Main description:

Over the last few decades, angiography has devel careful analysis of his angiographic findings and a oped enormously and an extensive literature has very thorough description of vascular anatomy been published on the subject. In the last few and its many variants. The extensive clinical ma years, the number of publications has decreased terial also enables him to indicate those circum because the applications of this diagnostic method stances in which angiography can make an impor seem to have been almost fully explored. tant contribution to diagnosis. One of the applications for which this statement This monograph deserves the attention of all who might not be true is angiography of the upper ex are interested in the anatomy and pathology of the tremity. The clinical interest for this field has nev arm and the hand, and is particularly intended for er been as great as for other parts of the body. radiodiagnosticians and surgeons. In Maastricht, Janevski was able to accumulate an A. E. VAN VOORTHUISEN, M.D.

Contents:

I Introduction.- 1.1 Outline of the Book.- 2 The History of Angiography of the Upper Extremities.- 3 Examination Technique.- 3.1 Preparation of the Patient for Upper Extremity Angiography.- 3.2 Premedication for Angiography under Local Anaesthesia.- 3.3 Instruments, Equipment and Contrast Media.- 3.3.1 Catheters.- 3.3.2 Needles and Guide Wires.- 3.3.3 Equipment.- 3.3.4 Local Anaesthesia.- 3.3.5 Contrast Media.- 3.4 Technique of Catheterization.- 3.4.1 Catheter Flushing.- 3.5 Catheter Technique for Hand Angiography.- 3.5.1 Introduction of the Catheter.- 3.5.2 Roentgenography.- 3.5.3 Postangiographic Care.- 3.6 Another Method for Hand Angiography (Direct Brachial Angiography).- 3.6.1 Advantages and Disadvantages of This Method.- 3.7 Complications.- 3.7.1 General Complications.- 3.7.2 Angiographic Complications: Our Experience.- 3.7.3 Neurological Complications Related to Catheter Angiography of the Brachiocephalic Vessels.- 3.7.4 Neurological Complications: Our Experience.- 4 Vascular Tonus and Pharmacoangiography.- 4.1 General Anatomic and Histologic Considerations.- 4.1.1 Innervation of the Vascular System of the Upper Extremities.- 4.2 Physiology of Vascular Tonus: General Discussion.- 4.3 Disturbed Vascular Tonus of the Extremities 24 4.3.1 Clinical Manifestations of Vasospasm of the Extremities.- 4.4 Roentgenographic Manifestations of Arterial Spasm: Our Experience.- 4.5 Pharmacoangiography.- 4.5.1 Vasodilators Used in Peripheral Angiography: Review of Literature.- 4.5.2 The Use of Tolazoline Hydrochloride in Peripheral Brachial Angiography.- 4.5.3 Tolazoline Hydrochloride.- 4.5.4 Toxic Effects.- 4.5.5 Contra-Indications.- 4.6 Our Investigations.- 4.6.1 Selection of Proper Drug.- 4.6.2 Time-Dose Relation in the Use of Tolazoline.- 4.6.3 Technique.- 4.6.4 Conclusions.- 5 Embryology of the Arteries of the Upper Limb.- 6 Anatomy of the Arterial System of the Upper Extremities.- 6.1 Aortic Arch.- 6.1.1 Different Types of Aortic Arch.- 6.2 The Arteries of the Upper Extremities on the Aortograms.- 6.2.1 The Innominate Artery.- a Dimensions of the Innominate Artery.- b Branches.- c Variations.- 6.3 The Arteries of the Upper Extremities on Selective Arteriograms.- 6.3.1 The Subclavian Artery.- 6.3.2 The Vertebral Artery.- a Calibre of the Vertebral A rtery.- 6.3.3 The Internal Mammary Artery.- a Variations.- 6.3.4 The Thyrocervical Trunk 54 a Variations.- 6.3.5 The Costocervical Trunk 56 a Branches.- 6.3.6 The Axillary Artery 56 a Branches.- b Variations.- 6.3.7 The Highest Thoracic Artery.- a Variations.- 6.3.8 The Thoracoacromial Artery.- 6.3.9 The Lateral Thoracic Artery.- a Variations.- 6.3.10 The Subscapular Artery.- a Variations.- 6.3.11 The Scapular Circumflex Artery.- a Variations.- 6.3.12 The Humeral Circumflex Artery.- a The Posterior Humeral Circumflex A rtery.- b The A nterior Humeral Circumflex A rtery.- c Variations.- 6.3.13 The Brachial Artery.- 6.3.14 Anastomoses around the Elbow Joint.- a The Deep Brachial A rtery.- b The Superior Ulnar Collateral Artery.- c The Inferior Ulnar Collateral Artery.- d Variations.- 6.4 The Arteries of the Forearm.- 6.4.1 The Radial Artery.- a Variations.- 6.4.2 The Ulnar Artery.- a Branches.- b Variations.- 6.4.3 The Common Interosseous Artery.- a Variations.- 6.4.4 Persistent Median Artery.- 6.5 The Arteries of the Hand.- 6.5.1 Introduction.- 6.6 Arterial Patterns in the Hand: Based upon a Study of 500 Arteriograms.- 6.6.1 Materials and Methods.- 6.7 The Deep Volar (Palmar) Arch.