Collateral circulation

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Collateral circulation
Identifiers
MeSH D003097
Anatomical terminology

Collateral circulation is the alternate circulation around a blocked artery or vein via another path, such as nearby minor vessels. [1] It may occur via preexisting vascular redundancy (analogous to engineered 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.

Contents

An example of the usefulness of collateral circulation is a systemic thromboembolism in cats. This is when a thrombotic embolus lodges above the external iliac artery (common iliac artery), blocking the external and internal iliac arteries and effectively shutting off all blood supply to the hind leg. Even though the main vessels to the leg are blocked, enough blood can get to the tissues in the leg via the collateral circulation to keep them alive.

Brain

Blood flow to the brain in humans and some other animals is maintained via a network of collateral arteries that anastomose (join) in the circle of Willis, which lies at the base of the brain. In the circle of Willis so-called communicating arteries exist between the front (anterior) and back (posterior) parts of the circle of Willis, as well as between the left and right side of the circle of Willis.

Leptomeningeal collateral circulation is another anastomosis in the brain.

Heart

Another example in humans and some other animals is after an acute myocardial infarction (heart attack). Collateral circulation in the heart tissue will sometimes bypass the blockage in the main artery and supply enough oxygenated blood to enable the cardiac tissue to survive and recover.

Eye

Collateral tortuous vein (center, left) in central retinal vein occlusion, revealed by laser Doppler imaging. Collateral vein in central retinal vein occlusion.gif
Collateral tortuous vein (center, left) in central retinal vein occlusion, revealed by laser Doppler imaging.

After central retinal vein occlusion, neovascularization may restore some blood flow to the retina, but the new vessels' bulk also presents a risk of causing acute glaucoma by blocking the drainage of aqueous humour. Collateral circulation is created (within months) around the blocked central vein via a generally winding path, usually from a branch vein to the choroid.

Hand

The circulatory system of the human hand features extensive collateral circulation in the form of the deep and superficial palmar arches, and the proper palmar digital arteries of the digits, with the exception of the thumb, which has its blood supplied by the princeps pollicis artery. As each finger has two proper digital arteries, blood can be continue to be supplied to specific digits if one of the two is injured.

Truncal venous system

Hepatic cirrhosis arising from congestion in the hepatic portal vein may give rise to collateral circulation between branches of the portal and caval veins of the liver, or between the two caval veins. Consequences of newly established venous collaterals arising from portal hypertension include esophageal varices and hemorrhoids (portocaval collateral circulation).

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<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 animals that takes blood away from the heart to one or more parts of the body. Most arteries carry oxygenated blood; the two exceptions are the pulmonary and the umbilical arteries, which carry deoxygenated blood to the organs that oxygenate it. The effective arterial blood volume is that extracellular fluid which fills the arterial system.

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

The 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">Circle of Willis</span> Circulatory anastomosis that supplies blood to the brain and surrounding structures

The circle of Willis is a circulatory anastomosis that supplies blood to the brain and surrounding structures in reptiles, birds and mammals, including humans. It is named after Thomas Willis (1621–1675), an English physician.

<span class="mw-page-title-main">Anastomosis</span> Connection or opening between two things that are normally diverging or branching

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">Cerebral circulation</span> Brain blood supply

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<span class="mw-page-title-main">Fluorescein angiography</span> Technique for examining the circulation of the retina and choroid of the eye

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<span class="mw-page-title-main">Abdominal aorta</span> Largest artery in the abdomen

In human anatomy, the abdominal aorta is the largest artery in the abdominal cavity. As part of the aorta, it is a direct continuation of the descending aorta.

Transcatheter arterial chemoembolization (TACE) is a minimally invasive procedure performed in interventional radiology to restrict a tumor's blood supply. Small embolic particles coated with chemotherapeutic drugs are injected selectively through a catheter into an artery directly supplying the tumor. These particles both block the blood supply and induce cytotoxicity, attacking the tumor in several ways.

A vascular bypass is a surgical procedure performed to redirect blood flow from one area to another by reconnecting blood vessels. Often, this is done to bypass around a diseased artery, from an area of normal blood flow to another relatively normal area. It is commonly performed due to inadequate blood flow (ischemia) caused by atherosclerosis, as a part of organ transplantation, or for vascular access in hemodialysis. In general, someone's own vein (autograft) is the preferred graft material for a vascular bypass, but other types of grafts such as polytetrafluoroethylene (Teflon), polyethylene terephthalate (Dacron), or a different person's vein (allograft) are also commonly used. Arteries can also serve as vascular grafts. A surgeon sews the graft to the source and target vessels by hand using surgical suture, creating a surgical anastomosis.

Neovascularization is the natural formation of new blood vessels, usually in the form of functional microvascular networks, capable of perfusion by red blood cells, that form to serve as collateral circulation in response to local poor perfusion or ischemia.

<span class="mw-page-title-main">Hepatic portal system</span> System of veins comprising the hepatic portal vein and its tributaries

In human anatomy, the hepatic portal system or portal venous system is the system of veins comprising the portal vein and its tributaries. The other portal venous systems in the body are the renal portal system, and the hypophyseal portal system.

<span class="mw-page-title-main">Subclavian steal syndrome</span> Medical condition

Subclavian steal syndrome (SSS), also called subclavian steal steno-occlusive disease, is a constellation of signs and symptoms that arise from retrograde (reversed) blood flow in the vertebral artery or the internal thoracic artery, due to a proximal stenosis (narrowing) and/or occlusion of the subclavian artery. This flow reversal is called the subclavian steal or subclavian steal phenomenon, regardless of signs/symptoms being present. The arm may be supplied by blood flowing in a retrograde direction down the vertebral artery at the expense of the vertebrobasilar circulation. It is more severe than typical vertebrobasilar insufficiency.

<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.

A circulatory anastomosis is a connection between two blood vessels, such as between arteries, between veins or between an artery and a vein. 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.

<span class="mw-page-title-main">Leptomeningeal collateral circulation</span>

The leptomeningeal collateral circulation is a network of small blood vessels in the brain that connects branches of the middle, anterior and posterior cerebral arteries, with variation in its precise anatomy between individuals. During a stroke, leptomeningeal collateral vessels allow limited blood flow when other, larger blood vessels provide inadequate blood supply to a part of the brain.

Sickle cell retinopathy can be defined as retinal changes due to blood vessel damage in the eye of a person with a background of sickle cell disease. It can likely progress to loss of vision in late stages due to vitreous hemorrhage or retinal detachment. Sickle cell disease is a structural red blood cell disorder leading to consequences in multiple systems. It is characterized by chronic red blood cell destruction, vascular injury, and tissue ischemia causing damage to the brain, eyes, heart, lungs, kidneys, spleen, and musculoskeletal system.

References