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Chaudhary A, Patra A, Garg P. Reappraisal of anatomical diversity of lateral circumflex femoral artery with its substantial clinical applicability: cadaveric study. Anat Cell Biol 2024; 57:346-352. [PMID: 39005044 PMCID: PMC11424569 DOI: 10.5115/acb.24.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/23/2024] [Accepted: 05/16/2024] [Indexed: 07/16/2024] Open
Abstract
Studies reveal variations in the in the origin, number, and branching patterns of the lateral circumflex femoral artery (LCFA). The present study aimed to document such variations and their potential clinical applicability. Thirty-two femoral triangles of 16 embalmed adult human cadavers were dissected to investigate the variation in the origin, number, and branching patterns of LCFA. The main branches of the LCFA were tracked independently for numerical variations in branching pattern. The distance between the origin of LCFA and mid inguinal point (MIP) was also measured in each case. LCFA was most commonly arising from profunda femoris (PF), followed by femoral artery (FA) and common trunk of the femoral artery (CFA). Duplication LCFA was observed in 15 (46.87%) limbs, in 5 (31.25%) cases duplication was only on right side, in 4 (25%) cases duplication was only on left side and in 3 (18.75%), duplication was bilateral. Cases with duplication of LCFA, showed numerical variations with descending pattern being the most common. The average distance of LCFA1 and LCFA2 from mid-inguinal point was 5.77±1.35 cm and 6.14±2.05 cm respectively. Detailed information regarding the occurrence of duplication will be great importance for surgeons, interventional radiologists, and other medical professionals performing procedures in the femoral region. Knowledge of variation of branching pattern of LCFA is utmost important as surgeons use the descending branch of the LCFA in bypass grafting and vascular reconstruction surgeries.
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Affiliation(s)
- Anju Chaudhary
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, India
| | - Apurba Patra
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, India
| | - Pooja Garg
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, India
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Ramella V, Papa G, Zorzi F, Rizzo M, Cai T, Liguori G. Penile revascularization using the descending branch of the lateral circumflex femoral artery: An alternative vascular graft. Int J Surg Case Rep 2023; 112:108939. [PMID: 37866017 PMCID: PMC10667744 DOI: 10.1016/j.ijscr.2023.108939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/07/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION AND RELEVANCE Microsurgical revascularization stands as the preferred method for addressing erectile dysfunction (ED) resulting from traumatic penile arterial insufficiency. Traditional microarterial bypass surgery (MABS) techniques have typically relied on utilizing the inferior epigastric artery (IEA) as the graft vessel. However, issues such as endothelial dysfunction in the vessel and alterations in abdominal tissue can negatively impact surgical outcomes. MABS using the descending branch of the lateral circumflex artery of the femur (DLCFA) should be proposed as a surgical option for penile arterial revascularization. CASE PRESENTATION A 29-year-old who experienced ED after a pelvic bone fracture with hypogastric vascular injury was referred to our center. Preoperatory penile Doppler ultrasound (PDU) examination documented the presence of arterial insufficiency. Selective hypogastric angiography pointed out the interruption of arterial blood flow at the level of the distal right internal pudendal artery. CASE DISCUSSION Access to the dorsal penile artery was gained through an infrapubic incision, the DLCFA pedicle was isolated through an incision along the anterolateral right thigh. After its transposition, the arterial bundle was anastomosed to the dorsal penile artery in an end-to-end fashion. Intraoperative PDU has been used to verify the patency of the anastomosis. At 6 months follow-up, optimal flow parameters on PDU were persistently registered, and the patient had consistent clinical improvement on the IIEF-5 score. CONCLUSION DLCFA grafting for penile revascularization is a suitable therapeutic option in traumatic ED due to its size and accessibility. Further experience is necessary to compare clinical outcomes among different revascularization techniques.
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Affiliation(s)
- Vittorio Ramella
- Department of Medical, Surgical and Health Sciences, Plastic, Reconstructive and Aesthetic Surgery Unit, University of Trieste, Trieste, Italy
| | - Giovanni Papa
- Department of Medical, Surgical and Health Sciences, Plastic, Reconstructive and Aesthetic Surgery Unit, University of Trieste, Trieste, Italy
| | - Federico Zorzi
- Department of Medical, Surgical and Health Sciences, Urology Unit, University of Trieste, Trieste, Italy
| | - Michele Rizzo
- Department of Medical, Surgical and Health Sciences, Urology Unit, University of Trieste, Trieste, Italy
| | - Tommaso Cai
- Department of Urology, Santa Chiara Hospital, Trento, Italy
| | - Giovanni Liguori
- Department of Medical, Surgical and Health Sciences, Urology Unit, University of Trieste, Trieste, Italy.
