The da Vinci telemanipulator system (Intuitive Surgical, Sunnyvale, CA USA) is the most advanced robotic surgical system and has been increasingly used for cardiac surgical procedures. We report out first clinical experience of use of the da Vinci telemanipulator system for endoscopic harvesting of the bilateral thoracic artery and multi-vessel small thoracotomy off pump CABG for 3-vessel disease. The da Vinci telemanipulator system has been previously utilized primarily for mitral valve surgery.
Cardiac Surgical Procedures ; Mammary Arteries ; Mitral Valve ; Robotics ; Thoracic Arteries ; Thoracotomy

We performed 70 proceudres of transarterial chemoembolization (TAE) through extrahepatic collateral vessels (n=27) or parasitic feeders (n=18) in 45 hepatocellular carcinoma patients. The collaterals developed after interruption of the hapatic artery due to repeated TAE(n=17), surgical ligation(n=7) and primary celiac occlusion (n=3). Radiologic findings suggesting the existence of parasitic or collateral supply for hepatocellular carcinoma were 1) a focal defect of Lipiodol retention on CT or plain film after TAE via the hepatic artery, 2) dilated and tortuous vessels around the mass on angiography, 3) persistent elevation of the level of serum alpha fetoprotein or continuous clinical symptoms in spite of sufficient devascularization of the tumor via the hepatic artery, and 4) radiological findings of direct invasion into adjacent organ. The sites of the catheter placement were the inferior phrenic artery (n=19), omental branches (n=16), periportal collaterals (n=6), pancreaticodenal arcade (n=3), gastroduodenal artery (n=3), internal mammary artery (n=2), intercostal artery (n=2), lateral thoracic artery (n=1), bronchial artery(n=1), and colic branches(n=1). Masses feeded by the inferior phrenic and chest wall collaterals were usually located at the dome area of the liver, and the omental and gastroduodenal collaterals developed in the masses located at the inferior tip of the liver. After TAE via collateral vessels, 37 patients underwent follow-up study. In 18 cases(48%), the tumor favorably responded to TAE. Specific complications of collateral TAE were epigastric soreness (n=10), severe shoulder pain (n=4), and embolization of the spinal artery during embolization through the intercostal artey (n=1). In conclusion, various extrahepatic collaterals are important alternative or additional routes for effective chemoembolization in patients with advanced hepatoma, and early recognition of the parasitic supply and the effort to perform TAE via collaterals is very important for effective management of the patients with the hepatoma.
alpha-Fetoproteins ; Angiography ; Arteries ; Carcinoma, Hepatocellular* ; Catheters ; Colic ; Ethiodized Oil ; Follow-Up Studies ; Hepatic Artery ; Humans ; Liver ; Mammary Arteries ; Shoulder Pain ; Thoracic Arteries ; Thoracic Wall

No abstract available.
Acidosis* ; Aorta, Thoracic* ; Umbilical Arteries*

BACKGROUND: The aim of this study was to compare the accuracy of measured cardiac output using the newly developed esophageal doppler device with that of the thermodilution method using a pulmonary artery catheter. METHODS: In 15 patients undergoing off-pump coronary artery bypass surgery, cardiac outputs were measured at four episodes of surgery; (1) after induction of anesthesia, (2) during dissection of the internal mammary artery, (3) during anastomosis of the left anterior descending artery, and (4) after closure of the pericardium. RESULTS: The bias between the two methods was 0.52 +/- 1.09 L/min. Analysis of the changes in cardiac output from sample episode 1 to 2, from sample episode 2 to 3 and from sample episode 3 to 4, expressed as percent change values, shows no significant differences between the two methods (P > 0.05). CONCLUSIONS: The esophageal doppler accurately reflects changes in cardiac output with time when compared with that of the thermodilution.
Anesthesia ; Arteries ; Bias (Epidemiology) ; Cardiac Output* ; Catheters ; Coronary Artery Bypass, Off-Pump* ; Humans ; Mammary Arteries ; Pericardium ; Pulmonary Artery ; Thermodilution* ; Thoracic Surgery

