4. Common upper extremity arterial anatomy:
The ulnar artery supplies the superficial palmar arch, the major
source of blood flow to the digits
Fig. Common upper extremity arterial
anatomy: The ulnar artery supplies the
superficial palmar arch, the major source of
blood flow to the digits. The radial artery
supplies the deep palmar arch, which in turn
supplies the dorsal arches of the hand.
Stepansky F et al. Radiographics 2008;28:e28-e28
5. The superficial palmar arch is formed mainly by the ulnar artery and is
completed by the superficial branch of the radial artery.
Fig. The superficial palmar arch is formed
mainly by the ulnar artery and is completed by
the superficial branch of the radial artery. A
complete arch is not always present. The
superficial palmar arch provides the arterial
supply to the digits via the digital palmar
arteries.
Stepansky F et al. Radiographics 2008;28:e28-e28
11. A Subclavie
•
•
•
•
•
Abord: spatiul supra/subclavicular
Raporturi cu V Subclavie
Flux pulsatil
Sediul stenozei ATS
Consecinte hemodinamice aval/amonte
ATENTIE: AS ABERANTA IN CAZURI PEDIATRICE
Se asociaza cu sdr. compresiv al cailor aeriene
12. Stenoza AS
• Prevalenta: 2-7%
• Diferenta TAS >15 mm
dr/stg
CAUZE:
• ATS – placa
• B. Takayasu
• Dispazia fibromusculara
• Radioterapie
Relatia cu:
•
•
•
Fumatul,
HDL-C
ATS (BCI, stenoza ACI, BOAP,
stroke)
• CAD – 0.5-4%
• PAD – 18.7%
Shadman R et al. J Am Coll Cardiol, 2004; 44:618-623
Gutierrez GR et al. Angiology. 2001;52:189–194
English JA et al.Cathet Cardiovasc Intervent. 2001;54:8–11
13. Stenoza AS - Diagnostic
• Clinic:
difer TAS dr/stg >15-20 mmHg
claudicatia bratului
• FRCV
Imagistica
• US
• Angio CT/RMN
• Angio-standard
15. Hemodinamica
• In relatie cu localizarea/severitatea
stenozei
• Local: V max S ampla
• Amonte: sdr. Furt S-V
• Aval: flux redus:
• A axilara
• A brahiala
• A mamara interna
17. Subclavian steal syndrome
• Stenoza/ocluzia AS ipsilaterala cu
devierea retrograda a fluxului in AV
• Stenoza situata proximal de originea AV
• Asimptomatic
• Simptome neurologie (ischemie cerebrala)
UNILATERAL/BILATERAL
DOBANDIT/CONGENITAL
Contorni, 1960;Fisher, 1961;Parrott, 1964
18. Subclavian steal syndrome
Fig. Subclavian steal syndrome. (a) TOF sequence
with a saturation band above the section demonstrates
absence of signal in the left vertebral artery (arrow).
(b) TOF sequence with a saturation band below the
section demonstrates signal corresponding to
retrograde flow in the left vertebral artery (arrow). (c)
Coronal maximum intensity projection (MIP) image
from contrast-enhanced MR angiographic study
demonstrates occlusion of the proximal subclavian
artery (arrow), with reconstitution distal to the origin of
a patent left vertebral artery.
Stepansky F et al. Radiographics 2008;28:e28-e28
19. Modificari precoce ale anvelopei spectrale a
AV in furtul S-V
• Tipul I (20%)
• Tipul II (40%)
Kliewer MA et al. Am J Radiol 2000;174:815-819
20. • Tipul III (12.5%)
• Tipul IV (27.5%)
Kliewer MA et al. Am J Radiol 2000;174:815-819
29. Definitie
Sdr. coronarian (anginos) aparut la
pacientii revascularizati prin by-pass cu a.
mamara interna la care se dezvolta
stenoza proximala de AS
Figure 1. Common upper extremity arterial anatomy: The ulnar artery supplies the superficial palmar arch, the major source of blood flow to the digits. The radial artery supplies the deep palmar arch, which in turn supplies the dorsal arches of the hand. (Reprinted with permission from reference 13.)
Figure 3. The superficial palmar arch is formed mainly by the ulnar artery and is completed by the superficial branch of the radial artery. A complete arch is not always present. The superficial palmar arch provides the arterial supply to the digits via the digital palmar arteries. (Reprinted with permission of Wesley Norman, PhD, from The Anatomy Lesson.)
Figure 5c. Subclavian steal syndrome. (a) TOF sequence with a saturation band above the section demonstrates absence of signal in the left vertebral artery (arrow). (b) TOF sequence with a saturation band below the section demonstrates signal corresponding to retrograde flow in the left vertebral artery (arrow). (c) Coronal maximum intensity projection (MIP) image from contrast-enhanced MR angiographic study demonstrates occlusion of the proximal subclavian artery (arrow), with reconstitution distal to the origin of a patent left vertebral artery.