“Choke” vessels between vascular territories of the abdominal wall: Literature review and rare case of Leriche's syndrome

Abstract

We undertook a review of the anatomical changes of "choke" vessels between the internal thoracic artery (ITA) and deep inferior epigastric artery (DIEA), as highlighted by a case of aortoiliac occlusive disease (Leriche's syndrome), and discuss the physiological concepts observed with regard to surgical delay procedures within the abdominal wall performed prior to abdominal cutaneous free flaps and coronary artery bypass grafting. Computed tomographic angiography (CTA) was undertaken on a patient with a rare case of Leriche's syndrome and a literature review of over 200 references on the anatomy, physiology and clinical uses of choke vessels in the abdominal wall was undertaken. The CTA demonstrated that in patients with Leriche's syndrome, there is a marked dilatation of all ITA-DIEA pathways and increased flow through choke vessels. If these changes can be surgically replicated in the form of a delay procedure for patients seeking to undergo autologous breast construction, this could improve the outcomes of abdominal cutaneous free flaps and coronary artery bypass grafting. We accordingly propose three surgical methods for augmenting blood flow to the abdominal wall: a) ligation of the DIEA; b) ligation of the distal ITA; and c) creation of an arterio-venous fistulae in the DIEA. Our review of the literature confirmed the viability of these propositions. The dilatation of choke vessels in response to increased haemodynamic stress may thus be utilised to enhance blood supply to tissues prior to transfer and can be achieved through simple and minimally invasive methods.

Leriche syndrome in a patient with acute pulmonary embolism and acute myocardial infarction: a case report and review of literature

“…The classical triad of clinical symptoms is intermittent claudication, impotence, and weak or absent femoral pulses [7]. Collateral vessels so-called choke vessels, always present along with the slowly-developing occlusions while acute aortic embolus extending from the inferior mesenteric artery to both external iliac arteries, could also happen [20,21]. Comorbidities such as AMI, dilated cardiomyopathy, ischemic bowel disease, gastric outlet obstruction, chronic obstructive pulmonary disease, chronic renal failure, and malignancy have been reported [7,18,22].…”

Casting Materials and their Application in Research and Teaching

“…India ink is easily miscible with water and has been used for angiography (Fujimoto et al, 2013), for enhancing clinical and surgical procedures (Shaari et al, 1999) and in casting (Zhao et al, 2004). The problem with aqueous solutions is their possible penetration of neighboring vascular territories via “choke vessels.” Choke vessels are arteries with reduced diameters that link adjacent vascular territories and that only dilate during times of increased demand for blood flow (Ye et al, 2012) making assessments of the exact borders of vascular territories difficult (Bergeron et al, 2006; Benzioni et al, 2009). India ink is easily miscible with other casting materials.…”

Experimental study of survival of pedicled perforator flap with flow-through and flow-end blood supply

“…The angiosome refers to a three‐dimensional block of tissue nourished by a specific feeding artery. Angiosomes of the skin and subcutaneous fasciae are connected by small‐calibre vascular anastomoses, choke vessels. The distal end of the feeding artery is transected to harvest the pedicle flap without anastomosing to the artery of the recipient site for skin resurfacing.…”