BACKGROUND: Partially resecting ribs of the recipient site to facilitate easy anastomosis of the internal mammary vessels to free flaps during breast reconstruction can cause chest wall pain or deformities. To avoid this, the intercostal perforating branches of the internal mammary vessels can be used for anastomosis. The purpose of this study was to investigate the location and size of the internal mammary perforator vessels based on clinical intraoperative findings and to determine their reliability as recipient vessels for breast reconstruction with microsurgical free tissue transfer. METHODS: Twelve patients were preoperatively screened for the presence of internal mammary perforators using Doppler tracing. After modified radical mastectomy was performed by a general surgeon, the location and size of the internal mammary perforator vessels were microscopically investigated. The external diameter was examined using a vessel-measuring gauge from a mechanical coupling device, and the distance from the mid-sternal line to the perforator was also measured. RESULTS: The largest arterial perforator averaged 1.5 mm, and the largest venous perforator averaged 2.2 mm. Perforators emerging from the second intercostal space had the largest average external diameter; the second intercostal space also had the largest number of perforators arising from it. The average distance from the mid-sternal line to the perforator was 20.2 mm. CONCLUSIONS: Internal mammary perforators presented consistent and reliable anatomy in this study. Based on these results, the internal mammary perforators appear to have a suitable diameter for microvascular anastomosis and should be considered as an alternative recipient vessel to the internal mammary vessel.
Breast Neoplasms ; Breast* ; Congenital Abnormalities ; Female ; Free Tissue Flaps ; Humans ; Mammaplasty* ; Mammary Arteries ; Mastectomy ; Mastectomy, Modified Radical ; Ribs ; Thoracic Wall

The arterial variations of the upper limb are frequently encountered in the human body. However, the appearance of multiple variations in one limb is uncommon. The present arterial variations were found in the right upper limb of 86 years-old female cadaver during a routine dissection. The variations of the arterial patterns are as follows: 1. Two thyrocervical trunks from subclavian artery and the internal thoracic artery is rising from lateral branch of thyrocervical trunks. 2. Thoracoacromial artery was divided two branches and the lateral thoracic artery arises from the small of two branches. 3. The distance of bifurcation of the brachial artery is 14.9 mm from the inferior border of teres major muscle. Medial branch of the brachial artery passes along the median nerve and becomes radial artery. Lateral branch of the brachial artery passes along the median nerve and becomes ulnar artery. 4. Bifurcation of radial artery is occurred at the distance of 46.9 mm from styloid process of radius. Deep palmar branch of radial artery is bifurcated on dorsum of hand. Branches for supplying first and second fingers arise from superficial palmar arch. The arterial variations of the upper limb could be caused a several bleeding in intravenous injection or surgeries and a wrong diagnosis. The knowledge of the arterial variation of the upper limb should be decreased to raise clinical problems.
Arteries ; Brachial Artery ; Cadaver ; Extremities ; Female ; Fingers ; Hand ; Hemorrhage ; Human Body ; Humans ; Injections, Intravenous ; Mammary Arteries ; Median Nerve ; Muscles ; Radial Artery ; Radius ; Subclavian Artery ; Thoracic Arteries ; Ulnar Artery ; Upper Extremity

BACKGROUND: There have been many reports of coronary angiographic findings aft er coronay bypass grafting,most of which are focused on the graft patency rate of the bypass conduits. However,postoperative angiography can provide numerous informations other than patency rates that are useful for establishing operative strategy. MATERIAL AND METHOD: We studied 73 patients in whom coronary angiography was done after more than 1 month of CABG.Mean interval from the operation to coronary angiography was 10.6 months and the reasons for coronary angiography follow up were residual or recurrent angina in 54 patients, abnormalities on myocardial perfusion scan or echocardiography in 13 patients,and for simple follow up in 6 patients. RESULT: Overall graft patency rate was 80.9% (internal thoracic artery 100%,saphenous vein 75.0%) in patients of simple follow up and 61.6% (internal thoracic artery 81.1%,saphenous vein 55.3%) in patients with ischemia. Progression of native coronary arterial disease proximal to the grafting site was found in 50 patients(68.5%). Among 201 coronary arterial branches that had not been completely occluded preoperatively, ninty five branches(47.3%)revealed progression of diameter stenosis by more than 20%on the follow up study. Among them,64 branches(31.8%)progressed to total occlusion.The incidence of disease progression was highter in the coronary arteries with patent grafts (57.5%)than in those with occluded grafts(36.3%)(p < 0.05). Comparing internal thoracic artery graft with saphenous vein graft, internal thoracic artery was superior to saphenous vein,not only in terms of patency(83.3% vs 56.6%), but also in terms of result of later percutaneous intervention success rate(100% vs 62%,p < 0.05). CONCLUSION: Due to the considerable incidence of progression of native coronary artery stenosis in the early postoperative periods, bypass grafting of a vessel with borderline stenosis,especially with vein graft,must be done prudently. And it was confirmed again that revascularization of left anterior descending artery is most important and that internal thoracic artery was superior to saphenous vein.
Angiography ; Arteries ; Constriction, Pathologic ; Coronary Angiography* ; Coronary Artery Bypass* ; Coronary Stenosis ; Coronary Vessels* ; Disease Progression ; Echocardiography ; Follow-Up Studies ; Humans ; Incidence ; Ischemia ; Mammary Arteries ; Perfusion ; Postoperative Period ; Saphenous Vein ; Thoracic Arteries ; Transplants ; Veins

