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1

The most common anatomical sites of arterial injury in the extremities: a review of 75 angiographically-proven cases

100%

Shakeri A. B. , Tubbs R. S. , Shoja M. M.

Folia Morphologica

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2006

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tom 65

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nr 2

116-120

EN

The incidence of vascular injury has increased worldwide. In an attempt to quantitate the specific arteries most commonly involved in the extremities, we reviewed 75 patients with extremity trauma who were evaluated with angiography (DSA, digital subtraction angiography). The majority of these injuries were related to motor vehicle accidents (93.3%). The mean age of these patients was 28.16 ± 11.14 years, 94.7% of these patients being male. The ratio of upper to lower extremity arterial trauma was 12 to 86. A total of 99 arterial injuries were detected angiographically. Simultaneous injuries to two and three extremity arteries were identified in 13.3% and 9.3% of patients respectively. The most common arteries injured were the anterior tibial, femoral, peroneal, and popliteal arteries. Associated fractures were present in 86.7% of patients. These data may prove useful to the clinician who evaluates post-traumatic injuries of the extremities.

2

Aortic bifurcation angle as an independent risk factor for aortoiliac occlusive disease

88%

Shakeri A. B. , Tubbs R. S. , Shoja M. M. , Nosratinia H. , Oakes W. J.

Folia Morphologica

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2007

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tom 66

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nr 3

EN

Recently, there has been interest in potential geometric risk factors that might result in or exaggerate atherosclerosis. The aortic bifurcation is a complex anatomical area dividing the high pressure blood of the descending abdominal aorta into the lower limbs and pelvis. The distribution of the bifurcation angle and any asymmetry, its relation with age and its possible contribution to the risk of aortoiliac atherosclerosis are presented here. Statistical analysis was performed by SPSS version 11.0 using, Fisher’s exact test, the Pearson and Spearman correlation tests and logistic regression analysis. The p value was set at 0.05. No correlations were found between age, bifurcation angle and angle asymmetry in the Pearson test (p > 0.05). Logistic regression analysis revealed that the bifurcation angle, but not its asymmetry, gender or age, was a significant and independent risk factor for aortoiliac atherosclerosis (model r² = 0.662, p = 0.027). With additional study these results may have implications regarding risk factors for aortoiliac atherosclerosis. To our knowledge, this study is the first of its kind to indicate the potential of such an important geometric risk factor for atherosclerosis at the aortic bifurcation.

3

Bilateral accessory middle cerebral arteries associated with an aneurysm of the anterior circulation

75%

Daghigi M. H. , Tubbs R. S. , Shoja M. M. , Shakeri A. B. , Pourisa M. , Salter E. G. , Oakes W. J.

Folia Morphologica

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2006

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tom 65

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nr 2

161-163

EN

An accessory middle cerebral artery is one variation of the intracranial vasculature that may be a source of misinterpretation by clinicians dealing with cerebrovascular diseases. We report a case of an elderly female found to have bilateral accessory middle cerebral arteries, who presented with the rupture of an aneurysm of the anterior part of the circle of Willis. Accessory middle cerebral arteries are rare anatomical findings and the bilateral occurrence is exceedingly rare. We believe this to be the first report of bilateral accessory middle cerebral arteries associated with an aneurysm of the anterior cerebral-anterior communicating arteries. The anatomical and clinical relevance of this variation is described.

4

Does a third head of the rectus femoris muscle exist?

63%

Tubbs R. S. , Stetler W. J. , Savage A. J. , Shoja M. M. , Shakeri A. B. , Loukas M. , Salter E. G. , Oakes W. J.

Folia Morphologica

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2006

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tom 65

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nr 4

377-380

EN

Current anatomical texts describe only two tendinous origins of the rectus femoris muscle. The authors identified one older reference in which a third head of the rectus femoris muscle was briefly described. In order to confirm the existence of this head, 48 adult cadavers (96 sides) underwent detailed dissection of the proximal attachments of the rectus femoris muscle. Of these sides 83% were found to harbour a recognised third head of the rectus femoris muscle. This additional head was found to attach deeply to the iliofemoral ligament and superficially with the tendon of the gluteus minimus muscle as it attached into the femur. This tendon attached to the anterior aspect of the greater trochanter in an inferolateral direction compared to the straight head. The mean length and width of the third head was 2 cm and 4 cm, respectively. The mean thickness was found to be 3 mm. Most commonly this third head was bilaterally absent or bilaterally present. However, 4.2% were found only on left sides and 5.2% were found only on right sides. The angle created between the reflected and third heads was approximately 60 degrees. Two sides (both left sides with one female and one male specimen) were found to have third heads that were bilaminar. These bilaminar third heads had a distinct layer attaching to the underlying iliofemoral ligament and a superficial layer blending with the gluteus minimus tendon to insert onto the greater trochanter. Although the function of such an attachment is speculative, the clinician may wish to consider this structure in the interpretation of imaging or in surgical procedures in this region, as in our study it was present on the majority of sides.