Anomalous retinal artery associated with branch retinal artery occlusion and neovascular glaucoma: A case report

BACKGROUND Congenital anomalous retinal artery is rare and does not typically affect visual acuity.However,an abnormal artery that passes through and supplies blood to the macular area complicated with branch retinal artery occlusion may negatively impact visual acuity.This study reports an unusual case of anomalous retinal artery combined with retinal artery occlusion.CASE SUMMARY A 52-year-old male presented with severely reduced vision in the right eye.The fundus examination revealed an anomalous artery,extending from the superior temporal arcade and crossing the macula into the inferior temporal quadrant.The anomalous artery was partially occluded,with a narrowed lumen.A cherry-red spot was observed with whitening of the macular area,suggesting macular edema.Fundus fluorescein angiography revealed disc leakage and a delayed filling time.Optical coherence tomography revealed increased thickness of the neuroretina and underlying layers.The patient was treated with vessel dilation,hyperbaric oxygen,ocular massage,and thrombolytics.Visual acuity of the right eye subsequently improved to 20/200 from hand motion at 4 cm.This improvement in visual acuity persisted when the patient was examined at the 1-mo follow-up visit.The patient was subsequently followed via telephone interview.The information provided via interview indicated that visual acuity in the affected eye was stable up to 6 years from the time of the initial presentation.However,after 3 additional years,the patient was diagnosed with neovascular glaucoma in the right eye,which was subsequently enucleated.CONCLUSION Although congenital retinal vascular anomaly,including anomalous retinal artery,rarely affects vision,when complicated with branch retinal artery occlusion,the abnormal artery that supplies the macula may severely reduce visual acuity.

A case of branch retinal artery obstruction complicated after anterior ischemic optic neuropathy

AIM: To report a case of branch retinal artery obstruction (BRAO) complicated after anterior ischemic optic neuropathy (AION). METHODS: A 42 year-old woman who complained of visual disturbance was performed ophthalmological examinations such as fundus photography, fluorescent angiography (FAG) and visual field test. RESULTS: At first visit, disc swelling was noted and arterial circulation was intact, however, 1 week after onset, the inferior branch retinal artery began to shrink and the flame hemorrhage intensified. Sixteen months later, the optic disc evidenced an atrophic change; additionally, a ghost vessel in the inferior branch retinal artery was found. CONCLUSION: We report a case of complications of BRAO arising after AION which caused the mechanical compression on the arterial circulation.

Treatment controversies in a rare case of a simultaneous branch retinal artery and vein occlusion secondary to hyperhomocysteinemia and hypertension

Dear Editor,Combined vascular occlusions involving retinal arteries and veins have been reported in the past. Combined occlusion of the central retinal vein （CRVO） and artery （CRAO）is well described;. Cilioretinal artery occlusion along with CRVO is frequently reported and is well characterized;.

Applied anatomy of radial midforearm flap pedicled with intermuscular branch of radial artery

To provide anatomic basis for transposition of vascularized radial midforearm flap.Methods On 40 adult cadaveric upper limb specimens injected with red dye,the origin,course,branchs,diameters and anastomosis of intermuscular branch of radial artery and its cutaneous branch were observed.Results Originating from radial artery,intermuscular branch of radial artery descended along periosteum closely between pronator teres and supinator,the main stem was (4.8±1.0)cm in length and (1.2±0.2)mm in diameter.After its periosteal branches were sent off to distribute over middle and inferior shaft of radius,its cutaneous branch perforated from intermuscle and deep fascia and anastomosed with some other cutaneous branches in the forearm.Perforating point of the cutaneous branch was located (11.1±1.3)cm beneath lateral epicondyle of humerus,its diameter was about (0.6±0.1)mm.Conclusion Radial midforrarm flap pedicled with intermuscular branch of radial artery can be transferred to repair soft tissue defect of elbow,forearm or hand.7 refs.

Missed diagnosis of femoral deep artery rupture after femoral shaft fracture: A case report

BACKGROUND Vascular injury is a rare complication of femoral shaft fractures,and rupture of the deep femoral artery is more difficult to diagnose because of its anatomical location and symptoms.Despite its low incidence,deep femoral artery rupture can lead to life-threatening outcomes,such as compartment syndrome,making early identification and diagnosis critical.CASE SUMMARY A 45-year-old male patient was admitted to our hospital due to right lower limb trauma in a car accident,with complaints of severe pain and swelling on his right thigh.X-ray demonstrated a right femoral shaft fracture.During preparation for emergency surgery,his blood pressure and blood oxygen saturation dropped,and sensorimotor function was lost.Computed tomography angiography was performed immediately to confirm the diagnosis of rupture of the deep femoral artery and compartment syndrome,so fasciotomy and vacuum-assisted closure were performed.Rhabdomyolysis took place after the operation and the patient was treated with appropriate electrolyte correction and diuretic therapy.Twenty days after the fasciotomy,treatment with the Hoffman Type II External Fixation System was planned,but it was unable to be immobilized internally based on a new esophageal cancer diagnosis.We kept the external fixation for 1 year,and 3 years of follow-up showed improvement of the patient’s overall conditions and muscle strength.CONCLUSION For patients with thigh swelling,pain,anemia,and unstable vital signs,anterior femoral artery injury should be highly suspected.Once diagnosed,surgical treatment should be performed immediately and complications of artery rupture must be suspected and addressed in time.

Recovery from Out-of-Hospital Cardiopulmonary Arrest Due to Type A Acute Aortic Dissection: A Case Report

Case: A 55-year-old man without past medical histories suffering from back pain for two weeks was successfully resuscitated from an 8-min cardiopulmonary arrest (CPA) and was brought to our hospital by ambulance. Computed tomography demonstrated type A acute aortic dissection (AAAD) with brachiocephalic artery occlusion. After admission, Glasgow Coma Scale score improved to E1VTM4, and voluntary movement was noted only in the right limbs. Outcome: The patient underwent emergency grafting of the ascending aorta and innominate artery under deep hypothermic circulatory arrest. After surgery, the patient recovered with mild disorientation and left hemiplegia. Magnetic resonance imaging of the head revealed no large infarction but revealed multiple acute ischemic changes. One year later, the patient demonstrated independent walk and successfully returned to work life. Conclusions: Immediate resuscitation and surgery resulted in good recovery from CPA after AAAD.

Correlation of ischemic ophthalmopathy with lacunar infarction

AIM:To investigate the correlation of ischemic ophthalmopathy(IO)with lacunar infarction(LI),an ischemic lesions in the cerebrovascular system.METHODS:Totally 204 cases of IO without any nervous system symptom and previously diagnosed LI served as the observational group.All 204 cases without IO,nervous system symptoms and previous LI served as the control group.Age and sex between the two groups matched well.LI was diagnosed by magnetic resonance imaging(MRI)and the results of the two groups were statistically analyzed and compared.RESULTS:IO included 174 eyes of 156 patients with non-arteritis anterior ischemic optic neuropathy(NAION),42 eyes of 36 patients with central retinal artery occlusion(CRAO)or branch retinal artery occlusion(BRAO)and 12 eyes of 12 patients with ocular ischemia syndrome(OIS).The detection rate of LI(72.54%)in IO group was obviously higher than that(15.68%)in the control group(P<0.001).IO was positively correlated with LI(r=0.573,P<0.05).In addition,most infarction sites located in the basal ganglia(67.57%),which were not the vital areas of cerebrum and not easy to be found due to their small size.The majority of those first visited IO patients(72.54%)without nervous system symptom and previously diagnosed LI had already suffered from LI.CONCLUSION:According to our studies,there is a positive correlation between IO and LI.IO can be used as an important predictor for the present of LI,especially obvious signs of the patient.

Study of Relationship Between the Blood Supply of the Extrahepatic Bile Duct and Duct Supply Branches from Gastroduodenal Artery on Imaging and Anatomy

Background： Liver transplantation has become the treatment of choice for patients with end-stage acute or chronic hepatic disease. Bile duct complications are common events after liver transplantation. The aim of this study was to evaluate the blood supply of the human bile duct and identify the underlying mechanisms of bile duct complications after liver transplantation. Methods： The duct supply branches from gastroduodenal artery and blood supply of extrahepatic bile duct system were re-evaluated through selective hepatic angiography from 600 patients. In addition, 33 cadavers were injected with latex casting material into the common hepatic artery, then the extrahepatic bile duct and the branches from the common hepatic artery were carefully dissected to visualize the gastroduodenal artery and its branching to the extrahepatic bile duct. Results： The bile duct artery arose from the branch of the gastroduodenal artery in 8.1% （49/600）. Of these 49 individuals, the bile duct artery was supplied by the gastroduodenal artery （61.22%, 30/49）, the proper hepatic artery （14.29%, 7/49）, or both the gastroduodenal artery and the proper hepatic artery （24.49%, 12/49）. In our study of 33 cadavers, the percentage that the bile duct artery arose from the gastroduodenal artery was 27.27%. The blood supply to the bile extrahepatic bile ducts was divided into different segments and formed longitudinal and arterial network anastomosed on the walls of the duct. Conclusions： There is a close relationship between the duct supply branches from gastroduodenal artery and the blood supplying patterns of the extrahepatic bile duct system. In liver transplant surgery, the initial part of the gastroduodenal artery is preferred to be preserved in the donor liver. It is of great significance to improve the success rate of operation and reduce complications.

Influence of aortic branch arteries on the hemodynamics of patient-specific type B aortic dissection following TEVAR

Objective:Because of the difficulty in obtaining patient specific flow data,branch arteries are often neglected in the flow simulations of a patient-specific type B aortic dissection(AD)following thoracic endovascular repair(TEVAR).This study aims to investigate the influence of the aortic branch arteries on the hemodynamics and physical flow phenomena commonly associated with aortic modeling of an AD after TEVAR.Methods:The three-dimensional geometry of a type B AD following TEVAR was generated from a high-quality CT dataset.Simulations were performed with all branch arteries,without the four visceral arteries of the abdominal aorta(FVAoAA),and without the upper three branches of the aortic arch(UTBoAA).Results:The removal of the UTBoAA has marginal effect on the flow patterns and hemodynamic parameters in the false lumen(FL);however,regardless of whether there are aorta branches supplied to the FL or not,the omission of FVAoAA will result in a wrong prediction of the flow direction at tears and flow volume to the FL.Conclusions:The omission of aorta branch arteries has great impact on the hemodynamic prediction including flow field and wall shear stress related parameters in a type B AD after TEVAR,which may induce misleading estimates of the potential thrombus in the FL.It is strongly recommended to keep aorta branches in the computational model to predict the post-operative hemodynamic performance in a type B AD following TEVAR.