Cystic artery

These drugs have also been studied for possible use in other conditions. Clinical studies show distinct benefit in some patients with pulmonary arterial hypertension, and possible benefit in systemic hypertension, cystic fibrosis, and benign prostatic hyperplasia. Preclinical studies suggest that sildenafil may be useful in preventing apoptosis and cardiac remodeling after ischemia and reperfusion. 

CABG coronary artery bypass graft CAD coronary artery disease CAP community acquired pneumonia caps capsule cardiotox cardiotoxicity CBC complete blood count CCB calcium channel blocker CF cystic fibrosis cGMP cyclic GMP, an intracellular chemical... 

The causes of human copper deficiency include (1) low intake - malnutrition, total parenteral nutrition (TPN) (2) high loss - cystic fibrosis, nephrotic syndromes and (3) genetic factors — Menkes disease. Copper deficiency may also be associated with chronic malabsorption, a situation which is made much worse in cases of gastric and bowel resection. Several special diets, including powdered milk, liquid protein and standard hospital diets are a means of inducing copper deficiency. The amount of copper in US food has decreased steadily since 1942, and may be related to the rising incidence of coronary artery disease. A copper deficiency may also occur as the result of the use of chelators for other purposes for example, diethyl dithiocarbamate is an in vivo metabolite of ANTABUSE (disulfiram). 

Some congenital diseases such as Marfan syndrome or Ehlers Danlos syndrome (type 4) can cause arteriopathies of cranial cervical vessels. In Ehlers Danlos syndrome, elongations, dissections, dilatation and aneurysms, as well as fistula in large and mid-size arteries, are found. Cystic medial necrosis (Ueda et al. 1999) leads to aortic dissections which can include supraaortic vessels (Fig. 5.27)... 

Outside the liver the common hepatic duct is joined by the cystic duct of the gallbladder and becomes the common bile duct (CBD). The extrahepatic and intrahepatic ducts are supplied with blood by a fine network of tiny arterial branches that originate from the hepatic and gastroduodenal arteries. As it has no other blood supply, the biliary tree is particularly susceptible to ischaemic injury, such as hepatic artery thrombosis or injury to the biliary plexus during laparoscopic surgery. This can result in extrahepatic and complex hilar and perihilar ischaemic strictures of the biliary tree. 

In the porta hepatis, the proper hepatic artery divides into the right branch (from which the cystic artery emerges) and the left branch (from which a middle hepatic artery occasionally emerges). The branches of the hepatic artery run close to the portal veins and may even (rarely) coil round them in places. An arterial sphincter is located prior to the further division of the hepatic artery into smaller branches. There are anastomoses between the arterial branches and the hepatic vein. By way of an arteriolar sphincter (46), the interlobular arteries branch into intralobular arterioles, supplying the lobules of the liver with arterial blood. The arterial blood enters the sinusoids either through terminal branches or through arterioportal anastomoses and mixes with the portal blood. The pressure in the hepatic arterioles is 30-40 mm Hg. (36, 46, 61)... 

With unclarified abdominal pain, sonography is usually the diagnostic procedure of choice. An aneurysm appears as a round or oval focus either intrahepatically or extrahepatically between the portal hilum and the pancreas. The hypoechoic, cystic focus may contain hyperechoic, thrombotic material. Occasionally, there is a connection to an afferent vessel. (128) A suspected aneurysm can be confirmed by colour Doppler sonography, with the possibility of distinguishing blood flow and arterial blood. An echo-free aneurysm provides a typical arterial sphygmogram. 

Embolization of the cystic artery can cause acute acalcu-lous cholecystitis (SEDA-15, 505). 

There is epidemiologic evidence to suggest an increased prevalence of duodenal ulcers in patients with certain chronic diseases, but the pathophysiologic mechanisms of these associations are uncertain. A strong association exists in patients with systemic mastocytosis, multiple endocrine neoplasia type 1, chronic pulmonary diseases, chronic renal failure, kidney stones, hepatic cirrhosis, and ai-antitrypsin deficiency. An association may exist in patients with cystic fibrosis, chronic pancreatitis, Crohn s disease, coronary artery disease, polycythemia vera, and hyperparathyroidism. 

Within the Aviptadil and bacteriophage programs, mondoBIOTECH is determined to obtain - as soon as possible - marketing approvals for the indications of pulmonary arterial hypertension (Aviptadil) and cystic fibrosis (bacteriophages). The company will also continue to seek additional opportunities for the TheraNostics concept. 

The typical origin of this vessel is the right hepatic artery in as many as 95% of patients [25], but it may also come up from the left hepatic artery (7%), common hepatic artery (3%), replaced or accessory right hepatic arteries (18%), as well as the gastroduodenal artery (1%) or superior mesenteric artery [26-29]. There is a 2%-15% incidence of double cystic artery [26, 30] (Fig. 4.12). 

The gallbladder blood supply comes not only from the cystic artery, but also from perforators to the body of the gallbladder from the hepatic parenchyma and the GDA. This is important from a practical viewpoint as, if the cystic artery is small, then this alternative route of blood supply to the gallbladder may be assumed to be present and prophylactic occlusion may be considered when avoiding microsphere flow into the cystic artery becomes impossible. 

In contrast, the cystic artery may be a source of parasitic supply for tumors located near the gallbladder fossa and, although infrequently, for... 

Fig. 4.13. a Marked parasitic supply to the tumor from the cystic artery (arrow), b In order to diminish the probability of non-target deposition of microspheres within the gallbladder, coil embolization of the parasitic branch is carried out. c The subsequent angiogram shows flow redistribution with complete opacification of the tumor bed which has now been disconnected from the cystic artery... 

Michels NA (1951) The hepatic, cystic and retroduode-nal arteries and their relations to the biliary ducts with samples of the entire celiacal blood supply. Ann Surg 133 503-524... 

Daseler EH, Anson BJ, Hambley WC, Riemann AF (1947) The cystic artery and constituents of the hepatic pedicle a study of 500 specimens. Surg Gynecol Obstet 85 47-63... 

Mlakar B, Gadzijev EM, Ravnik D, Hribernik M (2003) Anatomical variations of the cystic artery. Eur J Morphol 41 31-34... 

Sarkar AK, Roy TS (2000) Anatomy of the cystic artery arising from the gastroduodenal artery and its choledochal branch - a case report. J Anat 197 Pt 3 503-506... 

Loukas M, Fergurson A, Louis RG Jr, Colborn GL (2006) Multiple variations of the hepatobiliary vasculature including double cystic arteries, accessory left hepatic artery and hepatosplenic trunk a case report. Surg Radiol Anat 28 525-528... 

Right hepatic angiogram - Injection of 2 cc/s for 10-12 cc. Vessels of interest include the middle hepatic artery, supraduodenal artery, and cystic artery. Rarely, the right hepatic artery may arise directly from the aorta. 

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