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Tip SWM, Lee YT, Tang PH, Chang KTE, Soh SY, Tan AM, Loh AHP. Retroperitoneal tumors and congenital variations in vascular anatomy of retroperitoneal great vessels. J Pediatr Surg 2019; 54:2112-2116. [PMID: 30765156 DOI: 10.1016/j.jpedsurg.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/20/2018] [Accepted: 01/03/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND/OBJECTIVES Variations in vascular anatomy (VIVAs) of the retroperitoneal great vessels are uncommon but can potentially complicate surgical procedures and negatively affect treatment outcomes, yet their incidence and clinical impact are poorly studied. We sought to assess the incidence and clinical impact of VIVAs of retroperitoneal great vessels in patients with retroperitoneal tumors. METHODS We retrospectively analyzed imaging, surgical, treatment and survival data of all pediatric patients with retroperitoneal tumors who underwent resection between January 2007 and October 2016, comparing preoperative scans with corresponding intraoperative observations, and subsequent surgical outcomes. RESULTS Among 66 children with renal, adrenal and paravertebral tumors, 6 (9%) had retroperitoneal VIVAs. Retroperitoneal VIVAs were present only with right-sided tumors and significantly associated with more frequent intraoperative complications (P = 0.013). While the presence of retroperitoneal VIVAs was not directly associated with survival outcomes, relapse was more frequent in patients with VIVAs (33%) than those without (18.3%, P = 0.378), and relapse was also associated with lower overall and event-free survival (P < 0.001). CONCLUSIONS VIVAs of retroperitoneal great vessels occurred in 9% of our patients with retroperitoneal tumors. Retroperitoneal VIVAs were associated with higher rates of intraoperative complications and disease relapse but was not directly related to survival outcomes. TYPE OF STUDY Retrospective review study. LEVEL OF EVIDENCE Level III Retrospective comparative study.
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Affiliation(s)
- Sai Woon Merng Tip
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Phua Hwee Tang
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Kenneth Tou En Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Shui Yen Soh
- Department of Paediatric Subspecialties, Haematology and Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Ah Moy Tan
- Department of Paediatric Subspecialties, Haematology and Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Amos Hong Pheng Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
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Sollazzo V, Luglio G, Esposito E, Di Micco R, Giglio MC, Peltrini R, Schettino P, Amato B, De Palma GD, Limite G. Venous anomalies of the axilla: a single-institution experience. Aging Clin Exp Res 2017; 29:139-142. [PMID: 27878556 DOI: 10.1007/s40520-016-0673-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/03/2016] [Indexed: 11/25/2022]
Abstract
AIM Surgical treatment is still the cornerstone in the treatment of breast cancer, a very common neoplasia, particularly affecting the female elderly population. Axillary dissection is crucial in the treatment of some tumours, but variations in axillary vessels anatomy are poorly described in standard anatomy and surgical textbook. We aimed to describe anatomical variations in axillary vessels found in our institutional experience. PATIENTS AND METHODS A prospective 3-year study was conducted in our institution from January 2012 to December 2014. Sixty-one consecutive axillary lymph node dissections (ALNDs) were performed in 61 patients who underwent surgery for stage II and III invasive breast cancer. Anatomical details of axillary vascular anatomy and its variations have been evaluated, described and stored in a prospective database. RESULTS Sixty-one ALNDs have been performed in the study period. The anatomy of lateral thoracic vein, angular vein and axillary vein was studied and compared with standard anatomical description. Eighteen percentage of venous variations were found out of the 61 dissection performed. CONCLUSIONS Vascular anatomy of axilla is complex and variable. A better knowledge of all possible variations might be helpful in preventing injuries during ALND.
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Affiliation(s)
- Viviana Sollazzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Gaetano Luglio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Emanuela Esposito
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Rosa Di Micco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberto Peltrini
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Pietro Schettino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Gennaro Limite
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
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Kokkalis ZT, Tolis KE, Megaloikonomos PD, Panagopoulos GN, Igoumenou VG, Mavrogenis AF. Aberrant Radial Artery Causing Carpal Tunnel Syndrome. Arch Bone Jt Surg 2016; 4:282-284. [PMID: 27517078 PMCID: PMC4969379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 01/16/2016] [Indexed: 06/06/2023]
Abstract
Anatomical vascular variations are rare causes of carpal tunnel syndrome. An aberrant medial artery is the most common vascular variation, while an aberrant radial artery causing carpal tunnel syndrome is even more rare, with an incidence ranging less than 3%. This article reports a patient with compression of the median nerve at the carpal tunnel by an aberrant superficial branch of the radial artery. An 80- year- old man presented with a 5-year history of right hand carpal tunnel syndrome; Tinel sign, Phalen test and neurophysiological studies were positive. Open carpal tunnel release showed an aberrant superficial branch of the radial artery with its accompanying veins running from radially to medially, almost parallel to the median nerve, ending at the superficial palmar arterial arch. The median nerve was decompressed without ligating the aberrant artery. At the last follow-up, 2 years after diagnosis and treatment the patient is asymptomatic.