- 6.7.1 Complete Arch.- a Different Types of Complete Deep Volar Arch.- 6.7.2 Incomplete Arch.- a Different Types of Incomplete Deep Volar arch.- 6.7.3 Other Observations and Discussion.- 6.7.4 The Arteria Princeps Pollicis.- a Variations.- 6.7.5 The Arteria Radialis Indicis.- a Variations.- 6.7.6 The Volar Metacarpal Arteries.- 6.8 The Superficial Volar (Palmar) Arch.- 6.8.1 Complete Arch.- a Different Types of Complete Superficial Volar Arch.- 6.8.2 Incomplete Arch.- a Category I.- b Category II.- c Category III.- d Category IV.- 6.9 Other Observations and Discussion.- 6.9.1 The Calibre of The Deep and The Superficial Volar Arches.- 6.9.2 Branches of the Superficial Volar Arch.- 6.9.3 The Common Volar Digital Arteries.- a Variations.- 6.9.4 Tandler's Artery.- 6.9.5 Persistent Median Artery.- 6.9.6 The Proper Volar Digital Arteries.- 6.10 Conclusions.- 6.10.1 Brachial and Antebrachial Arteries.- 6.10.2 Arteries of the Hand.- 7 Vascular Injuries of the Upper Extremity.- 7.1 Different Types of Injury: Signs and Symptoms.- 7.2 Traumatic Diseases of the Arteries of the Proximal Part of the Upper Extremity.- 7.2.1 Injuries of the Innominate and Subclavian Arteries.- 7.2.2 Injuries of the Axillary Artery.- 7.2.3 Injuries of the Brachial Artery.- 7.2.4 Angiography.- 7.2.5 Report of Our Cases.- 7.3 Traumatic Arterial Injuries of the Forearm and Hand.- 7.3.1 Chronic Arterial Injuries.- a The Hypothenar Hammer Syndrome.- b The Thenar Hammer Syndrome.- 7.3.2 Analysis of Our Case Material.- 7.4 Conclusions.- 8 Congenital Vascular Lesions and Vascular Tumours.- 8.1 Congenital Stenosis, Atresia, Hypoplasia and Aplasia.- 8.2 Arteriovenous Communications.- 8.2.1 Arteriovenous Malformations.- 8.2.2 Arteriovenous Fistulae.- 8.2.3 Clinical Features.- 8.2.4 Haemangioma.- 8.2.5 Report of Our Cases.- 8.3 Conclusions.- 9 The Thoracic Outlet Compression Syndrome.- 9.1 Introduction.- 9.1.1 Historical Background.- 9.2 Anomalies Predisposing to the Thoracic Outlet Compression Syndrome.- 9.3 Aetiology of Vascular Changes.- 9.4 Symptomatology.- 9.5 Physical Examination.- 9.6 Roentgenological Examinations for the Thoracic Outlet Compression Syndrome and Radiodiagnosis.- 9.7 Our Investigation.- 9.7.1 Arteriography: Technical Aspects.- 9.7.2 Phlebography: Technical Aspects.- 9.7.3 Angiographic Signs of Compression at Different Points of the Thoracic Outlet and Radiological Diagnosis.- 9.8 Case Material.- 9.9 Non-Pathological Occlusions of the Arteries of the Upper Limb due to Incorrect Positioning of the Extremity.- 9.10 Conclusions.- 10 Arterial Occlusive Diseases of the Upper Extremity.- 10.1 Arteriosclerosis.- 10.1.1 Radiological Diagnosis of Arteriosclerosis.- 10.1.2 Analysis of Our Case Material.- 10.1.3 Conclusions.- 10.2 Steal Phenomena.- 10.2.1 Subclavian Steal.- a Aetiology.- b Symptomatology.- c Clinical Diagnosis.- d Angiography.- 10.2.2 Bilateral Subclavian Steal Syndrome.- 10.2.3 Innominate Steal Syndrome.- 10.2.4 Analysis of Our Case Material.- 10.2.5 Conclusions.- 10.2.6 Thyrocervical Steal Syndrome.- 10.2.7 Analysis of Our Case Material and Report of a Case.- 10.2.8 Conclusions.- 10.3 Vasospastic Disorders.- 10.3.1 Raynaud's Disease.- 10.3.2 Raynaud's Syndrome.- 10.3.3 Differential Diagnosis.- 10.3.4 Angiography.- 10.3.5 Angiographic Findings.- 10.3.6 Conclusions.- 10.4 Arterial Embolism and Thrombosis of the Upper Extremities.- 10.4.1 Literature on Arterial Embolism.- 10.4.2 Clinical Manifestations.- 10.4.3 Angiography.- 10.4.4 Analysis of Our Case Material.- 10.4.5 Literature on Arterial Thrombosis.- 10.4.6 Clinical and Radiological Diagnosis.- 10.4.7 Radiological Differential Diagnosis Between Embolic and Thrombotic Occlusions.- 10.4.8 Conclusions.- 10.5 Fibromuscular Hyperplasia.- 10.5.1 Clinical Manifestations.- 10.5.2 Angiography.- 10.5.3 Our Case Material.- 10.5.4 Conclusions.- 10.6 Thromboangiitis Obliterans (Buerger's Disease).- 10.6.1 Clinical Manifestations.- 10.6.2 Angiography.- 10.6.3 Analysis of Our Case Material.- 10.6.4 Differential Diagnosis of Thromboangiitis Obliterans and Arteriosclerosis Obliterans.- 10.6.5 Conclusions.- 10.7 Collagen Diseases.- 10.7.1 Scleroderma.- a Clinical Signs of Scleroderma Progressiva.- b Angiography.- c Analysis of Our Case Material.- 10.7.2 Lupus Erythematosus.- a Angiographic Signs.- 10.7.3 Rheumatoid Arthritis.- a Angiography.- 10.7.4 Conclusions on Arteriography in Collagen Diseases of the Hand.- 10.8 Conclusions on Angiography in Acquired Vascular Diseases.- Summary.- Index of Subjects.