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Immediate repair before radiotherapy
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
The superior epigastric artery is the inferior continuation of the internal mammary artery and enters the rectus abdominis muscle on its deep surface, approximately 7 cm below the costal margin (Figure 11.3.2.4). Several perforators arise from branches of this vessel, between the costal margin and the first tendinous intersection.7 The SEAP flaps are based on perforators arising from either the superficial or the deep branch of the superior epigastric artery, and the corresponding perforator flaps are named SSEAP and DSEAP, respectively. There are four dominant perforators which are evaluated within four zones along the Y-axis at distances of 0–5, 5–10, 10–15, and 15–20 cm.8 Emerging perforators with a caliber of more than 0.5 mm are most frequently encountered within an area 2–6 cm from the midline and 0–10 cm below the xiphoid process.
Respiratory system
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Terminal branches of internal thoracic artery– Superior epigastric artery– Musculophrenic artery
The Stomach (ST)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Superior epigastric artery and vein: Arises from the internal thoracic artery and vein to supply and drain the upper portion of the rectus abdominis muscle. Anastomose with the inferior epigastric artery and vein.
Pericardial Anatomy, Interventions and Therapeutics: A Contemporary Review
Published in Structural Heart, 2021
Reza Reyaldeen, Nicholas Chan, Saberio Lo Presti, Agostina Fava, Chris Anthony, E. Rene Rodriguez, Carmela D. Tan, Walid Saliba, Paul C Cremer, Allan L. Klein
Pericardial access is typically achieved from a subxiphoid approach, which allows better access to the pericardium and contrast guidance is used to help identify the needle tip and outline the heart in the pericardial space20,26 (Figure 9). Similar to fluoroscopy-guided pericardiocentesis, the blunt epidural Tuohy needle is directed toward the left scapula with the patient in a supine position and the angulation dependent on which aspect of the ventricular surface is required – a relatively shallow angle of less than 45 degrees used for anterior access compared to a steeper, greater than 45 degrees angle for inferior access20,21 (Figure 10). A steeper angle, aiming for the inferior aspect has a greater potential for intra-abdominal injury, namely damage to the diaphragm and associated structures, although the anterior approach can also increase the risk of superior epigastric artery perforation.20 General anesthesia is essential to minimize diaphragmatic movement and control respiration, which can increase the risk of cardiac perforation.26 Once pericardial access has been obtained, contrast fluoroscopy can be used to outline the pericardium and guide catheter delivery. Bleeding complications can be minimized by directing the needle through the left sternocostal triangle (known as the Larrey’s space, Figures 10 and 11) – which is largely avascular, aside from the left superior epigastric artery coursing along the costal margin.5 With this approach, the needle is directed inferiorly and leftwards of the xiphoid process, through the rectus abdominus muscle, minimizing potential contact with the liver, diaphragm and superior epigastric artery.5 Fluoroscopy is essential to access, and the guidewire should be visualized to freely move into the pericardial space, without a characteristic inter-arterial course, which can be best appreciated on a left anterior oblique (LAO) view as the wire should cross over both the left and right sides of the cardiac border21 (Figure 12).