Transarterial chemoembolization in a patient with the replaced right hepatic and left gastric arteries arising from the abdominal aorta: a new anatomical variation

PURPOSE

Knowing the anatomical variation of the coeliac trunk (CT) and its detailed interpretation in the preoperative period is important for the prevention of iatrogenic injury during liver surgery or endovascular intervention on the coeliac trunk and its branches.

METHODS

A diagnostic abdominal computed tomography angiography (CTA) was performed in a 61-year-old male patient, who was investigated for a liver cancer and chemoembolization was planned.

RESULTS

CTA reveals that right hepatic artery (RHA) arises directly from the abdominal aorta, at the level of CT. This vessel coursing to the right hepatic lobe, functioning therefore as a replaced right hepatic artery (RRHA). Also, the left gastric artery (LGA) arises directly from the abdominal aorta. This patient successfully underwent chemoembolization from RRHA.

CONCLUSION

We presented a case of new anatomical variation involving the origination of RRHA and LGA from the abdominal aorta.

Hidden Brain Anatomy in Peter Paul Rubens's Copy of "The Battle of Anghiari" by Leonardo da Vinci: "The Battle of Anghiari" and Brain Anatomy

The object of this article is a drawing by Peter Paul Rubens, a copy of "The Battle of Anghiari" by Leonardo da Vinci in 1503-1506. This work, created in 1603, was based on an engraving of 1553 by Lorenzo Zacchia, which was taken from a cartoon by Leonardo da Vinci. The original fresco itself is lost. The analysis of the drawing shows that the Peter Paul Rubens's copy of "The Battle of Anghiari" by Leonardo da Vinci, which was created six centuries ago, includes double content. The drawing depicting the battle secretly describes the three-dimensional image of the brain.

Skull Anatomy in "Saint Jerome in the Wilderness" by Leonardo da Vinci

As a result of a detailed study of "Saint Jerome in the Wilderness", we found that Leonardo described the skull in this work in an original way. A portion of the skull's face is visible in St Jerome's chest and abdomen projection. This image shows the orbit, the frontal bone, the nasal aperture and the zygomatic process. In our opinion, Leonardo described the skull in the painting with his usual originality.

180-degre carotid bifurcation with an internal carotid artery aneurysm

PURPOSE

Internal carotid artery (ICA) aneurysm is a rare pathology. In the clinical case we present, the patient had an ICA aneurysm as well as a rare anatomical variant of the carotid bifurcation.

METHODS

We present the case of a 45 year old man, who had two episodes of TIA revealed by loss of mind. Computed tomography revealed the fusiform aneurysm of a left ICA in the first segment with maximal diameter of 16 mm. There were no thrombotic mass in the dilated area. The carotid bifurcation angle was 180 degree. Although the aneurysm did not contain a thrombus mass, it was considered the source of the TIA because of turbulent blood flow.

RESULTS

Distal and proximal ligation was performed. A 5-cm long graft from the great saphenous vein was used for ICA revascularization from common carotid artery.

CONCLUSION

In our case, geometry of carotid bifurcation may have contributed to the ICA aneurysm, although there is no evidence for this correlation.

Artificial intelligence's interpretation of the neuroanatomical aspect of Peter Paul Rubens's copy of "The Battle of Anghiari" by Leonardo da Vinci

We tested to see how Ruben's copy of "The Battle of Anghiari" by Leonardo da Vinci would be interpreted by AI in a neuroanatomical aspect. We used WOMBO Dream, an artificial intelligence (AI)-based algorithm that creates images based on words and figures. The keyword we provided for the algorithm was "brain" and the reference image was Ruben's drawing. AI interpreted the whole drawing as a representation of the brain. The image generated by the algorithm was similar to our interpretation of the same painting.

Hidden Cardiovascular Anatomy in "Saint John the Baptist" by Leonardo da Vinci

Leonardo da Vinci conducted many anatomical studies during his life. Today, almost the complete set of these anatomical drawings and comments is owned by the British Crown and resides in the Royal Library at Windsor Castle, United Kingdom.Through the program Paint X, we moved two details on the painting "Saint John the Baptist." The moving details are circled along the faint contour by Leonardo da Vinci himself. We obtained heart and aortic arch imaging.

Cardiac anatomy in the 'Dreyfus Madonna' by Leonardo da Vinci

Leonardo's findings on the anatomy and physiology of the heart, preserved in his private sketches and notes, reveal a remarkable period of transition in the early history of cardiology. The object of this research is a 'Dreyfus Madonna'. Through the programme Paint X, we moved 1 detail (blue marked) in the direction of the green arrow and we get an image of the heart with branches of the aortic arch. If we compare the image of the heart obtained by us with the anatomical sketch of Leonardo (RL 19073-74v; K/P 1 66v), we will see a sharp resemblance to the branches of the aortic arch.

