SUMMARY:The classic description of the hand's superficial palmar arch is based on the anastomosis among the ulnar and radiopalmar arteries, a branch of the radial artery. However, the arch formation is highly variable regarding the size of the arteries that make it up and due to the existence of branches coming from other arteries and adding up as tributary to it. The objective of this paper is to classify these possible varieties, to define the formation of the arch, the reasons for its variable arrangement and the importance of its clinical and surgical applications. 86 formalized hands were dissected at 40%. There is prevalence concerning the size of the ulnar artery, with or without an arch. The anatomic knowledge of the variability in the arch formation becomes important in the application of surgical techniques that can help treating pathologies of the hand.
Endovascular treatment of posttraumatic arteriovenous fistulae (AVFs) in the lower extremities by means of covered stent-grafts is widely accepted, and many cases have been reported in the iliac-femoral region. However, few reports exist on the treatment of infrapopliteal AVFs, with or without a pseudoaneurysm, using this method. The authors present this case report dealing with a patient who had undergone a tibial and peroneal open fracture in his left limb 34 years ago. He developed a leg ulcer as a consequence of AVF between the tibialis posterior artery and vein, which resulted in venous insufficiency, which was treated by the endovascular approach with the placement of a stent-graft. Total healing was achieved over a period of 3 months. Angio-CT was performed, showing stent-graft patency 6 months after the endovascular procedure.
RESUMEN:El recorrido del nervio radial a través del codo constituye, para este elemento nervioso, un camino con riesgo de lesiones intrínsecas o extrínsecas. Cambios de la morfología de las estructuras osteomusculares que constituyen el desfiladero del nervio radial, tanto patológicos como traumáticos, pueden determinar el atrapamiento y compresión del mismo, determinando el daño del nervio y/o la inflamación localizada a nivel de las estructuras circundantes. Mediante la disección de 30 preparados, formolizados al 10%, y el análisis subsecuente de la disposición de las estructuras musculares e inserción de las mismas, se determinaron los posibles puntos de riesgo anatómico que pudiesen alterar al nervio radial o a sus ramos en la canal bicipital lateral o en su ingreso y distribución en el parte proximal del antebrazo (relación con el músculo supinador y los músculos extensores radial largo y corto). Definimos 4 zonas de posible atrapamiento y compresión del nervio radial y sus ramos: 1. Septo intermuscular lateral. 2. Músculo extensor radial corto. 3. Músculo supinator, a nivel de la Arcada de Frohse. 4. Músculo supinator, a la salida de la masa muscular, en el dorso del antebrazo. La compresión del nervio radial a nivel del codo es una de las neuropatías del miembro superior, más frecuentes. El objetivo de este trabajo fue analizar las implicancias anatómicas del recorrido del nervio radial en su pasaje desde el brazo al antebrazo, especialmente las relaciones con las estructuras osteomusculares, cuyas alteraciones pueden ser las responsables de patologías compresivas del nervio radial que puedan llevar a dolor, parestesias, con o sin pérdida sensorial y/o impotencia funcional.PALABRAS CLAVE: Nervio radial; Atrapamiento; Arcada de Frohse; Nervio interóseo antebraquial posterior. INTRODUCCIÓNEl nervio radial deriva de la porción dorsal del plexo braquial y sus raíces constitutivas provienen prácticamente de todas las que lo forman, es decir, de las raíces cervicales 5ª, 6ª, 7ª, 8ª y, en proporción variable, de la 1ª raíz torácica (Testut & Latarjet, 1954;Bouchet & Cuilleret, 1997). Luego de recorrer la axila y el surco del nervio radial del húmero, atraviesa el tabique intermuscular lateral del brazo, para ingresar en lo que denominamos el "desfiladero radial". Por lo tanto, se inicia a nivel de este tabique y finaliza en el borde inferior del fascículo superficial del músculo supinador, en el dorso del antebrazo.El "desfiladero radial" consta de 3 porciones. La primera porción se extiende desde el sitio en que el nervio radial perfora el tabique intermuscular lateral del brazo, hasta el nivel de la interlínea de la articulación húmero-radial del codo. En esta porción el nervio radial proporciona los ramos nerviosos destinados a los músculos con origen en el epicóndileo lateral del húmero, que conforman el límite anterolateral del desfiladero: músculos braquioradial y extensor radial largo del carpo (MERLC), extensor radial corto del carpo (MERCC), dispuestos sucesivamente de proximal a distal. Medialmente son...
Introduction and purpose:The increasing number of patients undergoing hemodialysis and the limited number of access sites have resulted in an increasing number of techniques to maintain vascular access for hemodialysis. Thrombosed arteriovenous (AV) fistulas with large venous aneurysms have poor treatment results, with both endovascular and surgical techniques, leading to a high rate of definitive AV access loss. The purpose of this study was to review the feasibility and initial results of this novel endovascular treatment of thrombosed AV fistulas with large venous aneurysms. Materials and methods: A novel endovascular treatment technique of inserting nitinol autoexpandable uncovered stents stretching through the whole puncture site area, thus creating a tunnel inside the thrombus, was retrospectively analyzed and described. Results: A total of 17 stents were placed in 10 hemodialysis fistulas, with a mean venous coverage length of 17.8 cm. In all the cases, 100% technical success was achieved, with complete restoration of blood flow in all patients. There were no procedure-related complications. The mean follow-up was 167 days (range 60-420 days), with a primary and assisted patency of 80% and 100%, respectively. No multiple trans-stent struts-related complications were observed. Three stent fractures were diagnosed with plain films at the site of puncture without consequence in the venous access permeability. Conclusion: The "stent tunnel technique" is a feasible, safe and effective alternative to salvage native hemodialysis access, thus extending the function of the venous access with no signs of stent-related complications and a respectable midterm patency.
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