) the clinical consequences of arterial thrombosis cannot be entirely attributed to mechanical occlusion of an artery, but may be due to depression of protective collateral blood flow induced by thrombosis, 2) serotonin is an important factor in this depression of collateral blood flow, and 3) isolation of the factors responsible for collateral inhibition could permit the development of therapeutic interventions.

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Transarterial chemoembolization through collateral vessels in hepatocellular carcinoma

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1993.29.6.1220 ◽

1993 ◽

Vol 29 (6) ◽

pp. 1220

Author(s):

Ji Hye Kim ◽

Joon Koo Han ◽

Jin Wook Chung ◽

Jae Hyung Park ◽

Man Chung Han

Keyword(s):

Hepatocellular Carcinoma ◽

Transarterial Chemoembolization ◽

Collateral Vessels

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Significance of collateral vessels on the prediction of superior vena cava syndrome on CT

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1993.29.4.704 ◽

1993 ◽

Vol 29 (4) ◽

pp. 704

Author(s):

Hyun Sook Kim ◽

Hyung Jin Kim ◽

Hyeng Gon Lee ◽

In Oak Ahn ◽

Sung Hoon Chung

Keyword(s):

Superior Vena Cava ◽

Superior Vena Cava Syndrome ◽

Superior Vena ◽

Vena Cava ◽

Vena Cava Syndrome ◽

Collateral Vessels

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The Clinical and Vascular Characteristics of RNF213 c.14576G>A Variant-Related Intracranial Major Artery Disease in China

Behavioural Neurology ◽

10.1155/2019/7908392 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Weiyang Cheng ◽

Sufang Xue ◽

Fang Wu ◽

Xiaowei Song ◽

Qiang Huang ◽

...

Keyword(s):

Ring Finger ◽

Image Data ◽

Chinese Patients ◽

Outer Diameter ◽

Ring Finger Protein ◽

Collateral Vessel ◽

Intracranial Atherosclerotic Disease ◽

Significant Difference ◽

Artery Disease ◽

Collateral Vessels

Background and Purpose. Recently, several studies indicated the c.14576G>A variant on the ring finger protein 213 (RNF213), a founder variant of moyamoya diseases (MMD), was associated with non-MMD intracranial major artery stenosis/occlusion (non-MMD ICASO). We proposed that RNF213 variant-related ICASO including MMD might be a special entity with its own characteristics based on a genetic background. The aim of the study was to learn the clinical and vascular features of RNF213 variant-related ICASO. Moreover, we tried to explore the clinical significance of a testing variant in ICASO patients in China. Methods. Clinical material and routine image data were collected in 160 Chinese patients with ICASO, including 41 verified MMD and 119 non-MMD. DNA samples were extracted, and the c.14576G>A variant on RNF213 was genotyped. Then, the clinical and vascular features were compared between the patients with and without a relevant variant. Furthermore, the patients with RNF213 mutation were performed with high resolution magnetic resonance imaging (HR-MRI) examination to conclude features of the artery wall. Results. There were 16 (10%) patients (including 9 MMD and 7 non-MMD ICASO) presenting a heterozygous c.14576G>A variant while none of homozygote was found. Compared to the patients without the c.14576G>A variant, the variant group had more female, less symptomatic patients, and more possibility of having collateral vessels in vascular imaging. In the symptomatic subgroup, there is no significant difference in clinical presentation (p>0.05) between two groups. However, RNF213 variant-related ICASO had lower scores in NIHSS (1.0±3.0 vs. 3.9±5.0, p<0.05) but not in mRS. In the symptomatic subgroup, in addition, most of the HR-MRI images of variant ICASO (77.8%, 7 of 9) were characterized by a shrunken outer diameter, concentric thickening vessel wall, and collateral vessel structures on the stenotic portion, which was prone to be diagnosed as HR-MMD (a MMD diagnosis diagnosed by HR-MRI). The rest of the two variants showed a relatively eccentric luminal narrow, normal outer diameter without collateral vessel findings, identified as HR-ICAD (intracranial atherosclerotic disease diagnosed by HR-MRI). Conclusions. Our study demonstrated that the c.14576G>A variant on RNF213 may be a biomarker to good outcome of ICASO in Chinese. The variant-related ICASO was characterized by both features of MMD and ICAD diagnosed by HR-MRI.

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