Anterior Tibial Artery Research Articles

Sphygmomanometer-induced hemostasis following iatrogenic guidewire perforation during lower extremity angioplasty.

Iatrogenic guidewire perforation is a well-known complication of lower extremity angioplasty that is often benign or can be easily treated with endovascular techniques. However, perforations that occur in arterial side branches may be more challenging to manage. If bleeding persists, open surgery and fasciotomy may be required to evacuate the resulting hematoma and prevent compartment syndrome. These subsequent procedures increase morbidity and, if the angioplasty was performed in the outpatient setting, necessitate patient transfer to a hospital. To address these challenges, we describe a non-invasive hemostasis technique involving serial sphygmomanometer cuff inflations over the affected site in a series of five patients who experienced this complication at our office. We retrospectively reviewed the medical records of consecutive patients undergoing lower extremity angioplasty that were found to have an arterial guidewire perforation on completion angiogram at our outpatient center between February 2012 and February 2017. Patients found to have iatrogenic guidewire perforations were administered intravenous protamine sulfate and were transferred to the surgical recovery room. Patients received ibuprofen or acetaminophen for pain management. A blood pressure cuff was placed around the site of perforation, and patients received serial cuff inflation cycles with repeated examinations of both limbs until patients reported cessation of pain and there were no signs of a developing hematoma. Patients were observed for two hours before they were discharged home. A follow-up duplex ultrasound examination was completed within one week of the intervention. Over the course of five years, 536 angioplasties were performed at our outpatient office. Five of these patients experienced iatrogenic guidewire perforation (0.93%). Perforations occurred in branches of the anterior or posterior tibial artery. All of these patients were successfully managed with the aforementioned hemostasis technique. None of these patients required transfer to a hospital for further management, and no complications were reported at follow-up. Complications of iatrogenic guidewire perforations in lower extremity arterial side branches can be safely and effectively managed by applying external compression around the affected site with an automatic blood pressure cuff.

Covered Endovascular Reconstruction of the Popliteal Artery Bifurcation in a Patient with a Popliteal Aneurysm

Popliteal artery aneurysms (PAAs) can present as extensive disease entities that predispose to distal ischaemic complications. Endovascular repair has become a common intervention but is typically limited to a single tube exclusion of the PAA that necessitates a distal landing zone. Presented is a technique of covered endovascular reconstruction of the popliteal artery bifurcation (CERPAB) using Viabahn Endoprosthesis (Gore & Associates, Flagstaff, AZ, USA) covered stent grafts delivered via a percutaneous femoral approach in a patient with extensive PAA with anterior tibial artery (ATA) and tibioperoneal trunk (TPT) involvement. A 79 year old patient presented with a PAA (20 mm diameter) with irregular luminal narrowing extending into the proximal ATA (5 mm diameter) and TPT (6 mm diameter), which was regarded as aneurysmal (normal diameter 3 mm). The patient was asymptomatic but showed growth under surveillance. Under general anaesthesia and through a percutaneous antegrade left femoral approach a 9 × 150 mm standard profile Viabahn stent graft was placed in the popliteal artery as a main body through a 10 F sheath using a 0.035 inch wire. The ATA and TPT were cannulated separately with subsequent placement, simultaneous deployment and kissing balloon dilatation of 6 × 50 mm and 7 × 50 mm low profile stent grafts in the respective arteries using a 0.018 inch platform through a single sheath, overlapping the popliteal stent graft by 3 cm. Procedural angiography (Fig. 1) showed successful exclusion of the PAA with adequate run off distally. Post-operatively, dual antiplatelet therapy with clopidogrel and aspirin was started and the patient was discharged home the next day. Follow up computed tomography at three months showed adequate patency (Fig. 2) with no complications during this period.Figure 2(A) Computed tomography angiography at the three month follow up showing a patent covered reconstruction of the popliteal artery bifurcation by Viabahn stent grafts with 3 cm of overlap. (B) Volume rendered computed tomography scan reconstruction of the covered endovascular reconstruction at the three month follow up.View Large Image Figure ViewerDownload Hi-res image Download (PPT) CERPAB seems to be a possible modality for treatment of patients with PAAs and involvement of the ATA and TPT by reconstructing the popliteal bifurcation and successfully excluding the aneurysmal tract from the peripheral circulation. This procedure is reminiscent of covered endovascular repair of the aortic or femoral bifurcation and allowed exclusion of the PAA without a distal landing zone. To the best of the authors’ knowledge, this is the first time such a procedure has been reported.

