Features of morphometric parameters of vessels in the human portal venous system identified by multislice computed tomography

The aim of this study was to identify the morphometric features of the human portal venous system by means of multislice computed tomography (MSCT).Materials and methods. A contrast X-ray study of the portal vein was carried out in 53 men who were treated in the surgical departments of the Krasnoyarsk Regional Hospital No. 1. The average age of the patients was 54.9 ± 1.7 years (36–71 years). Measurements were performed on 3D models of the vascular bed in the portal venous system (GE Advantage Workstation and Siemens singo.via workstations). Branching patterns, length, diameter, angle of the portal vein formation relative to the midline of the human body, and angles of formation of the vessels forming the portal vein in the frontal plane were evaluated.Results. Variations in the morphometric parameters of the intrahepatic vessels of the portal vein are obvious, although the branching patterns are not diverse and are reduced to one type – the magistral pattern (according to V.N. Shevkunenko). The veins that form the portal vein are represented by three systems, each of which has a stem and tributaries that differ in branching patterns and other morphological characteristics.Conclusion. The findings of the study made it possible to supplement the scientific materials regarding branching patterns and morphological characteristics of the portal vein and its tributaries as well as to use the morphometric characteristics of the superior and inferior mesenteric and splenic veins to resolve the issues of surgical intervention on the abdominal organs.

The Pattern of Facial Nerve Branching: A Cadaveric and Clinical Study

Background: Thorough understanding of the branches of the facial nerve is critical during parotidectomy. Many variations of the branching patterns have been observed among different populations. The objective of this study was to determine the different branching patterns in a Sudanese population. Materials and Methods: A total of 90 facial nerves were dissected. There were 40 cadavers (bilateral) and 10 patients (unilateral) who underwent parotidectomy. Only specimens with benign parotid pathology with intact facial nerve were included. Out of the 90 facial nerves examined, 41 were males and 9 females. Forty-six specimens (51%) were left; and 44 (49%) were right facial nerves. Facial nerve branching patterns were classified into 5 types as described by Katz and Kopuz. Results: The most common branching pattern was type III found in 42 cases (46.6%). The second most common was type I which was seen in 18 cases (20%). This is the most common type reported in the literature. Types II, IV, and V were found to be 8.8%, 12.2%, and 11% respectively. Conclusion: Facial nerve branching patterns are very variable and can be very complex. Significant differences exist between races. Surgeons who perform parotidectomy should be very familiar with these differences to avoid surgical misadventures.

Computed Tomographic Analysis of Aortic Arch Branching Patterns - Revisited

Background /ObjectivesBranching pattern of aortic arch (AA) has a direct impact on the outcome of thoracic surgical and angiographic procedures. Geographical variations in the branching pattern of AA has been described. Hence, this descriptive cross sectional study describes the AA variations in a Sri Lankan population compared to the available global statistics.MethodsContrast-enhanced computed tomographic studies (CTC) of thorax (n=219) performed in males (49.3%) and females (50.7%); aged 59±17 years (range: 4 to 96 years), were evaluated. Branching patterns of AA were categorized into seven types as described by Popieluszko et al.ResultsFour AA types were identified in the study population: Type 1 (90%; n=197), Type 2 (n=10, 4.6%), Type 3 (n=8, 3.7%) and Type 6 AA (n=4; 1.8%). The prevalence of AA variations was 10%. Type 1 was the most prevalent pattern in both genders: female-91%; males-88.9%. The most prevalent AA variant in females was Type 2 (n=6; 5.4%); males Type 3 (n=5; 4.6%). However, the branching pattern of AA has not demonstrated a significant gender influence (Odds: 0.792; 95% CI: 0.327 - 1.917; p=0.605). ConclusionVariations in branching pattern of AA is as high as 10% among Sri Lankans. Thus, an in-depth knowledge on population specific prevalence of AA variants would influence the modifications surgical approaches and the choice of angiographic catheters to be utilized, which in turn, would minimize inadvertent vascular injuries during thoracic surgical and angiographic interventions.

Branching patterns and anatomical variations of human aortic arch in Indian population

Knowledge of the aortic arch branching pattern is important during supra-aortic angiography, aortic instrumentation, thoracic and neck surgery. The aortic arch (AA) is located in the superior mediastinum. In 65–80% of the cases, the three branches arise from the aortic arch, namely, the brachiocephalic trunk (BCT), the left common carotid artery (LCCA), and the left subclavian artery (LSA). The purpose of this study is to describe different branching patterns of the arch of the aorta in Indian subjects. This observational study is based on dissection performed on Sixty embalmed arches of the aorta in adult Indian cadavers (in manuscript it was written as, 20 dissected heart specimens were collected of still-born fetuses) were exposed and their branches examined during cadaveric dissection in the department of Anatomy. The anatomical variations of the arch of the aorta and its branches, its branches at site of origin, and the distance of each branch from the point of origin to the median plane were measured. The usual three-branched pattern of arch of aorta was found in 44 specimens (73.33%). The common trunk for both brachiocephalic trunk and left common carotid artery was present in 11 specimens (18.33%). In 2 specimens (3.33%), the arch gives four branches. In 1 specimen (1.67%), give three branches. The wide spectrum of variations in the anatomical arrangement of the human aortic arch and its branches offer valuable information to catheterize the aortic arch and its branches for safely performing endovascular surgery. These anatomical and morphologic variations in the arch of the aorta and its branches are significant for diagnostic and surgical procedures in the thorax, head and neck regions.

