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Variability of the arteries of the axilla and arm in morphoclinical aspect


Author: ZORINA Zinovia
Degree:doctor of medicine
Speciality: 14.00.02 - Human Anatomy
Year:2021
Scientific advisers: Ilia Catereniuc
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Yurii Kiselevsky
doctor, associate professor (docent)
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 29 September, 2021 at the meeting of the Scientific Council and now it is under consideration of the National Council.

Abstract

Adobe PDF document1.10 Mb / in romanian
Adobe PDF document1.13 Mb / in english

Thesis

CZU 611.134.1/.2(043.2)

Adobe PDF document 7.94 Mb / in romanian
196 pages


Keywords

axillary artery, brachial artery, anatomical variants, individual variability, axilla, arm

Summary

Working hypothesis. The stringent scientific and practical need on morphological and clinical applicative knowledge building, studying the individual anatomical variability of the axilla and arm arteries and creating arterial hemodynamics mathematical model at this level. Research purpose. Determining the peculiarities of the general and individual variability of the axilla and arm arteries, according to gender, constitutional type and laterality, supplemented by an individual mathematical hemodynamic model for the given segment.

Research specific objectives1. Studying the literature referred to the variational aspects of the axilla and arm arteries and analyzing the data of theoretical and experimental research on the modalities of threedimensional mathematical modeling of hemodynamics in the given arterial bed. 2. Establishing the anatomical variants of the axilla and arm arteries by macroscopic and imaging methods according to the criteria related to origin, trajectory, number, type of branching, highlighting the most variable domains at this level. 3. Determination of the individual arterial variability of the axilla and arm arteries applying somatometric and morphometric parameters related to gender, constitutional type and laterality. 4. Comparative analysis of the obtained results with those present in the bibliographic sources. 5. Assessment of the axillary artery segment necessary for puncture and/or catheterization manipulations by reasoned identification of topographic landmarks. Research design. The study was an epidemiological, retrospective, descriptive, with reports and series of cases, conducted during 2016-2020. The scientific research was carried out at Nicolae Testemitanu SUMPh Department of Anatomy and Clinical Anatomy with the approval of the Scientific Council of the Consortium and the Research Ethics Committee according to no. 68 of 16.03.2017 favorable opinion and in compliance with the International Legislation on Biomedical Research on the involvement of human beings and national legal provisions.

Axilla and arm arteries macroscopic, imaging, somatometry and morphometric study methods with subsequent mathematical-statistical processing of the obtained data were used in the research process to achieve the purpose and objectives. The mathematical modeling of the hemodynamics of the axillary and brachial arteries was performed, at the same time, according to gender and constitutional type. The macroscopic study was performed on cadaveric material (upper limbs selected from the Anatomy and Clinical Anatomy Department of Nicolae Testemitanu SUMPh), by fine dissection method, which allowed us to identify anatomical variants of the arteries of the axilla and arm, studying their topographic and etiologic peculiarities, as well as their relationship to adjacent vasculonervous structures. The imaging study included the study of angiographies of the arteries of the upper limb and doplerographies at this level, taken from the database of Euromed Diagnostic Medical Center, IMSP SCM „Sfanta Treime”, IMSP SCR „Timofei Mosneaga” and IMSP Republican Medical Diagnostic Center. By studying the angiographies of the upper limb, the individual architecture of the blood vessels of the given region was determined with the identification of their variability and determination of their morphometric parameters, and by studying the Dopplers, the functional indices necessary to model their hemodynamics were obtained.

Scientific novelty and originality. A complex study of the morphoclinical aspect of the individual anatomical variability of the axillary and brachial arteries, as well as of their branches was performed, after which the obtained data were compared with those reflected in international bibliographic sources, but those obtained for the first time, such as the: - bifurcation of the axillary artery into two trunks, one of them continued with the brachial artery which had high bifurcation, and the second trunk – launched collateral branches characteristic of it and the brachial artery; - quadrifurcation of the subscapular artery; - common trunk consisting of 5 arteries: thoracodorsal; circumflex scapular; posterior circumflex humeral; deep brachial and superior ulnar collateral; - common trunk consisting of 4 branches: anterior/posterior circumflex humeral arteries and subscapular, and a secondary common trunk, consisting of deep brachial arteries and superior ulnar collateral; from the last then started the second deep brachial artery; - the double presence of the deep brachial artery, where the second artery starts from the superior ulnar collateral artery; - the double presence of the superior ulnar collateral artery, where the second artery arises from the deep brachial artery; - low origin of the superior ulnar collateral artery at the level of the distal third of the arm; - high origin of the inferior ulnar collateral artery at the level of the proximal third of the arm, etc., will complement the existing data and altogether will be the basis of a practical guide that will be useful for the imaging doctors and vascular surgeons in the therapeutic conduct.