Persisterende zwelling na enkelartroscopie: pseudoaneurysma van de arteria tibialis anterior als zeldzame complicatie

Persistent swelling after ankle arthroscopy: pseudoaneurysm of the anterior tibial artery as a rare complication A patient was admitted to a geriatric rehabilitation ward following a septic arthritis for which she received an antibiotic treatment and arthroscopic irrigation. She had a normal kidney function and received a prophylactic dose of enoxaparin for the prevention of a deep venous thrombosis (DVT). During the hospitalization, a progressive, painless swelling of the ankle was seen. The ultrasonography showed a pseudoaneurysm of the anterior tibial artery measuring 4.2 cm by 4 cm by 1.7 cm. Following the surgical consultation, compression therapy was started. The follow-up ultrasonography after 4 weeks showed absence of flow in the pseudoaneurysm. A pseudoaneurysm is a rare complication (0.008%) of foot and ankle surgery. Risk factors are malnutrition, immunosuppression, diabetes mellitus and trauma or infection. Abnormal coagulation may contribute to the development of a pseudoaneurysm. The diagnosis is mostly based on clinical clues, confirmed by means of color-flow Doppler imaging. The treatment options include non-surgical methods (external compression, ultrasound-guided compression and ultrasound-guided thrombin injections), percutaneous endovascular therapy (coil, stenting) or surgical ligation with an aneurysmectomy and an arterial reconstruction. Although pseudoaneurysms are a rare complication, their possibility should be considered in the period following the commencement of mobilization and weight-bearing after ankle surgery, especially if risk factors are present.

Bilateral Absent Fibular (Peroneal) Arteries‐ A Case Report

Arterial variations of the distal lower limbs are well documented. However, the absence of a fibular artery is a rare finding. During medical students’ dissection of a cadaver, bilateral missing fibular arteries were discovered and are reported here. The precise knowledge of the popliteal artery and its branches' anatomic variations is relevant to the clinical practice of vascular medicine, surgery, and interventional procedures. Radiologist and vascular surgeons in recent studies use the following terminology to describe the vascular branching pattern. The most common branching pattern in the lower extremity is the popliteal artery branching into the anterior tibial artery and tibiofibular trunk. The tibiofibular trunk bifurcates into the two terminal branches: the posterior tibial artery and the fibular artery. The fibular artery runs along the medial aspect of the fibula supplying the lateral compartment of the lower extremity. In this case report, there is a normal branching of the popliteal artery into the anterior tibial artery. As the popliteal artery continues, it transforms into the posterior tibial artery without the formation of the tibiofibular trunk and fibular artery. To compensate for the absent fibular artery, the posterior tibial artery was found to have smaller branching vessels that supply the lateral compartment of the lower extremity. This variation was found bilaterally in the subject.

Angiographic Analysis of the Anatomical Variants in Genicular Artery Embolization

Abstract Purpose Genicular artery embolization (GAE) has been proposed as a novel technique to treat painful synovitis related to osteoarthritis. An in-depth understanding of the genicular arterial anatomy is crucial to achieve technical success and avoid nontarget-related complications. Given the lack of previous angiographic description, the present study analyzes genicular arterial anatomy and proposes an angiographic classification system. Materials and Methods Angiographic findings from 41 GAEs performed during two US clinical trials from January 2017 to July 2019 were reviewed to analyze the anatomical details of the following vessels: descending genicular artery (DGA), medial superior genicular artery (MSGA), medial inferior genicular artery (MIGA), lateral superior genicular artery (LSGA), lateral inferior genicular artery (LIGA), and anterior tibial recurrent artery (ATRA). The diameter, angle of origin, and anastomotic pathways were recorded for each vessel. The branching patterns were classified as: medially, M1 (3/3 arteries present) vs M2 (2/3 arteries present); and laterally, L1 (3/3 arteries present) vs L2 (2/3 arteries present). Results A total of 91 genicular arteries were embolized: DGA (26.4%), MIGA (23.1%), MSGA (22.0%), LIGA (14.3%), and LSGA/ATRA (14.3%). The branching patterns were: medially = M1, 74.4% (n = 29), M2, 25.6% (n = 10); and laterally = L1, 94.9% (n = 37), L2, 5.1% (n = 2). A common origin for MSGA and LSGA was noted in 11 patients (28.2%). A direct DGA origin from the popliteal artery was reported in three patients (7.7%, n = 3). Conclusions A thorough understanding of the geniculate arterial anatomy is important for maximizing postprocedural pain reduction while minimizing complications, procedure time, and radiation exposure during GAE.

