Circulatory anastomosis

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A circulatory anastomosis is a connection (an anastomosis) between two blood vessels, such as between arteries (arterio-arterial anastomosis), between veins (veno-venous anastomosis) or between an artery and a vein (arterio-venous anastomosis). Anastomoses between arteries and between veins result in a multitude of arteries and veins, respectively, serving the same volume of tissue. Such anastomoses occur normally in the body in the circulatory system, serving as back-up routes in a collateral circulation that allow blood to flow if one link is blocked or otherwise compromised, but may also occur pathologically. [1]

Contents

Physiologic

Arterio-arterial anastomoses include actual (e.g., palmar and plantar arches) and potential varieties (e.g., coronary arteries and cortical branch of cerebral arteries).

There are many examples of normal arterio-arterial anastomoses in the body. Clinically important examples include:

Coronary

Surgical intervention

Coronary anastomoses are a clinically vital subject: the coronary anastomosis is the blood supply to the heart. The coronary arteries are vulnerable to arteriosclerosis and other effects. Inadequate supply to the heart will lead to chest pains (angina) or a heart attack (myocardial infarction). These can be ameliorated by surgical intervention to create a bypass using the anastomosis technique. Creation of an end-to-end anastomosis is a basic microsurgical skill that is taught to surgical residents and fellows. [2]

Naturally occurring

Coronary anastomoses are anatomically present though functionally obsolete. There was some suggestion that they may be helpful if a problem develops slowly over time (this will need to be verified) but in the case of the pathogenesis of CHD they do not provide a sufficient blood flow to prevent infarction.

There are anastomoses between the Circumflex and right coronary arteries and between the anterior and posterior inter-ventricular arteries. In the normal heart these anastomoses are non-functional.

Arterio-venous

Superficial arterio-venous anastomoses open when the body reaches a high temperature, and enable the body to cool itself. As warm arterial blood passes close to the surface it will decrease in temperature. This occurs together with sweating.[ citation needed ]

Pathologic

Pathological circulatory anastomoses result from trauma or disease and may involve veins, or arteries. These are usually referred to as fistulas. In the cases of veins or arteries, traumatic fistulas usually occur between artery and vein. Portacaval anastomosis, by contrast, is a veno-venous anastomosis between a vein of the portal circulation and a vein of the systemic circulation, which allows blood to bypass the liver in patients with portal hypertension, often resulting in hemorrhoids, esophageal varices, or caput medusae.

Circulatory anastomoses between monochorionic twins may result in twin-to-twin transfusion syndrome. [3]

Related Research Articles

<span class="mw-page-title-main">Artery</span> Blood vessels that carry blood away from the heart

An artery is a blood vessel in humans and most other animals that takes oxygenated blood away from the heart in the systemic circulation to one or more parts of the body. Exceptions that carry deoxygenated blood are the pulmonary arteries in the pulmonary circulation that carry blood to the lungs for oxygenation, and the umbilical arteries in the fetal circulation that carry deoxygenated blood to the placenta.

<span class="mw-page-title-main">Blood vessel</span> Tubular structure of the circulatory system which transports blood

Blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away from the tissues. Blood vessels are needed to sustain life, because all of the body's tissues rely on their functionality.

<span class="mw-page-title-main">Vein</span> Blood vessels that carry blood towards the heart

Veins are blood vessels in the circulatory system of humans and most other animals that carry blood toward the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and fetal circulations which carry oxygenated blood to the heart. In the systemic circulation, arteries carry oxygenated blood away from the heart, and veins return deoxygenated blood to the heart, in the deep veins.

<span class="mw-page-title-main">Circulatory system</span> Organ system for circulating blood in animals

The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, that consists of the heart and blood vessels. The circulatory system has two divisions, a systemic circulation or circuit, and a pulmonary circulation or circuit. Some sources use the terms cardiovascular system and vascular system interchangeably with the circulatory system.

<span class="mw-page-title-main">Coronary circulation</span> Circulation of blood in the blood vessels of the heart muscle (myocardium)

Coronary circulation is the circulation of blood in the arteries and veins that supply the heart muscle (myocardium). Coronary arteries supply oxygenated blood to the heart muscle. Cardiac veins then drain away the blood after it has been deoxygenated. Because the rest of the body, and most especially the brain, needs a steady supply of oxygenated blood that is free of all but the slightest interruptions, the heart is required to function continuously. Therefore its circulation is of major importance not only to its own tissues but to the entire body and even the level of consciousness of the brain from moment to moment. Interruptions of coronary circulation quickly cause heart attacks, in which the heart muscle is damaged by oxygen starvation. Such interruptions are usually caused by coronary ischemia linked to coronary artery disease, and sometimes to embolism from other causes like obstruction in blood flow through vessels.

<span class="mw-page-title-main">Coronary artery bypass surgery</span> Surgical procedure to restore normal blood flow to an obstructed coronary artery

Coronary artery bypass surgery, also known as coronary artery bypass graft, is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest pain caused by CAD, slow the progression of CAD, and increase life expectancy. It aims to bypass narrowings in heart arteries by using arteries or veins harvested from other parts of the body, thus restoring adequate blood supply to the previously ischemic heart.

