Variants of the popliteal artery terminal branches as detected by multidetector ct angiography

A rare variation in popliteal artery branching: anterior tibial artery and fibular artery from the common tibiofibular trunk

The popliteal artery is a continuation of the femoral artery and is the main arterial supply to the lower leg and foot. Variation in the branching of the popliteal artery typically occurs proximal or distal to where the vessel crosses the popliteus muscle. In the case of a routine dissection of a 92-year-old female cadaver, a variation of the popliteal artery was found where the branches are a posterior tibial artery and a common tibiofibular trunk. It is important to recognize the vascular variations that exist in the popliteal fossa to prevent any unforeseen complications during surgeries or procedures to the knee or lower leg.

Case report: Retrogenicular popliteal artery pseudoaneurysm following trivial knee hyperextension

INTRODUCTION

Popliteal artery pseudoaneurysm is rare after blunt trauma without associated bone fracture, usually presenting in a delayed fashion. We present a case of early presentation following minor civilian trauma.

CASE PRESENTATION

A 66-year-old man presented with left leg pain and swelling after a trivial knee hyperextension injury. Ultrasound revealed a popliteal artery pseudoaneurysm, confirmed by CT angiogram. Open surgical repair with interposition graft was successful. Intraoperatively, a 3 cm linear laceration in the retrogenicular popliteal artery and ipsilateral hamstring tear were noted.

DISCUSSION

Delayed presentation is typical, making early detection challenging. Our case emphasizes maintaining suspicion for popliteal artery pseudoaneurysm, especially after trivial knee injuries. Prompt imaging and intervention are crucial to mitigate potential complications.

CONCLUSION

Popliteal artery pseudoaneurysm from minor knee trauma is rare but should be considered in patients with leg pain and swelling. Early detection and surgical intervention are vital to prevent complications.

Variations in the Termination of the Popliteal Artery: A Multidetector Computed Tomography Angiography (CTA)-Based Retrospective Study

BACKGROUND

Comprehension of the intrucate anatomy and variations in the termination of the popliteal artery (PA) is increasingly essential for endovascular interventionists, plastic surgeons, vascular surgeons, and orthopedic surgeons, due to the rise in procedures like embolectomy, vascular grafting, free fibular flap surgery, and high-tibial osteotomy. Few studies from India have reported on the variant anatomy of PA termination, and none have used 128-slice tomography. This study aimed to observe the terminal branching pattern of the PA and the morphology of its terminal branches using 128-slice computed tomography angiography (CTA) and to analyze its relation to gender and laterality.

METHODOLOGY

A retrospective review of CTA images of 181 lower extremities from 100 patients (137 males and 44 females), aged five to 75 years, was conducted.

RESULTS

The usual type I-A pattern was found in 75.69% of cases, while 24.31% exhibited variant patterns. Type III was the most common variation observed (19.34%), with type III-A being the most prevalent (11.05%). Types II-B and II-C were not observed. Among 84 bilaterally examined cases, 19.05% had unilateral variations and 15.48% had bilateral variations, with 8.33% showing bilaterally similar variations and 7.14% dissimilar variations. No significant difference in branching patterns was found between genders or sides. The mean length of the tibial-peroneal trunk (TPT) in the type I-A pattern was 3.00 ± 0.99 cm (right side: 3.21 ± 1.02 cm; left side: 2.82 ± 0.93 cm; males: 2.9 ± 1.00 cm; females: 3.37 ± 0.85 cm), with statistically significant differences between sides and genders. In the type II-A pattern, the mean TPT length was 7.16 ± 3.75 cm. An exceptionally long TPT (12.97 cm) was noted in one case of the III-B pattern.

CONCLUSION

There is a high prevalence of variation in the termination pattern of the PA. Knowledge of these variations is crucial for any interventions in this region to avoid postoperative vascular complications and reduce patient suffering.

Analysis of the running position of the popliteal artery and branching level of the anterior tibial artery detected by magnetic resonance imaging to avoid vessel injury during surgery around the knee joint

Background

Vessel injuries during total knee arthroplasty or high tibial osteotomy are rare but have serious complications. This study aimed to analyze the running position of the popliteal artery (PA) and branching level of the anterior tibial artery (ATA), using magnetic resonance imaging (MRI). This analysis might be helpful in avoiding unnecessary vessel injury.

