Spinal Cord Angiography
Milosh Perovitch in Radiological Evaluation of the Spinal Cord, 2019
The development of selective spinal cord angiography and its introduction as a reliable diagnostic procedure was preceded by detailed anatomic and physiologic studies of the specific blood flow of the spinal cord. Numerous informative additional studies related to diverse aspects of spinal cord angiography published by Djindjian and other investigators had a great impact on its rapid development in a relatively short period of time. The technique of spinal cord arteriography can be divided into the nonselective and selective methods. The nonselective methods are still used in children because selective arteriography is difficult and often even impossible to perform due to the narrow arterial ostia. The catheters for the selective spinal cord arteriography were done according to the Seldinger technique via the femoral artery. Contrast media used for different types of angiographic procedures were thoroughly studied, and their chemical, radiographic, and biologic properties were well analyzed. Radiographic equipment plays an important role in achieving a successful selective spinal cord angiography.
Lower Limb
Bobby Krishnachetty, Abdul Syed, Harriet Scott in Applied Anatomy for the FRCA, 2020
This chapter is intended to cover the anatomical knowledge of lower limb that helps trainee anesthetists who are revising for the Primary and Final FRCA exams. The topics of importance to anesthetists are presented under 'structures', 'circulation' and 'nervous system'. The chapter includes a wide range of questions of clinical relevance that are asked in the exam. The popliteal fossa is a diamond-shaped area posterior to the knee joint. This is the site for popliteal nerve block for providing analgesia for procedures performed in the lower leg. The femoral triangle is a hollow area in the anterior thigh providing relatively easy access to the femoral neurovascular bundle. The main blood supply to the lower limb is by the femoral artery, which is the continuation of the external iliac artery. The femoral artery continues as the popliteal artery in the lower leg. The lumbar plexus is a network of nerve fibers that provide motor and sensory innervation to the lower limb.
Safe and strategic vascular access
Peter A. Schneider in Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
A poorly chosen or conducted access can make case complicated and possibly make a complicated case impossible. Use of the vascular system itself to assist the therapist in arriving at the site of the lesion for treatment has tremendous appeal. The retrograde femoral puncture is the most commonly used since it is safest and offers the highest degree of versatility. Consider the need for access as a breach of the vascular system, a necessary evil that should be minimized as far as possible. The most important maneuver for successful vascular access occurs prior to the procedure, and that is choosing the puncture site. A puncture of the mid-common femoral artery is desirable. Ultrasound guidance is extremely helpful in achieving this goal. Puncture of the artery proximal to femoral head is likely to be too far proximal and to enter the external iliac artery. A right-handed operator stands on the patient’s left side for forehand delivery of the needle and guidewire.
Liberating carotid arteries: measuring arterial pressure through femoral artery in mice
Published in Clinical and Experimental Hypertension, 2019
Li Wu, Wanrong Lin, Xian Fu, Xianliang Li, Xuelong Li, Youfu Li, Weijin Zhang, Jian Guo, Qingchun Gao
Researches involving arterial pressure measurements in mice have primarily relied on carotid arterial catheterization. However, in some circumstances, measuring arterial pressure through the carotid arterial impairs accuracy. This study was aimed to evaluate whether femoral artery could displace carotid artery for the blood pressure (BP) measurements in mice. Fifty-six Swiss mice (n = 14 in each group) were randomized into four groups: control, left femoral artery, right femoral artery, and union group, in which BP was measured through left carotid, left femoral, right femoral artery, and simultaneously from right femoral artery and left carotid artery, respectively. Arterial pressure was recorded for 5 min after catheterization. There was no significant difference of the success rate and mortality rate among four groups (P > 0.05), and no obvious difference (P > 0.05) of catheterization time among the first three groups. For intergroup comparison of arterial pressure, there was no significant difference (P > 0.05) of the systolic blood pressure (SBP), diastolic BP, mean arterial pressure, and pulse pressure among the first three groups. For intragroup comparison, SBP, diastolic blood pressure (DBP), mean arterial pressure (MAP) monitored from right femoral artery were similar (P > 0.05) with those from left carotid artery, with significantly positive correlation. The mean values of difference of SBP, DBP, and MAP were −1.3, 1.2, and 0.5 mmHg, respectively. Our results indicated that femoral artery catheterization could be a safe, feasible, reliable, and accuracy alternative for the direct measurement of arterial pressure in anesthesia mice.
A New Technique for Modeling of Hematogenous Osteomyelitis in Pigs: Inoculation into Femoral Artery
Published in Journal of Investigative Surgery, 2013
Louise K. Johansen, Eiliv L. Svalastoga, Dorte Frees, Bent Aalbæk, Janne Koch, Tine M. Iburg, Ole L. Nielsen, Páll S. Leifsson, Henrik E. Jensen
A new inoculation technique has been developed and applied in a porcine model of juvenile hematogenous osteomyelitis. Following the success of the model, we describe the inoculation technique in detail to enable its replication in future studies. The technique was based on an anatomical feature of the femoral artery that enables inoculation into the artery using a simple surgical procedure. Inoculation in the femoral artery is advantageous because the localization of lesions constitutes a discriminative model of the naturally occurring hematogenous osteomyelitis in long bones, usually involving femur and tibia in children. The procedure was performed under general anesthesia and consisted of five major steps: (1) Exposure of the right femoral artery, (2) retrograde catheterization, (3) inoculation of bacteria, (4) hemostasis of the arterial puncture site using compression, and (5) suturing of the wound in two layers.
Wall shear stress and near-wall flows in the stenosed femoral artery
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2017
Stenotic artery hemodynamics are often characertised by metrics including oscillatory shear index (OSI) and residence time (RT). This analysis was conducted to clarify the link between the near-wall flow behaviour and these resultant flow metrics. A computational simulation was conducted of a stenosed femoral artery, with an idealised representative geometry and a physiologically realistic inlet profile. The overall flow behaviour was characterised through consideration of the axial flow, which was non-dimensionalised against mean flow velocity. The OSI and RT metrics, which are a useful indicator of likely atherosclerotic sites, were explained through a discussion of the WSS values at different time points, the velocity behaviour and velocity profiles, with a particular focus on the near-wall behaviour which influences wall shear stress and the transient evolution of the wall shear stress. While, the stenosis throat experiences high values of wall shear stress, the smooth flow through this contracted region results in low variation in wall shear stress vectors and limited opportunity for any particle stasis. However, regions were noted distal and proximal (though to a lesser extent), where the change in recirculation zones over the cycle created highly elevated regions of both OSI and RT.