Tracing the Blood Flow Direction of the Angular Artery and Vein by Color Doppler Ultrasonography

Abstract

Whether the angular artery is the continuation of the facial or the ophthalmic artery has been a matter of debate. In the case that the angular artery is the continuation of the facial artery, the blood flow runs upward from caudal to cranial. On the other hand, when the angular artery is the continuation of the ophthalmic artery, the blood flow runs in the reverse direction. We sought an uncomplicated, non-invasive and reliable method to detect angular vessels and trace the direction of their blood flow.Thirteen adult volunteers of both genders were included in the study. The patients were healthy individuals between 20 and 60 years of age. The examination and imaging of the angular artery was performed using a color Doppler ultrasound. The angular artery was present in all cases on the right side but absent in three cases on the left side. The source of the angular artery was the facial artery in eight cases on the right side and six cases on the left side. In all other cases, the source of the angular artery was the ophthalmic artery. An angular vein was always present but not running concomitant to the artery in seven cases. When the facial artery was compressed at the mandibular border, the flow persisted only in those angular arteries that arose from the ophthalmic artery with the exception of one case involving both sides.Our study revealed that color Doppler ultrasonography is a noninvasive and reliable method for detecting the angular artery and vein and determining the direction of their blood flow. Thus, color Doppler ultrasonography is an uncomplicated method for adequate planning of axial nasolabial and other axial angular artery flaps even in real time before or during surgery.

Anatomic evaluation of the normal variants of the arteries of face using color Doppler ultrasonography: Implications for facial aesthetic procedures

“…One of the other arteries of interest in similar publications was the angular artery which was successfully mapped and tracked in a study by color Doppler US, showing that angular artery was absent in 10% of cases at left side, similar to our study with 11.62% absence. 11 Renshaw et al 12 evaluated the distribution patterns of the arteries of face and veins according to the final branch of the facial artery that was detected up to and including the nasal ala, using 13.6 MHz US probe, and described the following categories: angular, lateral nasal, and alar (grouped together as types I-III) in 26%, superior labial (type IV) in 21.5%, inferior labial (type V) 2%, and undetected (type VI) in 0.5%.…”

“…This study described the through metric pathway of face vasculature including facial, angular, supraorbital and supratrochlear as well as transverse facial arteries in the included sample of normal participants, using color Doppler US, for the first time. Previous scarce published studies using color Doppler US for limited part of the face like forehead, temporal or facial arteries showed that the arterial vasculature has great variations from person to person and even in two sides of face in one individual 11–13,18–21 . These variations make the detection of the so‐called facial danger zones difficult and requires the individual‐based evaluation by appropriate measures like US.…”

“…Previous scarce published studies using color Doppler US for limited part of the face like forehead, temporal or facial arteries showed that the arterial vasculature has great variations from person to person and even in two sides of face in one individual. [11][12][13][18][19][20][21] These variations make the detection of the so-called facial danger zones difficult and requires the individual-based evaluation by appropriate measures like US. In this regard, Doppler US could be used to detect the risk sites prior to the interventions, which is also a quick, real time and reliable method to avoid vascular complications which could be heavily burdensome.…”

“…10 Color Doppler ultrasonography (US) is one the available and noninvasive radiologic method to evaluate the anatomic mapping, normal variations, and also the flow of artery and could provide details of the probable arterial variations and effectively prevent unpredictable vessel damage during interventions. [11][12][13] Iran is one of the countries with highest prevalence of cosmetic and aesthetic procedures and the trends has been growing in the past decades. 14,15 Since most of these procedures are taking place in the facial region, placing the facial artery and its branches besides the other arteries of face at risk of invasion and serious vascular complications, we aimed to assess the normal variations of the facial artery in a normal sample of Iranian population via color Doppler US.…”

“…Radiologic imaging modalities have been used to evaluate facial artery and its branches 10 . Color Doppler ultrasonography (US) is one the available and noninvasive radiologic method to evaluate the anatomic mapping, normal variations, and also the flow of artery and could provide details of the probable arterial variations and effectively prevent unpredictable vessel damage during interventions 11–13 …”