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Morphological Analysis of Pig Femoro-iliaco-aorto-renal System on Corrosion Casts and MDCT Angiography Preliminary report for stenting training
Abstract
Domestic pigs were frequently used in training centers for residents and students in medicine for the stenting procedures at the level of renal arteries. On 12 domestic pigs (all male) with an average weight of 34 kg (30.0-39.9 kg), were analysed the morphological parameters of femoro-iliaco-aorto-renal arterial system. An analysis of the pelvic segment length (I-II-III) and abdominal (IV), shows almost perfect equality of the lengths of the two segments on the right (76.26 ± 5.30 mm / 76.21 ± 4.51 mm) and a mean difference of 1.25 mm in favour of segment IV (abdominal) (75.53 ± 5.10 mm / 76.78 ± 4.44 mm), a difference that correlate with left renal artery cranial origin. Pelvic diameter portions of femoro-iliac arterial axis increase linear in average by 10% per segment (from 3.99 ± 0.40 mm ± 4.89 in segment I at 4.89±0.33 mm in segment III). Increasing the diameter from the segment III to segment IV is approximately of 30%. The diameter of the proximal part of renal artery (3.46 ± 0.36 mm) on the studied material is smaller than the diameter of the proximal part of the external femoral artery (segment I) (3.99 ± 0.40 mm), making it easy retrograde catheterisation of femoro-iliac-aorto-renal arterial axis. Knowledge of the morphological parameters of femoro-iliaco-aortic arterial axis and their evolution in correlation with the weight of laboratory animals-domestic pigsfavours the achievement in good conditions to arterial catheterization for proximal renal artery stenting.
... Plastic compounds have been used for several decades to generate anatomical constructs for the training of new surgeons and medical students alike. Previous publications show three main directions of study in this area: (i) corrosion casting designed to highlight the vascular-ductal systems of the parenchymal organs [1][2][3][4]; (ii) creating plastinated anatomical cross-sections, with computer aided three-dimensional reconstruction and modeling of the anatomical structures [5][6][7][8][9]; (iii) embedding of anatomical preparations in plastic mass [10,11]. In recent decades, the development of microsurgery has allowed the use of free muscle flaps (with or without fasciocutaneous structures) to cover or fill important soft tissue defects. ...
Plastic compounds have been used for several decades to generate anatomical constructs for the training of new surgeons and medical students alike. The present study seeks to highlight the advantages and disadvantages of two different plastic compounds (Technovit 7143 and Epoxi BIODUR?E12) used to create corrosion casts of the vascular branching patterns in free muscle flaps. Porcine latissimus dorsi muscle free flaps were used in this study to create corrosion casts of their vascular branching tree by injecting the two different plastic compound into the main arterial supply. The casts generated by Epoxy BIODUR? E12 have superior qualities compared to the casts injected with Technovit 7143, because the injection process is smoother at all branching levels, without dilation, strictures or intramuscular extravasation of the injectable plastic compound. The corrosion casts resulted from injecting Epoxy BIODUR? E12 exhibit better elasticity and better resistance to mechanical handling compared to the ones injected with Technovit 7143.
Renal artery stensosis (RAS) continues to be a problem for clinicians, with no clear consensus on how to investigate and assess the clinical significance of stenotic lesions and manage the findings. RAS caused by fibromuscular dysplasia is probably commoner than previously appreciated, should be actively looked for in younger hypertensive patients and can be managed successfully with angioplasty. Atheromatous RAS is associated with increased incidence of cardiovascular events and increased cardiovascular mortality, and is likely to be seen with increasing frequency. Evidence from large clinical trials has led clinicians away from recommending interventional revascularisation towards aggressive medical management. There is now interest in looking more closely at patient selection for intervention, with focus on intervening only in patients with the highest-risk presentations such as flash pulmonary oedema, rapidly declining renal function and severe resistant hypertension. The potential benefits in terms of improving hard cardiovascular outcomes may outweigh the risks of intervention in this group, and further research is needed.
Background
Prospective, international, multi-centre, randomised (1:1) trial to evaluate the clinical impact of percutaneous transluminal renal artery stenting (PTRAS) on the impaired renal function measured by the estimated glomerular filtration rate (eGFR) in patients with haemodynamically significant atherosclerotic renal artery stenosis.