As a result of the imaging study, a bony landmark was established that will provide safety in performing catheterization of the axillary artery, thus avoiding possible iatrogenic complications that may occur as a result of its puncture. Mathematical modeling of the hemodynamics of the axillary and arm arteries allowed obtaining important hydrodynamic parameters for the segments concerned according to gender and constitutional type. Main scientific results submitted for support 1. Determining the individual variability of the axilla and arm arteries according to gender, constitutional type and laterality. 2. Evaluation of the morphometric parameters of the axillary and brachial arteries and their branches depending on gender and constitutional type. 3. Establishing the anatomical variants of the axilla and arm arteries according to the criteria: origin, trajectory, number, branching method and, determining the variational frequency of each artery. 4. Mathematical modeling of the hemodynamics of the axillary and brachial arteries at the level of the branching of their main collaterals and at the level of the bifurcation of the brachial artery.

Theoretical significance and applicative value of research. The current study highlighted new morphological features of the axilla and arm arteries, with medical applicative value. Based on the obtained results, objective criteria of vascular exploration were developed, which will contribute to solving the uncertainty in initiating the investigation procedure or surgical tactics in the axilla and arm, when at this level is present one of the arterial anatomical variants. The obtained results will considerably complete the contemporary morphological scientific basis in the practical guidance of the new diagnostic and interventional methods at the level of the axilla and arm that will contribute to maintaining and strengthening the health of patients.

Approval of scientific results. The research results were presented and discussed at various scientific forums: The annual scientific conference of collaborators and students of Nicolae Testemitanu State University of Medicine and Pharmacy (Chisinau, 2017, 2018, 2019); MedEspera 2018: 7th International Medical Congress for Students and Young Doctors (Chisinau, 2018); 19th Congress of the Romanian Society of Anatomy (Cluj-Napoca, Romania, 2018); 10th International Symposium of Clinical and Applied Anatomy (Moscow-Russia, 2018); The XXIV National Congress of the Bulgarian Anatomical Society (Stara-Zagora, Bulgaria, 2019); Scientific and practical conference with international participation dedicated to the 90th anniversary of the birth of Professor P. I. Lobko, „Modern morphology: problems and development prospects” (Minsk, Belarus, 2019); Scientific-practical conference with international participation: Actual problems of morphology in theoretical and practical medicine is timed to the 75th anniversary of the founding of the Higher State Educational Institution of Ukraine „Bukovynian State Medical University” (Cernauti, Ucraina, 2019); Timisoara Anatomical Days. First Edition With International Participation (Timisoara, Romania, 2019); MedEspera 2020: 8th Intern. Medical Congr. for Students and Young Doctors (Chisinau, 2020); The XIth International Symposium on Clinical Anatomy (Varna, Bulgaria, 2020); Congress dedicated to the 75th anniversary of the founding of Nicolae Testemitanu State University of Medicine and Pharmacy (Chisinau, 2020).

Thesis publications. The research results were reflected in 24 scientific papers, including 9 articles (1 article in reviewed foreign journals, 3 articles in journals from the National Register of profile journals, 5 articles in international collections) and 15 theses in the papers of scientific national and international conferences and congresses. There were obtained 2 certificates of innovator and 6 acts of implementation in practice of scientific results.

The thesis was discussed, approved and recommended for defense at the meeting of the Department of Anatomy and Clinical Anatomy of Nicolae Testemitanu State University of Medicine and Pharmacy (minutes no. 8 of 21.04.2021) and the Scientific Profile Seminar 311. Anatomy and Morphology (minutes no. from 24.05.2021).

Summary of thesis compartments. The thesis is presented on 196 pages. The basic section of the thesis is exposed on 118 pages and consists of the introduction, 6 chapters, general conclusions and recommendations. The iconographic material includes 6 tables and 61 figures. The bibliography contains 282 sources, and the annexes – 58 figures and 8 tables.