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Rennert RC, Nguyen VN, Abedi A, Atai NA, Carey JN, Tenser M, Amar A, Mack WJ, Russin JJ. Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case series. Front Neurol 2023; 14:1102496. [PMID: 37153667 PMCID: PMC10160605 DOI: 10.3389/fneur.2023.1102496] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/29/2023] [Indexed: 05/10/2023] Open
Abstract
Background and purpose The treatment of complex intracranial aneurysms can be challenging with stand-alone open or endovascular techniques, particularly after rupture. A combined open and endovascular strategy can potentially limit the risk of extensive dissections with open-only techniques, and allow for aggressive definitive endovascular treatments with minimized downstream ischemic risk. Materials and methods Retrospective, single-institution review of consecutive patients undergoing combined open revascularization and endovascular embolization/occlusion for complex intracranial aneurysms from 1/2016 to 6/2022. Results Ten patients (4 male [40%]; mean age 51.9 ± 8.7 years) underwent combined open revascularization and endovascular treatment of intracranial aneurysms. The majority of aneurysms, 9/10 (90%), were ruptured and 8/10 (80%) were fusiform in morphology. Aneurysms of the posterior circulation represented 8/10 (80%) of the cases (vertebral artery [VA] involving the posterior inferior cerebellar artery [PICA] origin, proximal PICA or anterior inferior cerebellar artery/PICA complex, or proximal posterior cerebral artery). Revascularization strategies included intracranial-to-intracranial (IC-IC; 7/10 [70%]) and extracranial-to-intracranial (EC-IC; 3/10 [30%]) constructs, with 100% postoperative patency. Initial endovascular procedures (consisting of aneurysm/vessel sacrifice in 9/10 patients) were performed early after surgery (0.7 ± 1.5 days). In one patient, secondary endovascular vessel sacrifice was performed after an initial sub-occlusive embolization. Treatment related strokes were diagnosed in 3/10 patients (30%), largely from involved or nearby perforators. All bypasses with follow-up were patent (median 14.0, range 4-72 months). Good outcomes (defined as a Glasgow Outcomes Scale ≥4 and modified Rankin Scale ≤2) occurred in 6/10 patients (60%). Conclusion A variety of complex aneurysms not amenable to stand-alone open or endovascular techniques can be successfully treated with combined open and endovascular approaches. Recognition and preservation of perforators is critical to treatment success.
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Affiliation(s)
- Robert C. Rennert
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Vincent N. Nguyen
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Aidin Abedi
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Nadia A. Atai
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Joseph N. Carey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Matthew Tenser
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Arun Amar
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - William J. Mack
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jonathan J. Russin
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Jonathan J. Russin,
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Rennert RC, Russin JJ. Rethinking Cerebral Bypass Surgery. Neurosurg Clin N Am 2022; 33:403-417. [DOI: 10.1016/j.nec.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wolfswinkel EM, Ravina K, Rennert RC, Landau M, Strickland BA, Chun A, Wlodarczyk JR, Abedi A, Carey JN, Russin JJ. Cerebral Bypass Using the Descending Branch of the Lateral Circumflex Femoral Artery: A Case Series. Oper Neurosurg (Hagerstown) 2022; 22:364-372. [DOI: 10.1227/ons.0000000000000144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
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Rennert RC, Russin JJ. Commentary: Reimplantation Bypass Using One Limb of a Double-Origin Posterior Inferior Cerebellar Artery for Treatment of a Ruptured Fusiform Aneurysm: Case Report. Oper Neurosurg (Hagerstown) 2020; 19:E320-E321. [PMID: 32503035 DOI: 10.1093/ons/opaa171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/10/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert C Rennert
- Department of Neurological Surgery, University of California San Diego, San Diego, California
| | - Jonathan J Russin
- Department of Neurological Surgery, Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California
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Wang L, Jing L, Sun H, Shi X. Letter to the Editor. Graft selection in cerebral revascularization surgery. J Neurosurg 2020; 134:1678-1679. [PMID: 32796148 DOI: 10.3171/2020.6.jns201957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Long Wang
- 1SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Lujun Jing
- 2Beijing Electric Power Hospital, Capital Medical University, Beijing, China
| | - Huaiyu Sun
- 3TieMei General Hospital of Liaoning Health Industry Group, Liaoning, China; and
| | - Xiang'en Shi
- 4SanBo Brain Hospital, Capital Medical University, Beijing, China