Methods
Patients will be randomised to receive either PTRAS using the Dynamic Renal Stent system plus best medical treatment or best medical treatment. Renal stenting will be performed under angiographic imaging. For patients randomised to best medical treatment the degree of stenosis measured by renal duplex sonography (RDS) will be confirmed by MR angio or multi-slice CT where possible. Best medical treatment will be initiated at randomisation or post procedure (for PTRAS arm only), and adjusted as needed at all visits. Best medical treatment is defined as optimal drug therapy for control of the major risk factors (blood pressure ≤ 125/80 mmHg, LDL cholesterol ≤ 100 mg/dL, HbA1c ≤ 6.5%). Data recordings include serum creatinine values, eGFR, brain natriuretic peptide, patients' medical history and concomitant medication, clinical events, quality of life questionnaire (SF-12v2™), 24 hour ambulatory blood pressure measurement, renal artery duplex ultrasound and echocardiography. Follow-up intervals are at 2, 6, 12 and 36 months following randomisation.
The primary endpoint is the difference between treatments in change of eGFR over 12 months. Major secondary endpoints are technical success, change of renal function based on the eGFR slope change between pre-treatment and post-treatment (i.e. improvement, stabilisation, failure), clinical events overall such as renal or cardiac death, stroke, myocardial infarction, hospitalisation for congestive heart failure, progressive renal insufficiency (i.e. need for dialysis), need of target vessel revascularisation or target lesion revascularisation, change in average systolic and diastolic blood pressure, change in left ventricular mass index calculated from echocardiography, difference in the size of kidney (pole to pole length) measured by renal duplex sonography, total number, drug name, drug class, daily dose, regimen and Defined Daily Dose (DDD), of anti-hypertensive drugs, and change in New York Heart Association (NYHA) classification. Approximately 30 centres in Europe and South America will enrol patients. Duration of enrolment is expected to be 12 months resulting in study duration of 48 months.
Trial registration
Trial registration number: NCT00640406
Both the United States and Canada have projected shortages of qualified laboratory-animal veterinarians within the next 10 years. This gap is occurring because of retirement, increased regulatory requirements for research animal oversight, and insufficient numbers of veterinarians entering this field. One of the primary means of increasing student interest in nontraditional practice areas, such as laboratory animal medicine, is to ensure that they have appropriate exposure to the topic during their basic clinical training. We outline a recommended curriculum for laboratory animal medicine for North American veterinary medical colleges, which provides strategies for integrating comparative medicine material into the curriculum, incorporates flexibility for a range of delivery methods, and suggests potential resources that may be used to develop this material.
Crossed fused renal ectopia (CFRE) is the second most common fusion anomalies (FAs) of the kidneys after horseshoe kidney. Crossed fused renal ectopia (CFRE) results from one kidney crossing over to the opposite side and subsequent fusion of the parenchyma of the two kidneys. We report, by multidetector-row computed tomography (MDCT) angiography, an extremely rare case of a left CFRE (L-shaped kidney type), consisting of multiple renal arteries (one main renal artery for the upper renal parenchyma, and three renal arteries (one main and two additional) for the lower renal parenchyma) and two left renal veins, which produced a double nutcracker syndrome (both anterior and posterior). The L-shaped left kidney has a maximum length of 18.5 cm, a maximum width of 10.2 cm, and a maximum thickness of 5.3 cm. The upper pole of the kidney is located at the level of the lower third of T12 vertebral body (4.6 cm left to the mediosagittal plan); the lower pole is located along the lower half of the L5 vertebral body (1.5 cm left to the mediosagittal plan). The following case will focus on the relevant anatomy, embryology, and the clinical significance of this entity.
We report an atypical case of a 63-year-old male with the presence of seven renal arteries (RAs) (three right and four left) found incidentally on multi-detector computed tomography (MDCT) angiography which was used to investigate peripheral vascular disease of the lower limbs. Each arterial lumen was analyzed for the diameter at its origin; length and trajectory in the frontal plane (ascendant + or descendant -); and the distance between the point of origin from the abdominal aorta (AA) to its renal intraparenchymal penetration point. We also analyzed the distance between the extreme points of origin of the right and left RAs from the AA and the distance between the extreme points of penetration into the renal parenchyma of the right and left RAs. On each side, the endoluminal diameter at the origin of the main RA was significantly larger than that of the other AdRAs; however, the AdRAs were much longer than that of the main RA. From the six AdRAs, four were hilar RAs and two were superior polar RAs. Knowledge of such cases is of great clinical significance, as it may be beneficial in various urological operations or invasive arterial procedures.
