J.Jpn. Surg. Soc.. 82(9): 935-939, 1981

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Report on the annual meeting

CLINICAL SIGNIFICANCE OF COLLATERAL CIRCULATION IN SURGERY

It is very important for all surgeons to consider the developement and function of collateral circulation after obstruction of the main blood vessels, because ligation or division of the main blood vessels is frequently inevitable in many surgical procedures. After obstruction of blood flow in the stem, there is an alteration in the pattern and direction of flow in its branches. For the most parts, the collateral circulation that responds to the stem obstruction in the human depends on preexisting pathways. Consequently, selection of the site of ligation or dividing and preservation of major blood vessels are most significant during surgery.
An illustration that collateral circulation played important role not only in cardiovascular surgery but also in general surgery was presented showing angiograms before and after the operation. For example, Blalock- Taussig operation in which the subclavian artery was necessarily devided depended on collateral circulation between the cervical or intercostal arterial networks and the branches of axillary artery, and Appleby's operation in which the celiac axis was intentionally devided for en-block dissection of lymphnodes around its main branches in patients with gastric carcinoma depended on collateral pathways through the pancreaticoduodenal arcades. Moreover, it was pointed out that preservation of collateral connections in the mesentery was also the principal procedure to keep the pedicled segment of the stomach or the intestine viable and to make function well.

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