<span class="mw-page-title-main">Anastomosis</span> Connection or opening between two things

An anastomosis is a connection or opening between two things that are normally diverging or branching, such as between blood vessels, leaf veins, or streams. Such a connection may be normal or abnormal ; it may be acquired or innate ; and it may be natural or artificial. The reestablishment of an anastomosis that had become blocked is called a reanastomosis. Anastomoses that are abnormal, whether congenital or acquired, are often called fistulas.

<span class="mw-page-title-main">Radial artery</span> Large forearm artery

In human anatomy, the radial artery is the main artery of the lateral aspect of the forearm.

<span class="mw-page-title-main">Right coronary artery</span> Blood vessel supplying the human heart

In the blood supply of the heart, the right coronary artery (RCA) is an artery originating above the right cusp of the aortic valve, at the right aortic sinus in the heart. It travels down the right coronary sulcus, towards the crux of the heart. It gives off many branches, including the sinoatrial nodal artery, right marginal artery, posterior interventricular artery, conus artery, and atrioventricular nodal branch. It contributes the right side of the heart, and parts of the interventricular septum.

An embolus, is described as a free-floating mass, located inside blood vessels that can travel from one site in the blood stream to another. An embolus can be made up of solid, liquid, or gas. Once these masses get "stuck" in a different blood vessel, it is then known as an "embolism." An embolism can cause ischemia—damage to an organ from lack of oxygen. A paradoxical embolism is a specific type of embolism in which the embolus travels from the right side of the heart to the left side of the heart and lodges itself in a blood vessel known as an artery. Thus, it is termed "paradoxical" because the embolus lands in an artery, rather than a vein.

<span class="mw-page-title-main">Superficial palmar arch</span>

The superficial palmar arch is formed predominantly by the ulnar artery, with a contribution from the superficial palmar branch of the radial artery. However, in some individuals the contribution from the radial artery might be absent, and instead anastomoses with either the princeps pollicis artery, the radialis indicis artery, or the median artery, the former two of which are branches from the radial artery.

<span class="mw-page-title-main">Posterior descending artery</span> Artery supplying the heart

In the coronary circulation, the posterior descending artery (PDA), also called the posterior interventricular artery, is an artery running in the posterior interventricular sulcus to the apex of the heart where it meets with the left anterior descending artery also known as the anterior interventricular artery. The PDA supplies the posterior third of the interventricular septum. The remaining anterior two-thirds is supplied by the left anterior descending artery, which is a branch of left coronary artery.

<span class="mw-page-title-main">Vascular disease</span> Medical condition

Vascular disease is a class of diseases of the vessels of the circulatory system in the body, including blood vessels – the arteries and veins, and the lymphatic vessels. Vascular disease is a subgroup of cardiovascular disease. Disorders in this vast network of blood and lymph vessels can cause a range of health problems that can sometimes become severe, and fatal. Coronary heart disease for example, is the leading cause of death for men and women in the United States.

In medicine, collateralization, also vessel collateralization and blood vessel collateralization, is the growth of a blood vessel or several blood vessels that serve the same end organ or vascular bed as another blood vessel that cannot adequately supply that end organ or vascular bed sufficiently.

Collateral circulation is the alternate circulation around a blocked artery or vein via another path, such as nearby minor vessels. It may occur via preexisting vascular redundancy, as in the circle of Willis in the brain, or it may occur via new branches formed between adjacent blood vessels (neovascularization), as in the eye after a retinal embolism or in the brain when an instance of arterial constriction occurs due to Moyamoya disease. Its formation may be related by pathological conditions such as high vascular resistance or ischaemia. It is occasionally also known as accessory circulation, auxiliary circulation, or secondary circulation. It has surgically created analogues in which shunts or anastomoses are constructed to bypass circulatory problems.

<span class="mw-page-title-main">Surgical anastomosis</span> Surgical technique

A surgical anastomosis is a surgical technique used to make a new connection between two body structures that carry fluid, such as blood vessels or bowel. For example, an arterial anastomosis is used in vascular bypass and a colonic anastomosis is used to restore colonic continuity after the resection of colon cancer.

Coronary artery anomalies are variations of the coronary circulation, affecting <1% of the general population. Symptoms include chest pain, shortness of breath and syncope, although cardiac arrest may be the first clinical presentation. Several varieties are identified, with a different potential to cause sudden cardiac death.

<span class="mw-page-title-main">Left anterior descending artery</span> Artery of the heart

The left anterior descending artery is a branch of the left coronary artery. It supplies the anterior portion of the left ventricle. It provides about half of the arterial supply to the left ventricle and is thus considered the most important vessel supplying the left ventricle. Blockage of this artery is often called the widow-maker infarction due to a high risk of death.

The heart is a muscular organ situated in the mediastinum. It consists of four chambers, four valves, two main arteries, and the conduction system. The left and right sides of the heart have different functions: the right side receives de-oxygenated blood through the superior and inferior venae cavae and pumps blood to the lungs through the pulmonary artery, and the left side receives saturated blood from the lungs.

References

  1. Johnson, DR. "Introductory Anatomy: Circulatory System and Blood". Archived from the original on November 8, 2010. Retrieved February 21, 2011.
  2. Akelina Y. Microsurgical technique for 1mm vessel end to end anastomosis. J Med Ins. 2014;2014(2). doi:https://doi.org/10.24296/jomi/2
  3. Shulman, Lee S.; Vugt, John M. G. van (2006). Prenatal medicine. Washington, DC: Taylor & Francis. pp. Page 447. ISBN   0-8247-2844-0.