The celiac trunk is the first unpaired midline branch of the abdominal aorta that usually gives rise to the left gastric artery (LGA), the common hepatic artery (CHA) and the splenic artery (SpA). Despite this classic arrangement, many variations exist. We describe an atypical case of an absent CT and anomalous origin of the LGA, CHA and the SpA from the abdominal aorta using multidetector computed tomography angiography (MDCTA) in a 72-year-old male patient. The LGA arose from the anterior wall of the AA at the level of the T12-L1 intervertebral disk [33.8 mm above the origin of the superior mesenteric artery (SMA)]. The SpA originated directly from the anterolateral wall of the AA at the junction of the upper-third and middle-third of the L1 vertebral body (24.8 mm above the origin of the SMA). The CHA branched directly from the anterior wall of the AA at the level of the middle-third of the L1 vertebral body (17 mm above the origin of the SMA). The 64-slice MDCTA system has become the primary tool for evaluation of abdominal blood vessels. It is important to be aware of such a variation as it can have a significant impact on surgical and clinical practice.
The authors report a case of a 44-year-old male found to have unusual origins of the celiac trunk (CT) and superior mesernteric artrery (SMA) as revealed by routine multidetector computed tomograph (MDCT) angiography. The CT and SMA originate from the thoracic aorta (TA) 21 mm and 9 mm above the aortic hiatus, respectively. The median arcuate ligament (MAL) is located at the level of the L1-L2 intervertebral disc. The course of the CT descends in the thoracic cavity making a 14° acute downward angle in front of the TA; below the level of the MAL, the CT descends, making an angle of 47°. The course of the SMA descends at both the thoracic and abdominal level making an angle of 17°, and having an aortomesenteric distance of 9 mm at the level of the third part of the duodenum. In the present case, the supradiaphragmatic origin of the CT and the SMA was determined by their incomplete caudal descent, associated with a pronounced apparent descent of the diaphragm. A thoracic origin of the CT and SMA and the acute downward aortomesenteric angle (17°) associated with a reduced aortomesenteric distance at the level of the third part of the duodenum (9 mm), although no clinical signs are present, may predispose the patient to develop simultaneously a triple syndrome: the compression of CT by MAL (celiac axis compression syndrome), the compression of SMA by MAL (superior mesenteric artery compression syndrome), and the compression of the duodenum by the SMA (superior mesenteric artery syndrome). Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.
We describe in this paper a rare case of a 45-year-old male with a common stem origin of the left gastric artery (LGA), right inferior phrenic artery (RIPA), and left inferior phrenic artery (LIPA), in association with the presence of a hepatosplenomesenteric trunk (HSMT) arising from the abdominal aorta (AA), as revealed by routine multidetector computed tomography (MDCT) angiography. The common stem origin of the LGA, RIPA, and LIPA had an endoluminal diameter of 3.3 mm, the LGA of 2.8 mm. The endoluminal diameter of the RIPA and LIPA was at the origin of approximately 1 mm, complicating selective chemoembolization of the liver parenchyma. Clin. Anat., 2012. © 2012 Wiley Periodicals, Inc.
We describe in this article a rare case of a 39-year-old male with an inferior phrenic arteries trunk (IPAaT) originating from a common stem with a superior additional left renal artery (SAdLRA) from the abdominal aorta as revealed by routine multidetector computed tomography angiography. The IPAaT with an endoluminal diameter at the origin of 2.8 mm had an upward path with a total length of 18.4 mm, forking to the right inferior phrenic artery and left inferior phrenic artery. These two arteries had an endoluminal diameter at the origin of 1.7 mm and 2.0 mm, respectively. The presence of the common stem of the IPAaT with a SAdLRA and the length of the IPAaT complicate selective chemoembolization of the liver parenchyma. Clin. Anat., 2012. © 2012 Wiley Periodicals, Inc.
The authors describe a case of a 57-year-old male patient with peripheral vascular disease which presented on MDCT angiography the absence of the celiac trunk (CT). The left gastric artery (LGA), common hepatic artery (CHA), and splenic artery (SA) (with an internal diameter at origin of 3.3, 6.0, and 6.2 mm, respectively) originated directly and independently from the abdominal aorta (AA). The LGA arose from the anterior wall of the AA [27 mm above the origin of the superior mesenteric artery (SMA)]. The SA and CHA arose from the left side of the anterolateral wall of the AA at 19 and 14 mm (respectively) above the origin of the SMA. The incidence and developmental and clinical significance of this vascular variation are discussed with a detailed review of the literature.
