13.2 Diagnosis and differential diagnoses
13.3 Pathology
13.4 Clinical manifestation
13.5 Treatment
13.5.1 Conservative treatment
13.5.2 Endovascular therapy
13.5.3 Surgical treatment
D Congenital vascular diseases
2.1 Stenotic arterial malformations
2.1.1 Aortic isthmus stenosis
2.1.2 Coarctation of the abdominal aorta
2.1.3 Fibromuscular dysplasia
2.2 Aneurysmal arterial diseases
2.2.1 Congenital aneurysms
2.2.2 Aneurysms as a sign of vasculitis
2.2.3 Pseudoaneurysms and mycotic aneurysms
3.1 Congenital malformations of the inferior vena cava
3.1.1 Clinical findings
3.1.2 Diagnosis
3.1.3 Treatment
E Diseases of the lymphatic system
1 Diseases of the lymphatic system
1.2 Etiology and pathogenesis, differential-diagnostic aspects, and course: lymphedema.lipedema
1.2.1 Lymphedema
1.2.2 Lipedema
1.3 Treatment
1.3.1 Treatment for lymphedema
1.3.2 Treatment for lipedema
1.3.3 Contraindications to lymph drainage and/or compression bandages
1.4 Conclusions and summary
A
Diseases of the arteries
1 Supra-aortic vessels
1.1 Extracranial stenoses and occlusive processes
Anatomy of the extracranial arteries: Reinhard Putz
Introduction: Jennifer Franke and Horst Sievert
Doppler/duplex ultrasonography: Tom Schilling
Conservative treatment: Horst Sievert and Jennifer Franke
Endovascular treatment: Horst Sievert and Jennifer Franke
Surgical treatment: Farzin Adili and Thomas Schmitz-Rixen
1.1.1 Anatomy of the extracranial arteries
The external arterial supply to the head is provided by branches of the external carotid artery, which arises bilaterally from the common carotid artery at approximately the level of the fourth cervical vertebra or upper margin of the thyroid cartilage (Fig. 1.1-1). Its course is highly variable; it usually runs ventral and superficial to the internal carotid artery until it is behind the mandible. Its anterior branches pass to the thyroid gland, tongue and facial skin. A deep branch passes to the pharynx. Posteriorly, arteries branch off to the occiput and auricle. Behind the temporomandibular joint, the external carotid artery divides into its two terminal branches, the superficial temporal artery and the maxillary artery (Fig. 1.1-2). These two branches, like the occipital artery, may serve as collaterals to supply the brain in cases of occlusion of the internal carotid artery or vertebral artery. The lingual artery arises just above the hyoid bone and enters the tongue in an anterior direction behind the hyoglossus. One of its branches passes under the sublingual gland to the gingiva and mandibular muscles. The facial artery sometimes arises from a common trunk with the lingual artery and turns around the submandibular gland anteriorly to the edge of the mandible, through which it passes in a small ostium in front of the insertion of the masseter muscle. After giving off the inferior and superior labial arteries, it winds through the facial muscles lateral to the nose as far as the medial angle of the eye, where it connects with the superficial terminal branches of the ophthalmic artery—although this is rarely relevant in practice.
The posteriorly-directed occipital artery is important in that after crossing under the sternocleidomastoid and splenius muscles it supplies a dense vascular network rising at the occiput at the posterior margin of the trapezius muscle; this network has connections with the neighboring arteries. The superficial temporal artery is often visible on the surface at the temple; it divides at the level of the upper margin of the auricle into an often noticeably tortuous frontal branch and a parietal branch (Fig. 1.1-2).
The maxillary artery is the most important branch for the supply of the external parts of the head (Figs. 1.1-2, 1.1-3). After its origin (the mandibular part), it passes anterior or posterior to the lateral pterygoid muscle (pterygoid part) into the depth of the infratemporal fossa (pterygopalatine part), where the pterygoid venous plexus is also located. From it, branches pass to the teeth in both jaws, to the masticatory muscles, to the gingival and nasal mucosa, and—via the medial meningeal artery, which passes through the foramen spinosum—to the dura mater in the middle cranial fossa and part of the anterior cranial fossa.
Fig. 1.1–1 Variants in the branching of the common carotid artery (60%, according to Lippert and Pabst 1985).
Fig. 1.1–2 Overview of the branches of the external carotid artery.
Fig. 1.1–3 Course of the maxillary artery (after Lippert and Pabst 1985).
1.1.2 Clinical picture (carotid artery, vertebral artery)
Cerebral ischemic events are the most frequent cause of stroke (80–85% of cases) and currently represent the third most frequent