Internal thoracic artery-inferior epigastric artery as a collateral pathway in aortoiliac occlusive disease Mehmet Yurdakul, MD, Muharrem Tola, MD, Ensar.

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Presentation transcript:

Internal thoracic artery-inferior epigastric artery as a collateral pathway in aortoiliac occlusive disease Mehmet Yurdakul, MD, Muharrem Tola, MD, Ensar Özdemir, MD, Murat Bayazit, MD, Turhan Cumhur, MD Journal of Vascular Surgery Volume 43, Issue 4, Pages 707-713 (April 2006) DOI: 10.1016/j.jvs.2005.12.042 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 Right common iliac artery occlusion in a 65-year-old man. A, Abdominal aortogram reveals occlusion of right common iliac artery. There is faint reconstitution of the distal external iliac artery on the right via the deep circumflex iliac artery (arrow) that is due to partial washout of contrast material by unopacified blood from the ipsilateral of the internal thoracic artery-inferior epigastric artery (ITA-IEA) collateral. B, Selective angiography of the right subclavian artery demonstrates anastomosis between the ITA-IEA (arrow) via the superior epigastric artery, reconstituting the right external iliac artery. C, Color duplex ultrasonography shows monophasic spectral pattern in the IEA. The flow was measured as 126 mL/min in the IEA and 262 mL/min in the femoral artery, the contribution of the ITA-IEA collateral to lower-extremity perfusion is calculated to be 48%. Journal of Vascular Surgery 2006 43, 707-713DOI: (10.1016/j.jvs.2005.12.042) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 Correlation between internal thoracic artery (ITA) and inferior epigastric artery (IEA) blood flow (r = 0.55, P < .0001). Journal of Vascular Surgery 2006 43, 707-713DOI: (10.1016/j.jvs.2005.12.042) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 Scattergram illustrates the proportion of contribution of the internal thoracic artery (ITA)-inferior epigastric artery (IEA) collateral pathway to lower-extremity perfusion vs ITA-IEA flow. Local linear regression curve indicates that mean maximum flow is 85 mL/min. Journal of Vascular Surgery 2006 43, 707-713DOI: (10.1016/j.jvs.2005.12.042) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 4 Graph shows the flow in the internal thoracic artery-inferior epigastric artery (IEA) collateral according to their level of occlusion (1-abdominal aorta, 2-common iliac artery, 3-external iliac artery). The o shows the extremes of the data. Journal of Vascular Surgery 2006 43, 707-713DOI: (10.1016/j.jvs.2005.12.042) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 5 Graph shows the proportion of contribution of the internal thoracic artery-inferior epigastric artery collateral pathway to lower-extremity perfusion according to their level of occlusion (1-abdominal aorta, 2-common iliac artery, 3-external iliac artery). Whiskers represent median ± SD.. Journal of Vascular Surgery 2006 43, 707-713DOI: (10.1016/j.jvs.2005.12.042) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 6 Schematic view of the collateral circulation via the internal thoracic and epigastric arteries in occlusion of the left common and external iliac arteries. ITA, Internal thoracic artery; SEA, superior epigastric artery; IEA, inferior epigastric artery. Journal of Vascular Surgery 2006 43, 707-713DOI: (10.1016/j.jvs.2005.12.042) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions