The normal growth of the pulmonary trunk in human foetuses

The rate of growth of the pulmonary trunk during gestation has not been sufficiently determined. The present study was performed on 128 spontaneously aborted human foetuses aged 15-34 weeks in order to compile normative data for pulmonary trunk dimensions at various gestational ages. With the use of anatomical dissection, digital-image analysis (the Leica QWin Pro 16 system) and statistical analysis (ANOVA, regression analysis) a range of measurements (length, diameter and volume) was analysed for the pulmonary trunk during gestation. No significant gender differences were found (p > 0.05). Growth curves were generated of the best fit for the plot for each morphometric feature against gestational age. The results obtained show a statistically significant correlation (p < 0.001) between the parameters examined and gestational age. Both the length and diameter of the pulmonary trunk were found to increase in a linear fashion throughout gestation. The length ranged from 3.17 &#177; 0.36 mm to 13.54 &#177; 1.39 mm, according to the linear function y = -5.6035 + 0.5705 x &#177; 0.9171 (r = 0.96). The diameter ranged from 1.51 &#177; 0.24 mm to 5.30 &#177; 1.53 mm, according to the linear model y = -1.4813 + 0.2154 x &#177; 0.7452 (r = 0.86). The pulmonary trunk volume ranged from 5.94 &#177; 2.21 mm3 to 312.37 &#177; 154.34 mm3, according to the quadratic function y = 143.2 - 20.961 x + 0.791 x2 &#177; 63.306 (R2 = 0.74). The growth curves generated from my data may be useful as a reference for foetal echocardiographers in the detection of congenital cardiovascular abnormalities

An angiographic study of the anterior tibial artery in patients with aortoiliac occlusive disease

The anterior tibial artery is of great clinical relevance to vascular infrapopliteal surgery. The sources (origins), length and luminal diameter of the anterior tibial artery in 46 men and 30 women with Lerich syndrome were studied by means of radiological and digital methods. The results obtained were described by twoway analysis of variance (Multi-group ANOVA) for unpaired data &#8212; the means for six subtypes with regard to sex and side of the body, using the STATISTICA 5.5 program. The anterior tibial artery occurred most frequently (92.11%) as a terminal branch of the popliteal artery in its normal (IA: 87.5 %, IB: 2.63%) and high (IIA 1: 1.32%, IIA 2: 0.66%) division. In the remainder (7.89%), the anterior tibial artery arose from both the anterior tibioperoneal trunks (IC: 1.97%, IIB: 5.92%). The statistical analysis of the sources of the anterior tibial artery did not show gender differences. Symmetry of the left and right popliteal patterns was observed in the two most frequent subtypes: IA (r1 = 0.80) and IIB (r2 = 0.83). The anterior tibial artery was the longest (p = 0.02 for men, p = 0.04 for women) in subtype IIA 2. The greatest diameter of the anterior tibial artery was characteristic for a trifurcation (IB) and the smallest for subtype IIA 2 (p = 0.04). Both the length (p = 0.03) and luminal diameter (p = 0.04) of the anterior tibial artery in men were significantly greater than in women in all the popliteal subtypes observed. Morphometric parameters of the right and left anterior tibial artery showed no statistically significant differences. The anterior tibial artery was the predominant vessel in a trifurcation (IB) and in the two subtypes with an anterior tibioperoneal trunk (IC, IIB). These results have implications in vascular grafting below the knee

The normal growth of the thoracic aorta in human foetuses

The present study was performed on 128 spontaneously aborted human foetuses aged 15-34 weeks in order to establish normal values for thoracic aorta dimensions at various gestational ages. Using anatomical dissection, digital-image analysis (the Leica QWin Pro 16 system) and statistical analysis (ANOVA, regression analysis) the growth of the length, the original and terminal external diameters and the volume of the thoracic aorta during gestation was examined. No significant gender differences were found (p > 0.05). The growth curves were generated of the best fit for the plot for each morphometric feature against gestational age. Both the length and external diameters of the thoracic aorta increased in proportion to the advance in foetal age. The length ranged from 12.49 &#177; 1.85 mm to 48.82 &#177; 6.31 mm according to the linear function y = &#8211;19.654 + 2.0512 x &#177; 3.5168. The original external diameter ranged from 1.25 &#177; 0.28 mm to 5.65 &#177; 0.48 mm according to the linear fashion y = -2.3834 + 0.2367 x &#177; 0.3850. The terminal external diameter ranged from 1.15 &#177; 0.26 mm to 5.18 &#177; 0.45 mm, in agreement with the linear model y = -2.1438 + 0.2156 x &#177; 0.3555 (r = 0.96, p < 0.001 for each feature). The volume of the thoracic aorta ranged from 15.75 &#177; 8.06 mm3 to 1158.01 &#177; 301.85 mm3 according to the quadratic function y = 1376.2 - 154.42 x + 4.419 x2 &#177; 125.6 (R2 = 0.90). The growth curves generated from my data may be useful as a reference for foetal echocardiographers, who must distinguish abnormal from normal foetal development

Compensating crural anastomoses in chronic critical limb ischaemia

Compensating crural anastomoses develop in patients with multi-level occlusion of the calf arteries in the course of atherosclerosis, arteriitis, diabetes, and in vascular malformations of the limbs. The peroneal artery is frequently the only patent calf vessel, especially in diabetic patients who have advanced tibial occlusive disease. The purpose of this study was to identify different types of compensating crural anastomoses in chronic critical limb ischaemia. Using combined anatomical-radiographic and statistical methods, 86 compensating crural anastomoses were studied in 59 specimens of lower limbs (amputated at the thigh) in the course of chronic critical ischaemia. Three types of compensating crural anastomosis and their components were identified. The most common type (55.8%) was the posterior tibioperoneal anastomosis. Less common (23.3%) was the intertibial anastomosis and least common (20.9%) the anterior tibioperoneal anastomosis. The posterior tibioperoneal anastomosis was concurrent with anterior tibioperoneal anastomosis in 26.3% of cases and with the intertibial anastomosis in 15.3% of cases. The great importance of the peroneal artery in the formation of natural crural collateral circulation should encourage vascular surgeons to consider peroneal bypasses

Length growth of the various aortic segments in human foetuses

This study defines normal growth for the various aortic segments in 128 spontaneously aborted human foetuses aged 15-34 weeks. With the use of anatomical dissection, digital-image analysis (using the Leica Q Win Pro 16 system) and statistical analysis (ANOVA, regression equation), a range of length measurements for the ascending aorta, aortic arch and thoracic aorta was examined. No significant gender differences were found (p &#8805; 0.05). The length of the ascending aorta ranged from 2.63 &#177; 0.42 to 10.80 &#177; 1.49 mm, according to the linear function y = -4.678 + 0.4647 x &#177; 0.8447. The aortic arch length increased from 3.93 &#177; 0.57 to 15.25 &#177; 1.98 mm, in accordance with the linear model y = -6.079 + 0.6370 x &#177; 1.1133. The length of the thoracic aorta ranged from 12.49 &#177; 1.85 to 48.82 &#177; 6.31 mm, according to the linear pattern y = -19.654 + 2.0512 x &#177; 3.5168. The sum of the lengths of these aortic segments generated the linear function y = -30.410 + 3.153 x &#177; 5.4332. The relationships between the lengths of the various aortic segments generated the linear regressions: y = -0.2256 + 0.7276 x &#177; 0.3093 (for the ascending aorta vs. the aortic arch), y = 0.0252 + 0.3105 x &#177; 0.2189 (for the aortic arch vs. the thoracic aorta), and y = -0.2408 + 0.22709 x &#177; 0.2026 (for the ascending aorta vs. the thoracic aorta). The ascending aorta, aortic arch and thoracic aorta also increased proportionally (5:7:22) during gestation

External diameters of the pulmonary arteries in human foetuses: an anatomical, digital and statistical study

This study defines the growth patterns for the external diameters of the pulmonary arteries in human foetuses, including relationships with sex, side of body (right-left) and foetal age. Using anatomical dissection, digital-image analysis (system of Leica Q Win Pro 16) and statistical analysis (ANOVA, regression analysis), a range of external diameters for the right and left pulmonary arteries in 128 spontaneously aborted human foetuses aged 15-34 weeks was examined. No significant gender differences were found (p > 0.05). In the examined age range the values of the external diameter of the right pulmonary artery ranged from 0.97 &#177; 0.24 to 2.95 &#177; 0.89 mm, according to the linear function y = -0.7753 + 0.1148 x &#177; 0.4580 (r = 0.83; p < 0.001). The values of the external diameter of the left pulmonary artery ranged from 0.88 &#177; 0.25 to 2.63 &#177; 0.80 mm, in accordance with the linear relationship y = -0.6228 + 0.1007 x &#177; 0.4280 (r = 0.81; p < 0.001). The external diameters of the right pulmonary artery were greater than those of the left pulmonary artery (p < 0.001). Parallel to the increase in the values of the external diameters of both the pulmonary arteries, the pulmonary artery-to-ascending aorta diameter ratio (the relative diameter of the pulmonary artery) decreased with advanced foetal age from 0.46 &#177; 0.10 to 0.43 &#177; 0.13 for the right pulmonary artery, and from 0.43 &#177; 0.10 to 0.39 &#177; 0.12 for the left one. The growth curves generated may be useful as reference data for foetal diagnosis

External diameters of the crural arteries in patients with chronic critical limb ischaemia

Knowledge of the diameters of the crural arteries forms the basis for reconstructive vascular surgery and percutaneous angioplasty. The external diameters of the crural arteries were examined in 152 specimens of lower limbs by anatomical, digital and statistical methods. The diameters of all the crural arteries were significantly greater (p &#8804; 0.01) in the male subjects. The differences between the right and left arterial diameters were statistically significant (p &#8804; 0.01) only in relation to the posterior tibial artery. In subtypes IC and IIB the anterior tibial artery was the strongest, the peroneal artery was of intermediate diameter and the posterior tibial artery was the weakest. In subtype IB the anterior tibial artery presented as the predominant vessel but in subtypes IIA-1 and IIA-2 it was the posterior tibial artery that did so. In subtype IA 24 examples of the coexistence of angiometric variants of the crural arteries were distinguished. It was demonstrated that the strongest vessel was the anterior tibial artery (32.24%), rarely the posterior tibial artery (14.47%) or the peroneal artery (9.87%). In most cases (21.71%) three of the crural arteries had intermediate diameters. In 13.16% of cases there were two arteries of intermediate diameter, the posterior tibial and the peroneal, which accompanied a strong anterior tibial artery and, the least common variant (6.58%), two intermediate tibial arteries with a weak peroneal artery. A hyperplastic peroneal artery (6.59%) compensated for either the anterior tibial artery (1.98%) or the posterior tibial artery (4.61%)

A new variant of aberrant left brachiocephalic trunk in mam: case report and literature review

Importance is placed on aberrant arteries in the radiological and surgical literature. A normal left brachiocephalic trunk is characteristic for the right aortic arch. However, an aberrant left brachiocephalic trunk arising as the last branch of the aortic arch on the left side has not yet been described in the literature. Described here is a new variant of the retro-oesophageal aberrant left brachiocephalic trunk, occasionally observed in a patient during diagnostic investigation or surgical treatment for steno-obstructive involvement of the carotid district. The triple anomaly of the left aortic arch consisted of: 1. the presence of a hypoplastic left brachiocephalic trunk behind the oesophagus, 2. the absence of a brachiocephalic trunk on the right side and 3. separate origins of the arteries on the right side, with the right common artery preceding the right subclavian artery. In front of the trachea an 8-mm prosthetic PTFE was implanted from the proximal segment of the right subclavian artery to the junction of the left common carotid and left subclavian arteries. The author demonstrates the inadequacy of auxiliary investigations to detect aberrant arteries, which may only be identified precisely intra-operatively

Skeletopic analysis of the gonadal veins in human foetuses

During ontogenesis an imbalance is observable in the development of the skeletal and vascular systems. By means of anatomical and radiological methods the gonadal veins were studied in relation to the vertebral column in 60 human foetuses of both sexes aged from 4 to 6 months of prenatal life. In male foetuses aged 4&#8211;5 months the origin of the gonadal veins projected onto the sacral apex (r1 = 0.95, r3 = 0.85), and in 6th month they extended below the vertebral column (r1&#8217; = 0.80, r3&#8217; = 0.90). In female foetuses the origin of the gonadal veins in the 4th month projected symmetrically onto S1 (r5 = 0.70, r7 = 0.70). In the 5th month of intrauterine life the origin of the left ovarian vein was found at S2 (r7&#8217; = 0.80) and the origin of the right one at S1&#8211;S2 (r5&#8217; = 0.80). In the 6th month the origin of the left ovarian vein was located at S3 (r7&#8217; = 0.80) and the right one at S2&#8211;S3 (r5&#8217;&#8217; = 0.90). The skeletopic analysis of the origin of the gonadal veins demonstrated gender (the origin was higher in females) and syntopic (the origin was higher on the right side) differences (p &#8804; 0.05). In foetuses of both sexes aged 4 months of prenatal life the termination of the left gonadal veins projected onto Th12&#8211;L1 (r4 = 0.85, r8 = 0.80) and in foetuses aged 5&#8211;6 months it projected onto L1&#8211;L2 (r4&#8217; = 0.90, r8&#8217; = 0.95). In both sexes the termination of the gonadal veins on the right side projected constantly onto L2 (r2 = 0.90, r6 = 0.95) from the 4th to the 6th month of intrauterine life. The skeletopic analysis of the termination of the gonadal veins showed syntopic dimorphism (p &#8804; 0.05) without gender differences (p > 0.05). On the right side the termination of the gonadal (testicular and ovarian) veins projected constantly onto L2. On the left side the termination of the left gonadal (testicular and ovarian) veins apparently descended by one vertebra (pseudodescensus)

Digital-image analysis of the left common carotid artery in human foetuses

The rate of growth of the left common carotid artery during gestation has not been sufficiently evaluated. The present study was performed on 128 spontaneously aborted human foetuses aged 15&#8211;34 weeks to compile normative data for the dimensions of the left common carotid artery at varying gestational ages. Using anatomical dissection, digital image analysis (system of Leica Q Win Pro 16) and statistical analysis (ANOVA, regression analysis), a range of measurements (length, original external diameter and volume) for the left common carotid artery during gestation was examined. No significant gender differences were found (p > 0.05). The growth curves of the best fit for the plot of each morphometric parameter against gestational age were generated. The lengths ranged from 14.82 &#177; 2.22 to 42.84 &#177; 4.32 mm, according to the linear model y = -9.6918 + 1.5963 x &#177; 3.1706 (r = 0.95; p < 0.001). The original external diameter increased from 0.72 &#177; 0.18 to 3.28 &#177; 0.40 mm, according to the linear function y = &#8211;1.5228 + 0.1428 x &#177; 0.2749 (r = 0.95; p < 0.001). The left common carotid artery-to-aortic root diameter ratio increased from 0.356 &#177; 0.062 to 0.480 &#177; 0.101. The left common carotid artery-to-aortic arch diameter ratio increased from 0.447 &#177; 0.079 to 0.535 &#177; &#177; 0.113. The volume ranged from 6.73 &#177; 4.06 to 369.30 &#177; 107.42 mm3 in accordance with the quadratic function y = 344.8 &#8211; 41.001 x + 1.254 x2 &#177; &#177; 46.955 (R2 = 0.87). The parameters examined have clinical application in the early recognition of arterial abnormalities, especially aortic coarctation