Angiography of the Upper Extremity

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.