The Influence of Abdominal Obesity on Endothelial Function of the Tibial Artery in the Elderly Essential Hypertensives of Different Sex

Abstract Background To investigate the relationship between abdominal obesity and endothelial function of the tibial artery in the elderly essential hypertensives of different sex. Methods A total of 658 elderly patients (≥60 years old) with essential hypertension and 64 elderly subjects without clinical evidence of hypertension were recruited from the department of geriatrics from August 2000 to May 2016. The dilatation of anterior tibial artery induced by reactive hyperemia was examined by high-resolution vascular ultrasound and was defined as endothelium-dependent dilatation (EDD). All the participants were divided into 4 groups based on blood pressure (≥140/90 mm Hg) and waist circumference (male ≥90 cm, female ≥85 cm): normotensive without abdominal obesity (n = 34), normotensive with abdominal obesity (n = 30), hypertensive without abdominal obesity (n = 287), and hypertensive with abdominal obesity (n = 371). Results A gradual decline in EDD was observed from normotensive without abdominal obesity (9.37 ± 1.11%), normotensive with abdominal obesity (8.59 ± 0.99%), hypertensive without abdominal obesity (7.70 ± 0.30%) to hypertensive with abdominal obesity (6.75 ± 0.26%) (P < 0.05). There was no significant difference in EDD between the male and female elderly hypertensives with or without abdominal obesity. In male elderly hypertensives, EDD in those with central obesity was more blunted compared with those without central obesity (6.31 ± 0.38% vs. 7.46 ± 0.38%, P < 0.05). Whereas, in female elderly hypertensives, EDD in those with abdominal obesity was similar to those without abdominal obesity. In male elderly hypertensives, EDD was correlated with waist circumference (r = −0.194, P < 0.05) while such association was not shown in females. Multivariate linear regression analysis revealed that waist circumference was associated with EDD (β = −0.161, P < 0.05) in the male elderly hypertensives, but not in females. Conclusions Waist circumference is an influencing factor of EDD in male elderly essential hypertension patients. However, abdominal obesity has little effect on EDD of the tibial artery in female elderly hypertensives.

Limb Preservation with Balloon Angioplasty in Critical Limb Threatening Ischemia: A Case Report

Introduction: Chronic limb-threatening ischemia (CLTI) is a syndrome that represents the end-stage of peripheral artery disease (PAD) that increased the risk of major amputation and cardiovascular events. The initial treatment for CLTI may significantly impact the risk of major amputation or death. Objective: This case report aims to describe limb preservation with balloon angioplasty in a Critical Limb Ischemia patient. Case Presentation: A hypertensive 72-years old female complained of left leg pain followed by a wound on her left toe four months ago. Her toe was amputated, but the wound persists. On physical examination, the pulsation was diminished in her left foot. Duplex ultrasound showed monophasic spectral doppler from left popliteal artery to distal left anterior tibial artery (ATA) and distal posterior tibial artery (PTA). CT-Angiography showed short total occlusion (2cm) at the distal left Superficial Femoral artery (SFA), multiple stenoses with maximal 90% stenosis at the left ATA, and chronic total occlusion at the proximal-mid left posterior tibial artery (PTA). She was diagnosed with CLTI left inferior extremity Fontaine IV Rutherford 5. The angiography result was similar to the CT-angiography result. The patient was successfully treated with plain balloon angioplasty from distal left SFA to distal left ATA and drug-coated balloon angioplasty from the distal left SFA to the popliteal artery. Her wound was also consulted to the surgical department. Conclusion: Appropriate revascularization is fundamental to limb preservation. We successfully perform endovas- cular strategy with TIMI flow 3 from left SFA to distal left ATA and distal PTA in our patient, but we still need further holistic CLTI management.

Anterior tibial artery injury is not the contraindication of medial plantar flap: digital subtraction angiography evidence and clinical application

The medial plantar artery (MPA) is often sacrificed as the vascular pedicle of the medial plantar flap (MPF). However, for patients with ankle soft tissue defect caused by traffic accident, the anterior tibial artery (ATA) could be damaged and the blood supply of the distal foot would only come from the MPA and the lateral plantar artery (LPA). In this case, sacrificing the MPA for the MPF means that the LPA will become the mainly source of blood supply of the distal foot. Whether the blood supply of the distal foot is adequately guaranteed remains to be discussed. A total of seven patients with ankle soft tissue defect and ATA injury were enrolled in the study. The digital subtraction angiography (DSA) was performed to observe the hemodynamics of the ipsilateral foot. The MPF was harvested only when the foot arterial network consisting of the MPA, the LPA, the deep plantar arch, and the deep plantar artery of DPA, and the blood redistribution existed. DSA results showed the blood from the posterior tibial artery was redistributed to the ipsilateral foot and the MPA is not the dominant artery in the foot. Seven MPFs were harvested, and all flaps survived completely. No complications, such as pain, ulcer, and necrosis, occurred in the ipsilateral toes. The DSA could accurately and intuitively evaluate the hemodynamics of foot in patients with ATA injury. The DSA data and clinical practice proved that the ATA injury is not the contraindication of the MPF.