The congenital popliteal vasculature patterns in fibular free flap reconstruction by means of surgical anatomy in cadavers

Fibular free flap (FFF) is frequently used for reconstruction requiring vascularized bone. Thus, understanding its vasculature variation is crucial. This study investigates the popliteal artery branching variations in Thai cadavers and compares them with previous studies. One hundred and sixty-two legs from 81 formalin-embalmed cadavers were dissected. The popliteal artery branching patterns were classified. The previous data retrieved from cadaveric and angiographic studies were also collected and compared with the current study. The most common pattern is type I-A (90.7%). For the variants, type III-A was the majority among variants (6.2%). Type IV-A, hypoplastic peroneal artery, was found in one limb. A symmetrical branching pattern was found in 74 cadavers. Compared with cadaveric studies, type III-B and III-C are significantly common in angiographic studies (p = 0.015 and p = 0.009, respectively). Type I-A is most common according to previous studies. Apart from this, the prevalence of type III-A variant was higher than in previous studies. Furthermore, type III-B and III-C are more frequent in angiographic studies which might be from atherosclerosis. Thus, if the pre-operative CTA policy is not mandatory, the patients at risk for atherosclerosis and population with high variants prevalence should undergo pre-operative CTA with cost-effectiveness consideration.

EP.WE.78Variation in the Branching Pattern of the Anterior Branches of the External Carotid Artery

Aims The external carotid artery (ECA) shows a variable branching pattern of its stemming vessels. The aim of this study is to investigate the origin of the three primary anterior branches of the external carotid artery (ECA): the superior thyroid (STA), lingual (LA), and facial arteries (FA). Methods The branching pattern of the external carotid artery was studied on 15 Thiel embalmed cadavers of Scottish population (7 males and 8 females). The carotid triangle was dissected bilaterally in order to uncover the common carotid (CCA), internal carotid (ICA) and external carotid arteries (ECA). Moreover, the origin sites of the main anterior branches of the ECA (STA, LA and FA) were assessed in relation to the carotid bifurcation (CB) and with regard to sex and side. Results The STA was found to arise more frequently from the ECA (60%) than from the CCA (40%). Regarding the assessment of the branching patterns of the external carotid artery, the specimens where the STA, LA and FA emerged as individual branches were 90% of cases. The distances from the vessel origin site to the CB were found to be (8.11 ± 2.77), (19.38 ± 8.85) and (27.95 ± 10.15), for the STA, LA, and FA respectively. Conclusions In-depth knowledge of the branching pattern of the external carotid artery is of great importance. The current findings have confirmed that the ECA branching pattern is highly variable. Therefore, considering some radiological imaging before conducting any invasive procedure in the neck region could be vital to prevent iatrogenic injuries.

Novel Classification of the Branching Patterns of the Superficial Branch and the Deep Branch of the Superficial Circumflex Iliac Artery and the Superficial Inferior Epigastric Artery on Computed Tomographic Angiography

Background Recent advances in the superficial circumflex iliac artery (SCIA) perforator flap transfer emphasized the necessity to comprehensively understand the lower abdominal vasculature. This study aimed to clarify the relationship among the superficial inferior epigastric artery (SIEA), the superficial branch (SCIAs), and the deep branch (SCIAd) of the SCIA. Methods Computed tomographic angiography was retrospectively reviewed in 312 hemiabdomens in 161 female patients who underwent abdominal flap breast reconstruction. We assessed the presence, caliber, and branching patterns of the SCIA branches and the SIEA. Results The SIEA-SCIA common trunk was present in 40.1% of the hemiabdomen and was identified in either side of the abdomen in 63.6% of patients. At least one superficial vessel larger than 1.5 mm was found in 61.5% of hemiabdomens. Seven branching patterns of the SCIA-SIEA system were noted: (1) the SCIA and the SIEA originated together (17.0%); (2) the SIEA and the SCIAs shared an origin (22.8%), (3) the SCIA and the SIEA branched separately (17.0%), (4) each artery originated separately (8.0%); (5) the SCIAs and the SCIAd emerged together with the SIEA absent (17.3%); (6) the SCIAs and the SCIAd originated separately with the SIEA absent (13.1%); (7) the SIEA and SCIAd originated separately with the SCIAs absent (3.5%). Conclusion SCIA-SIEA branching patterns were classified into seven distinctive patterns. This novel classification may help surgeons to choose the optimal pedicle when using the hemi-abdomen region as the donor site.