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Srinivasan VM, Kan P, Huang AT, Burkhardt JK. Occipital Artery to Middle Cerebral Artery Bypass Using the Descending Branch of the Lateral Circumflex Femoral Artery as an Interposition Graft for Blood Flow Augmentation in Progressive Moyamoya Disease. World Neurosurg 2020; 139:208-214. [PMID: 32251811 DOI: 10.1016/j.wneu.2020.03.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The superficial temporal artery to middle cerebral artery (MCA) end-to-side anastomosis is the most commonly used direct extracranial-intracranial bypasses type for Moyamoya disease (MMD). In progressive MMD without suitable scalp arteries, other bypass constructs may need to be considered to augment blood flow. CASE DESCRIPTION We present the exceptional case of a 48-year-old woman with progressive MMD and repeated transient ischemic attacks originating from the right hemisphere despite previous bilateral bypasses. We used the descending branch of the lateral circumflex femoral artery as an interposition graft for an occipital artery to M4 MCA bypass with 2 end-to-side anastomoses to augment blood flow. The ipsilateral occipital artery had already formed bilateral transdural collaterals; the goal was to preserve its supply while using the artery as a donor for an interposition graft. Access to the Sylvian fissure was limited because of the previous superficial temporal artery to MCA bypass with an extensive superficial collateral network necessitating preservation. The posterior aspect of the Sylvian fissure was targeted to revascularize the posterior frontal and parietal region using an interposition graft matching the vessel size of a distal MCA vessel segment. Surgery was technically successful, without complications, and the patient recovered without new neurologic deficits. The bypass graft was patent on postoperative computed tomographic angiography and transcranioplasty ultrasound. CONCLUSIONS This case illustrates the need for creative bypass constructs in progressive MMD patients with multiple prior surgeries. Two surgical goals are paramount: flow augmentation with preservation of the existing collateral network to avoid complications and new deficits.
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Affiliation(s)
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew T Huang
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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Rennert RC, Strickland BA, Ravina K, Brandel MG, Bakhsheshian J, Fredrickson V, Carey J, Russin JJ. Assessment of ischemic risk following intracranial-to-intracranial and extracranial-to-intracranial bypass for complex aneurysms using intraoperative Indocyanine Green-based flow analysis. J Clin Neurosci 2019; 67:191-197. [PMID: 31266716 DOI: 10.1016/j.jocn.2019.06.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/13/2019] [Accepted: 06/21/2019] [Indexed: 11/28/2022]
Abstract
Cerebral bypass is often needed for complex aneurysms requiring vessel sacrifice, yet intraoperative predictors of ischemic risk in bypass-dependent territories are limited. Indocyanine Green (ICG)-based flow analyses (ICG-BFAs; Flow 800, Carl Zeiss, Oberkochen, Germany) semi-quantitatively assess cortical perfusion, and in this work we determine the efficacy of ICG-BFA for assessing post-operative ischemic risk during cerebral bypass surgery for complex aneurysms. Retrospective clinical and pre/post-bypass intra-operative ICG-BFA data (delay and blood flow index [BFI]) on ten patients undergoing cerebral bypass for complex cerebral aneurysms requiring vessel sacrifice were collected from a single-institution prospective database and analyzed via non-parametric testing and logistic regression. Mean age was 55.9 ± 14.8 years. Pre/post-bypass delay (median 35.6 [5.1-51.3] vs. 26.0 [17.1-59.9]; p = 0.2) and BFI (median 56.1 [8.1-120.4] vs. 32.2 [3.0-147.4]; p = 0.2) did not significantly differ. Two patients (20%) developed post-operative ischemia in bypass dependent territories. Delay ratio did not differ between patients with and without post-operative ischemia (median 1.15 [0.67-1.64] vs. 0.83 [0.36-3.56]; p = 0.6), nor predict stroke risk (odds ratio = 1.1, p = 0.9). Conversely, BFI ratio was significantly lower for patients experiencing post-operative ischemia than those without ischemia (median 0.11 [0.06-0.17] vs. 0.99 [0.28-1.42]; p = 0.03). A BFI ratio <0.21 predicted the occurrence of post-operative ischemia (odds ratio = 0.02, p = 0.05). These data suggest that intraoperative ICG-BFA may help assess post-operative ischemic risk during cerebral bypass surgery for complex aneurysms requiring vessel sacrifice.
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Affiliation(s)
- Robert C Rennert
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Ben A Strickland
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kristine Ravina
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael G Brandel
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Vance Fredrickson
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joseph Carey
- Department of Plastic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jonathan J Russin
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Intracranial–Intracranial Bypass with a Graft Vessel: A Comprehensive Review of Technical Characteristics and Surgical Experience. World Neurosurg 2019; 125:285-298. [DOI: 10.1016/j.wneu.2019.01.259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 01/28/2019] [Indexed: 12/28/2022]
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