Methods

In total, 105 patients (41 men and 64 women), whose running position of the PA and branching level of the ATA could be detected by preoperative MRI, were included in this study. We configured zones A, B, C, and D to be 5–10, 15–20, 25–30 and 35–40 mm distal from the lateral tibial plateau in the axial view, respectively. First, the distance between the posterior cortex of the tibia and anterior border of the PA was measured. Second, the PA position from the medial border of the tibia was measured. This measured value was divided by the transverse diameter of the tibia, and multiplied by 100 to obtain the PA position from the medial border of the tibia. Third, the branching level of ATA was measured from the joint line. Subsequently, each value was compared between men (the M group) and women (the W group).

Results

The distance between the posterior cortex of the tibia and the anterior border of the PA was 5.5 ± 1.9, 10.4 ± 2.4, 12.5 ± 2.3 and 12.5 ± 2.3 (mm; mean ± SD) in zones A, B, C, and D, respectively. Comparing both groups, this distance was significantly larger (more separated posteriorly) in zones C and D in the M group. The PA position from the medial border of the tibia was 51.7 ± 6.5, 52.7 ± 8.2, 56.7 ± 10.5 and 66.8 ± 14 (%; mean ± SD) in zones A, B, C, and D, respectively. On comparing the two groups, this position was significantly larger (more laterally shifted) in zone D in the W group. The branching level of the ATA was not detected within 40 mm distal to the joint line in 92 patients (87.6%). However, it was detected within 40 mm (mean 32.5 mm; range 20–38) in 12 patients (11.4%). Among them, 11 were women. Only one woman had an aberrant branching pattern: the ATA bifurcated at the joint level.

Conclusion

The PA positioned closest at the joint level, gradually separated and shifted laterally towards the distal side. The distance between the posterior cortex of the tibia and the anterior border of the PA was closer in women than in men in zones C and D. Although a difference of 2 mm is small, the risk of PA injury can be considered to be higher in women than in men. Furthermore, ATA injury is also a concern during retraction of the tibialis anterior muscle posteriorly, and the descending cut of the tibial tuberosity, particularly in women.

Prevalence and characteristics of the aberrant anterior tibial artery: a single-center magnetic resonance imaging study and scoping review

BACKGROUND

Planning surgical procedures of the lower leg benefits from considering the possibility of an aberrant anterior tibial artery (AATA), but previously published data on the frequency of this anatomic variant shows heterogeneity. We assessed the prevalence of AATA in a Latin American cohort using magnetic resonance imaging (MRI) and compared these with other studies reported in the literature.

METHODS

We retrospectively included consecutive patients who had undergone multiplanar knee MRI at a radiology department in Lima, Peru. The MRI protocol included coronal T1 weighted, axial, sagittal and coronal proton density fat-saturated (PDFS) and sagittal T2 weighted images. Two experienced radiologists assessed all images and were blinded to each other's findings. The frequency of the AATA was compared to previous cohorts. A scoping review was undertaken to provide an overview of previously published data on the prevalence of ATAA.

RESULTS

We analyzed 280 knee MRI examinations of 253 patients (median age 41 years (IQR 31-52), 53.8% male). The aberrant anterior tibial artery variant was present in 8 of 280 (2.9%) evaluated knees, resulting in a prevalence of 3.2% in our study population. The PDFS sequence in the axial or sagittal orientation was most effective to identify AATA. The frequency of AATA in the reviewed literature using different radiological modalities ranged from 0.4 to 6% (median 1%, IQR (0.5-2.3%).

CONCLUSIONS

The AATA is a frequent vascular variant that can be detected by MRI in the preparation of invasive interventions of the lower leg.

Arteries of the Lower Limb-Embryology, Variations, and Clinical Significance

OBJECTIVES

The purpose of this article is to review the embryology of the lower limb arterial anatomy along with common variants and their clinical relevance.