As experiences with endovascular aortic devices increases over time, hybrid repair for the treatment of thoracoabdominal aortic aneurysms (TAAA) by using a combination of thoracoabdominal endovascular aneurysm repair and visceral revascularization has been reported with acceptable result. A 55-year-old man with type III TAAA involving visceral arteries has been treated successfully with tube stent-graft followed by right renal revascularization that was facilitated by a rare anatomic configuration. The authors present a type III TAAA patient with rare anatomic configuration of the visceral arteries successfully treated with hybrid endovascular-surgical TAAA repair.
Aneurysm ; Aortic Aneurysm, Thoracic ; Arteries ; Chimera ; Humans

The axillary artery (AA) is often referred to as having three parts, with these divisions based on its location relative to the pectoralis minor muscle. In third part, AA gives off the subscapular (SSA), anterior circumflex humeral, and posterior circumflex humeral arteries (PCHA). However, variations in these arteries were extremely diverse. So, we observed actually some branching patterns of these arteries in this study. METHOD: We studied the pattern of SSA in 128 upper limbs from donated cadavers. RESULT: SSA was originated directly from the third and second parts of AA in 37.5% (48/128) and 4.7% (6/128), respectively. A PCHA made a common trunk with SSA in 25.8% (33/128), and these trunks arose from the third and second parts of AA in 21.1% (27/128) and 4.7% (6/128), respectively. A lateral thoracic artery (LTA) arose from SSA in 12.5% (16/128), and these were originated from the third and second parts of AA in 4.7% (6/128) and 7.8% (10/128), respectively. In 19.5% (25/128) of upper limbs, LTA, SSA, and PCHA have a common trunk, and these arose from the third and second parts of AA in 12.5% (16/128) and 7.0% (9/128), respectively. According to the branching pattern of the SSA, its origin was significantly different.
Arteries* ; Axillary Artery* ; Cadaver ; Methods ; Thoracic Arteries ; Upper Extremity

The branches of the axillary artery have been studied in 38 Korean female cadavers. 1. The superior thoracic artery arose from the first part and the second part of the axillary artery in 84% of sides. 2. The thoracoacromial artery arose from the axillary artery near the superomedial border of the axillaly artery more often (91%) than from any other source. 3. The lateral thoracic artery was found on 64% of the sides as a main axillary artery, usually arising from the second part of the axillary artery(61%). It arose from the subscapular artery in 28%. 4. The subscapular artery was seen as the lagrgest of the axillary artery. It arose from the second part (42%) and the third (58%) of the axillary artery. 5. The posterior circumflex humeral artery was a direct branch of the third part of axillary artery in 37% of sides. In 21% fo sides the posterior circumflex humeral artery arose by a common stem from the third part of the axillary artery. In 33% of sides the posterior circumflex humeral artery arose from the subscapular artery. 6. The anterior circumflex humeral artery was found more constantly at the third part of the axillary artery than the posterior circumflex humeral artery was. It arose from a direct branch of the third part of the axillary artery in 70% of sides.
Arteries ; Axillary Artery* ; Cadaver ; Female* ; Humans ; Thoracic Arteries