Variation in the number of renal arteries (RAs) constitutes the most common and clinically important renal vascular variation. In this study, the authors describe a rare case of a 58-year-old male with eight RAs (bilateral quadruple) as revealed by routine multidetector computed tomography angiography. All the eight RAs originated from the abdominal aorta and penetrated the renal parenchyma at the level of renal sinus. The main RAs had the intraluminal diameter larger than the diameter of the additional renal arteries (AdRAs) at the origin. All the AdRAs had a greater length than the main RAs. These aspects are particularly important in planning microsurgical procedures. Clin. Anat. 2012. © 2012 Wiley Periodicals, Inc.
Renal ostial stenting (ROS) is the most common endovascular intervention for treatment of atherosclerotic renal artery stenosis. The two most common indications for ROS are refractory hypertension and progressive renal insufficiency. It is important to recognize that this intervention is most often done to mitigate either or both problems and will rarely “cure” either. ROS remains controversial with published data that both support and refute its utility. This article is the first in a two-part series dedicated to performing the “typical” procedure. The second part will deal with common problems and complications.
Laboratory animals play an indispensable role in research discovery and technological advances, and they will continue to yield basic, exciting, and prodigious information that can enrich the future of people and other animals. For both ethical and scientific reasons, all-individuals whose work requires the use of laboratory animals must take the time to conduct a thorough review of the literature to determine what animal models are available and which are the most relevant, and they must learn and understand the uniqueness of the selected species, breed, and strain. Scientists have the privilege, but not the right, to use animals as experimental subjects. This privilege must not be abused. Therefore, it is imperative that before working with any laboratory animal, you know your "subject."
The use of swine for teaching purposes in medicine and surgery has largely increased in recent years. Detailed knowledge of the porcine anatomy and physiology is a prerequisite for proper use of pigs as a teaching or an experimental model in interventional radiology. A systematic study of the radiological anatomy was undertaken in more than 100 female pigs aged 6-8 weeks. All studies were performed under general anesthesia in a single session. Animals were sacrificed at the end of the study. Selective angiographies were systematically obtained in all anatomical territories. In other animals CT and MRI examinations were performed and were correlated to anatomical sections and acrylic casts of the vascular structures. Endoscopical examinations of the upper gastrointestinal tract, including retrograde opacification of the biliary and pancreatic ducts, were added in selected animals. The main angiographic aspects of the brain, head and neck, thorax, abdomen, and pelvis were recorded. Similarities and differences in comparison with human anatomy are stressed. Potential applications in interventional radiology are indicated.
The information in this issue reflects the combined effort of many professionals with expertise in laboratory animal science and medicine, regulatory affairs, and education. Collectively, their diverse experience and perspectives introduce a wealth of new educational strategies, technologies, training options, assessment tools, and curricula that can be used to meet the education and training needs of the laboratory animal research community. It is our hope that publication of this issue will build on the foundation of Education and Training in the Care and Use of Laboratory Animals: A Guide for Developing Institutional Programs and will provide contemporary methods for developing or expanding institutional animal care and use training programs. Appropriate education and training help to empower employees and enable them to conduct responsible and humane animal research. This essential foundation also helps individuals to discuss the benefits of their research and related support efforts with coworkers, family, and the general public. However, it is equally important for institutions to continuously provide opportunities to educate and train their employees because advancements in scientific knowledge and technologies are constantly evolving. The continuity and maintenance of high-quality education and training programs will not only help to ensure optimal animal care and use but will also provide assurance to the public that animal research is conducted responsibly.
We assessed the similarities of the iliac bifurcation in two breeds of swine to the known human carotid bifurcation, in order to assess its applicability as a preclinical model of the human carotid bifurcation.
Mixed-Landrace crossbreed (domestic; n = 66) and Yucatan miniswine (Yucatan; n = 13) were studied. The diameters of the iliac bifurcation arteries were measured from angiographic pictures, the relations between the arterial diameters and the animal's weight assessed, and diametrical ratios calculated. Findings were compared with the known human carotid bifurcation.
The external iliac diameter (approximately 6-7mm) in the lower weight swine was similar to the known human common carotid artery. The best similarity was found between the diametrical ratios of the human internal to common carotid artery (mean 0.63) to the swine profunda to external iliac (means 0.68 and 0.65 for the domestic and Yucatan, respectively). The arterial diameters of the domestic swine were highly correlated with their weight that increased considerably with time, while in the Yucatan group, arterial diameters did not change with increasing weight and the average weight increase rate was low. Thus, the estimated arterial diameter increase rate over time was high in the domestic while minor in the Yucatan group.
Similarities were found between the swine iliac bifurcation arteries to the human carotid bifurcation in terms of diameters, diametrical ratios and angle. The swine iliac bifurcation may be used for preclinical endovascular research of devices intended to the human carotid bifurcation, with miniswine strains a preferable model for long-term studies.