Left Ventricular Myxoma with Embolization Causes Acute Infrarenal Aortic Occlusion

Atrial myxoma is the most common benign tumor of the heart; moreover, atrial myxoma embolization to the peripheral vessels is rare. We present an unusual case of total acute infrarenal aortic occlusion resulting from embolic implantation from a left ventricular myxoma. A 37-year-old man with acute lower limbs ischemia, spinal cord ischemia, and acute renal insufficiency was urgently operated and discharged after surgery.

Aortofemoral Reconstruction for an Infected Graft Using Thrombosed Femoral Veins

INTRODUCTION

Treatment of an infected aortic prosthesis is difficult and the ideal graft material is subject to debate.

REPORT

A case of infected aortic prosthesis treated using bilateral thrombosed superficial femoral veins (SFVs) is presented. Bilateral reversed SFVs were cut longitudinally at both proximal ends about 3-4 cm and were sutured side by side. The operating time was 5 h. No sign of recurrent infection was observed when the patient suffered a myocardial infarction and died 6 months post-operatively.

DISCUSSION

Thrombosed SFVs may be considered as a therapeutic option for infected aortic graft replacement.

Basilic Vein Elevation for Arteriovenous Fistula Creation: Results of 60 Cases Following 1 Year

Basilic vein elevation (BVE) is a procedure where the basilic vein (BV) is surgically exposed, mobilized, and elevated into a more superficial position for the purpose of facilitating arteriovenous fistula (AVF) cannulation. The purpose of this study is to review the use of BVE as an adjunct to fistula maturation. Between January 2009 and December 2013, 60 patients received BVE. After performing the anastomosis between brachial artery and BV, the elevated vein was placed just anterior to the surgical incision, 3 to 4 mm deep. Patients' morbidity, mortality, and patency rates were evaluated. The 90-day mortality was 0%. Maturation rates were 91.6%. The mean time to maturation was 52 days (range, 25-75 days). Primary patency rate at 12 months was 90% and secondary patency rate was 95%. The mean vein size was 4.5 ± 0.5 mm. AVF surgery via BVE offers satisfactory results in patients with chronic hemodialysis.

Anatomical repair of a congenital aneurysm of the distal abdominal aorta in a newborn

Congenital (primary) neonatal abdominal aortic aneurysm (AAA) is an extremely rare truncular arterial abnormality among numerous congenital vascular malformations. Only seven cases have been reported as congenital origin in newborns. This report presents the case of a male infant in whom a 33-mm congenital AAA was diagnosed prenatally and was successfully treated 10 days after birth without exogenous graft material or aneurysmorrhaphy. Follow-up study at 39 months demonstrated excellent clinical, ultrasound scan, and computed tomography scan findings. Anatomic reconstruction with native vessels is the preferred surgical technique to ensure the child's potential for harmonious growth.

Foot venous system arterialization for salvage of nonreconstructable acute ischemic limb: a case report

Patients 73 years old man, was admitted to the Hospital with acute ischaemia of the left lower limb, pain started 4 days ago. Ultrasound investigation and lower limbs angiography were performed. Giant infrapopliteal aneurysm and thrombosis due to massive embolism of the crural and pedal arteries' was revealed. In order to keep the limb, urgent surgical treatment--popliteal aneurysm ligation and foot venous system arterialisation was performed. Urgent venous arterialisation may be considered as viable alternative in patients with limb acute ischaemia, when arterial reconstruction is impossible to perform. In our case improvement of the foot perfusion during 8 days increases the interest to this technique.

Petrous carotid artery's in situ bypass: anatomic study

The purpose of our study was to reveal the possibility of cervical-to-petrous carotid artery in situ bypass with maximum preservation of cranial nerves. Four human cadavers prepared in formalin were investigated. Eight surgical approaches were used (bilateral exposure on each cadaver). The skin incision started from the level of the temporomandibular joint. The VII, IX, X, and XII cranial nerves, starting from the stylomastoid angle, were maximally preserved. Resection of the styloid process, subluxation of the mandibular joint, and milling of tympanic bone revealed the petrous carotid artery. Exposure of the carotid bifurcation was performed with a mini-skin incision. After dividing the petrous internal carotid artery (ICA) and the cervical ICA, the cervical ICA was dilated using a Fogarty catheter to simulate aneurysmal dilatation. The patient's saphenous vein after stripping was utilized for the bypass. The vein was passed into the lumen of the dilated cervical ICA, and a cervical-to-petrous carotid bypass was performed. In each case, the described technique made it possible to expose the intrapetrous carotid artery adequately. In two cases it was impossible to make a luxation, and therefore the mandibular branch was resected. The vertical segment's mean length was 12 mm (range 10-15 mm). In all cases, the VII, IX, X, and XII cranial nerves were preserved maximally. The main points of the approach are luxation of the mandibular articulation and milling of the tympanic bone. Our study in cadavers suggests the possibility of petrous carotid artery bypass without exposing the cervical ICA.