Collateral Pathways

Arterial System

Ashley Davidoff MD

Introduction

Occluded Right Common Carotid

Caollateral via the Circle of Willis

This angiogram of the carotid arteries, (a,b) show an occluded right common carotid artery (white arrow)with serpiginous thrombus in the artery behind the occlusion (maroon overlay in b and d). The left common carotid artery is almost a normal artery and fills the right system via the circle of Willis (red arrow) The occluded left common carotid and thrombus is magnified in c and d.

High Grade Stenosis of the LAD and Collateral Circulation theough the PDA

The first angiogram is from a an injection of the left coronary artery in the RAO projection. A subtotal stenosis is seen in the proximal LAD (arrow). There is an implied high pressure gradient between the proximal and distal LAD and a predicted low pressure in the distal vessel. The second injection was into a normal right coronary artery with delayed iaging when most of the contrast had disappeared from the vessel and shows septal collateral vessels supplying the downstrem low pressure LAD from a high pressure RCA. code heart cardiac stenosis atherosclerosis collaterals septal collaterals coronary artery septal perforators angiogram angiography

Long Segment Celiac Axis Stenosis with Collaterals via the Pancreaticoduodenal Arcade

Angiogram of the SMA shows retrograde filling of the celiac axis which has a significant long segment stenosis. This stenosis has an unusual appearance in that it is relatively long but the most likely cause is atherosclerosis.

Courtesy Laura Feldman MD 35076c

Traumatic occlusion of the Renal Artery

Collateral Supply via the Capsular Artery

The angiogram of the right renal artery following traumatic injury shows an occluded artery (bright red) with an intact capsular artery (bright pink) that gives rise to a capsular artery (bright pink) that gives rise to branches of the inferior adrenal but also serves to collateralize the intrarenal arterial system (dull red).