DESIGN

Embryologic variations of the lower limb arterial system may be explained by i.) persistence of primordial arterial segments, ii.) abnormal fusion, iii.) segmental hypoplasia/absence, or a combination of both. Persistent sciatic artery, corona mortis, and popliteal entrapment syndrome will also be discussed with associated symptoms, and potential complications.

CONCLUSION

Knowledge of these variations is essential for surgical and endovascular management as failure to recognize them can result in complications.

Imaging primer for CT angiography in peripheral vascular trauma

The use of computed tomography angiography (CTA) for the evaluation of peripheral vascular trauma has become increasingly prevalent in the past decade with the development of multidetector CT (MDCT) and multiple studies subsequently demonstrating high sensitivity, specificity, and diagnostic accuracy when compared with conventional angiography. Additional benefits of MDCT include the ability to rapidly acquire the images, perform multiplanar and 3D reconstructions, and assess the adjacent soft tissues and bones. Rapid intravenous injection of iodinated contrast material is required for optimal arterial enhancement. CTA manifestations of an arterial injury may be direct, and include active contrast extravasation, pseudoaneurysm, arteriovenous fistula (AVF), intimal injury, dissection, or occlusion. There are also indirect signs which have a high association with vascular injury, and should raise suspicion, when present. Pitfalls related to image acquisition or patient factors can be mitigated with appropriate planning and post-processing techniques.

Variations in terminal branches of the popliteal artery: cadaveric study

INTRODUCTION

Identifying the branching pattern of the popliteal artery (PA) is a vital step in planning radiological and surgical procedures involving the anterior and posterior tibial and fibular arteries. The aim of this study was to characterize the course and morphology of the terminal branches of the PA.

MATERIALS AND METHODS

The anatomical variations in the branching patterns of the anterior and posterior tibial and fibular arteries were examined in 100 lower limbs fixed in a 10% formalin solution. A dissection of the popliteal region of the leg was carried out according to a pre-established protocol, using traditional techniques. Morphometric measurements were then obtained twice by two researchers.

RESULTS

In most cases (72%) the PA divides to form the anterior tibial artery (ATA) and a common junction for the posterior tibial and fibular arteries (type I), which further splits into the fibular artery and the posterior tibial artery (PTA). This type was subdivided into two subgroups according to whether the ATA (subgroup a) or the common junction of the posterior tibial and fibular arteries (subgroup b) had the larger diameter. Other identified variations included division of the PA into the ATA and PTA-8% (type II), trifurcation-12% (type III), the division of the PTA into the ATA and FA-8% (type IV), and aplasia of the PTA-8% (type IV).

CONCLUSION

Although the typical PA branching type was observed, it can be classified further into two additional sub-types based on the diameter of the ATA and the common junction of the posterior tibial and fibular arteries.

Peroneal artery entrapment syndrome (PRAES): a rare cause of ischaemic toes

A 75-year-old man presenting with intermittent discolouration of his left toes was referred to vascular surgery with suspicion of embolic vascular disease. A contrast-enhanced MR angiogram was performed which revealed bilateral dominant peroneal arteries (PRAs). There was evidence of short atherosclerotic stenosis directly at the point where the left PRA passes through the tibiofibular interosseous membrane which we postulate to be the source of the emboli. We present what is believed to be the first reported case of PRA entrapment complicated by distal toe emboli.

VIDEO: Preoperative CT Angiography for Fibular Free Flap Reconstructions

OBJECTIVE

The objective of this video article is to provide an introduction to the use of fibular free flaps. Normal and variant vascular anatomy of the fibular free flap is discussed, as are imaging acquisition and CT angiography interpretation, computer-assisted design and manufacturing, and the limitations of the fibular free flap.

CONCLUSION

The fibular free flap is commonly used for head and neck reconstructive surgery. Variation exists between individuals regarding the origin of the peroneal artery and the perforating arteries. Our method of performing CT angiography and reporting its findings for patients undergoing a fibular free flap procedure provides a reproducible means of identifying important elements of the vasculature and effectively communicating their locations to surgeons. Accurate communication can maximize the success of the flap harvesting and the preoperative manufacture of custom fibular cutting guides.