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Affiliation(s)
- Zinon T Kokkalis
- Department of Orthopaedics, National and Kapodistrian University of Athens, ATTIKON University Hospital, Athens, Greece
| | - Konstantinos E Tolis
- Department of Orthopaedics, National and Kapodistrian University of Athens, ATTIKON University Hospital, Athens, Greece
| | - Panayiotis D Megaloikonomos
- Department of Orthopaedics, National and Kapodistrian University of Athens, ATTIKON University Hospital, Athens, Greece
| | - Georgios N Panagopoulos
- Department of Orthopaedics, National and Kapodistrian University of Athens, ATTIKON University Hospital, Athens, Greece
| | - Vasilios G Igoumenou
- Department of Orthopaedics, National and Kapodistrian University of Athens, ATTIKON University Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- Department of Orthopaedics, National and Kapodistrian University of Athens, ATTIKON University Hospital, Athens, Greece
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Buisman WJ, Ünlü Ç, de Boer SW, Bos WJ, Nieuwenhuijs JL, Wille J. An undetected common renal arterial trunk: surgical consequences and morbidity analysis. Surg Radiol Anat 2016; 38:1111-1114. [PMID: 26861012 DOI: 10.1007/s00276-016-1638-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 01/29/2016] [Indexed: 11/27/2022]
Abstract
We present a patient with a recurrent precaval left renal artery, stemming from a right-sided common trunk renal artery. The patient was a 44-year male who presented with a post-traumatic grade IV renal injury. After 3 months without renal function improvement and repeated urinary tract infection, a laparoscopic nephrectomy of the affected right kidney was performed, without upfront identification of the vascular variation, resulting in ischemia of the remaining left kidney. An anastomosis of the common renal trunk and the distal left renal artery was created in between the abdominal aorta and the inferior vena cava. This case describes the importance of upfront detection of renal vascular variations using the appropriate imaging techniques.
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Affiliation(s)
- W J Buisman
- Departments of Vascular Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
| | - Ç Ünlü
- Departments of Vascular Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - S W de Boer
- Departments of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - W J Bos
- Departments of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J L Nieuwenhuijs
- Department of Urology, Beatrix Hospital, Gorinchem, The Netherlands
| | - J Wille
- Departments of Vascular Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
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Gamo E, Jiménez C, Pallares E, Simón C, Valderrama F, Sañudo JR, Arrazola J. The superior mesenteric artery and the variations of the colic patterns. A new anatomical and radiological classification of the colic arteries. Surg Radiol Anat 2016; 38:519-27. [PMID: 26728989 DOI: 10.1007/s00276-015-1608-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/08/2015] [Indexed: 11/25/2022]
Abstract
The superior mesenteric artery (SMA) supplies irrigation to the small intestine, ascending and a variable area of the transverse colon. Although medical imaging and surgical procedures have been widely developed in the last decades, the anatomy of the SMA using advanced imaging technology remains to be elucidated. Previous studies have used small sample sizes of cadaveric or radiological samples to propose a number of classifications for the SMA. In this study, we aimed to provide a more detailed description and useful classification of the SMA and its main branches [middle colic artery (MCA), right colic artery (RCA), and ileocolic artery (ICA)]. Samples (n = 50, 28 males and 22 females) were obtained from the repository of human cadavers located at the Department of Human Anatomy and Embryology, Complutense University of Madrid. This sample was dissected by preclinical medical students and completed by two of the authors (Gamo and Jiménez). A second set of samples was obtained from a bank of computerized tomography (CT) (560 CTs, 399 males and 161 females) collected by the Radiology Department at the Clínico San Carlos Hospital, Spain. Based on the results obtained from these studies, we propose a new classification of four patterns for the SMA anatomy. Pattern I as the independent origin of the three main branches of the SMA (cadaveric 40 %; CT 73.69 %); Pattern II is subdivided in three sub-patterns based on the common trunks of origin: Pattern IIa, common trunk between RCA and MCA (cadaveric 20 %, CT 4.28 %); Pattern IIb, common trunk between RCA and ICA (cadaveric 32 %, CT 15 %); Pattern IIc, common trunk for the three main branches (cadaveric 0 %, CT 0.35 %); Pattern III, as the absence of RCA (cadaveric 8 %; CT 2.32 %) and Pattern IV, based on presence of accessory arteries (not found in any of the samples). Although the independent origin of the three colic arteries have been classically described as the most frequent, the right colic artery is responsible of major variations.
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Affiliation(s)
- E Gamo
- Department of Human Anatomy and Embryology. School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - C Jiménez
- Department of Human Anatomy and Embryology. School of Medicine, Complutense University of Madrid, Madrid, Spain.
| | - E Pallares
- Radiology Department. Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - C Simón
- Computer Science and Statistics. Area: Statistics and Operations Research, Rey Juan Carlos University, Móstoles, Spain
| | - F Valderrama
- Department of Human Anatomy and Embryology. School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - J R Sañudo
- Department of Human Anatomy and Embryology. School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - J Arrazola
- Radiology Department. Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
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Fabrizio T. Indications for, and limitations of, the retroangular flap in facial reconstruction according to its vascular mapping. Br J Oral Maxillofac Surg 2015; 53:529-32. [PMID: 25866251 DOI: 10.1016/j.bjoms.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 03/12/2015] [Indexed: 11/16/2022]
Abstract
We have used the retroangular flap for the reconstruction of facial defects after excision of tumours. Important variables such as vascular mapping, type of anaesthesia, duration of stay in hospital, and the diagnosis and treatment of complications were taken into account in assessing its effectiveness. We studied 187 patients, 103 men and 84 women, who were treated with the retroangular flap, and the morphological and cosmetic results analysed. There are many vascular variations of the flap The patients were followed up for a median of 12 (range 12-125) years and their reconstructions were successful. The technique can be considered as one of first methods of choice for the reconstruction of cutaneous defects of the middle third of the face.
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Affiliation(s)
- T Fabrizio
- Unit of Plastic Surgery, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy.
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