Collateralization

In medicine, collateralization, also vessel collateralization and blood vessel collateralization, is the growth of a blood vessel or several blood vessels that serve the same end organ or vascular bed as another blood vessel that cannot adequately supply that end organ or vascular bed sufficiently.

Coronary collateralization is considered a normal response to hypoxia and may be induced, under some circumstances, by exercise. It is considered to be protective.

Collateral or anastomotic blood vessels also exist even when blood supply is adequate to an area, and these blood vessels are often taken advantage of in surgery. Some notable areas where this occurs include the abdomen, rectum, knee, shoulder, and head.

Coronary collateralization exists latently in the normal heart. Microscopic collateral vessels of the heart undergo a process called transformation that widens the vessel lumen at the expense of its cell wall in response to myocardial stresses—specifically, myocardial spasm and hypoxia secondary to myocardial infarction or acutely stressful exercise. The status of the coronary collaterals has also been shown to be influenced by the presence of diabetes mellitus.

The functional significance of the coronary collateral vessels is a matter of continuing experimental investigation although their existence has been known for over three centuries and been documented repeatedly in man and beast over the past seven decades. Although a now-classic series of experiments by Schaper in the late 1960s and '70s expanded our understanding of the mechanisms by which these usually redundant, microscopic (40-10 um in diameter in their native state) ur-arterioles are transformed by ischemia or stenosis into vessels with life-preserving blood capacity, equally as many studies have denied the function of these vessels to preserve myocardium by salvaging tissue perfusion and maintaining blood pressure as have documented this. It was only during the 1980s that a consensus among researchers was reached that these vessels can preserve as much as 30 to 40% of coronary blood flow to an otherwise-occluded blood vessel, and, while not capable of preventing ischemia in the event of high-output exercise, can nevertheless maintain aortic, pulmonic, and atrial blood pressure, redirect ST elevation into less serious ST depression in ischemia, and prevent infarction and symptoms of infarction, even in the case of complete left main coronary artery stenosis.

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