Endovascular Embolisation for Proximal Anterior Tibial Artery Aneurysm

A 72 year old woman presented with left lower limb pain. There was no history of smoking, infection, or lower limb injury. Angiography revealed a proximal left anterior tibial artery (ATA) aneurysm (A). Coil embolisation of the aneurysm was performed under local anaesthesia. A Carry microcatheter (UTM, Aichi, Japan) was inserted to the aneurysm through the ipsilateral femoral artery. Galaxy G3 microcoils (Johnson & Johnson, New Brunswick, NJ, USA) were used to complete embolisation from the distal to proximal aspect of the aneurysm. Intra-operative angiography showed no blood flow into the aneurysm (B). She remains asymptomatic three months after surgery.Image 1

DISTAL ARTERIOVENOUS FISTULAS IN THE TREATMENT OF CHRONIC CRITICAL LOWER LIMB ISCHEMIA

Summary. The aim of the study. To study the effectiveness of the proposed surgical methods in the treatment of critical ischemia of the lower extremities.
 Materials and methods. In our work the analysis of results of treatment of 36 patients with chronic critical ischemia of the lower extremities who were on treatment in ZOKL of them is presented. Andriy Novak. Grade III A ischemia was diagnosed in 11 patients, grade III B — in 15, grade IV — in 10 patients and studied the microcirculation of the lower extremities in 31 people without pathology of the cardiovascular system, taking into account the angiosomal approach.
 We found that the highest rates of perfusion units on the thigh were found in the basin of the sciatic and posterior arteries, the lowest — in the basin of the deep femoral artery and popliteal artery.
 On the shin, the highest rates of microcirculation were found in the basin of the posterior tibial artery, the lowest - on the foot.
 Results and discussion. The level of regional perfusion of the corresponding angiosomes of the skin of the lower extremities after anastomosis between the anterior tibial artery and anterior tibial vein showed that the improvement of microcirculation is observed in those angiosomes whose blood supply is provided by the anterior tibial artery and its artery and artery.
 When creating anastomoses between the posterior tibial artery and the posterior tibial vein, the microcirculation in the skin increased 3-5 times compared to baseline and its level was 70 % of normal in those angiosomes, which supply blood to the posterior tibial artery and its continuation on the foot. At the same time, there is an increase in skin microcirculation in the angiosome of the tibial artery, which is apparently due to the presence of a relatively large number of first-type anastomoses in the triceps.
 In our opinion, any of the proposed treatments should begin before the development of critical ischemia.
 Conclusions. The dependence of skin perfusion on the main arterial blood flow is proved taking into account the angiosomal theory, which allows to use this method in the diagnosis and evaluation of the results of treatment of chronic critical ischemia of the lower extremities.
 Microcirculation of the skin of the lower leg and foot improves 3.5–5 times 30 days after the creation of arteriovenous fistula below the occlusion of the anterior tibial artery and posterior tibial artery in chronic critical ischemia of the lower extremities.

Single-Center Experience With Optical Coherence Tomography-Guided Directional Atherectomy System for Below-the-Knee Critical Limb Ischemia

BACKGROUND. Below-the-knee (BTK) peripheral arterial disease (PAD) more often presents as critical limb ischemia. Endovascular revascularization strategies continue to evolve to achieve long-term limb-salvage outcomes. A single-center experience with optical coherence tomography (OCT)-guided atherectomy using Pantheris SV (Avinger) is reported. METHODS. All patients with PAD in femoropopliteal or infrapopliteal vessels (n = 27) who underwent plaque debulking by Pantheris SV were analyzed retrospectively. Baseline comorbidities, Rutherford classification, lesion length and characteristics, adjunctive treatment strategy, device-related failures/complications, and major adverse events were analyzed. Additionally, 6-month target-lesion revascularization (TLR) rate was available for 21 of 27 patients. RESULTS. Mean patient age was 70.5 years, 16 patients (59%) were women, and 19 patients (70%) had Rutherford class 5 to 6 symptoms. A total of 58 vessels were treated, including 32 iliofemoropopliteal and 26 infrapopliteal vessels. Chronic occlusions were present in 19% of iliofemoropopliteal lesions and 17.2% of infrapopliteal lesions. The most commonly treated BTK lesion (12 of 26) was the anterior tibial artery (ATA). Following atherectomy, 21 were treated with angioplasty, 4 with angioplasty followed by coronary drug-eluting stent (DES), and 1 with cutting balloon and laser atherectomy. Four failures/complications occurred; 3 of these were device related (failure to pass through lesion due to proximal ATA angulation, coronary DES dislodgment while treating BTK in-stent restenosis, and 1 requiring laser atherectomy for no-flow post atherectomy and angioplasty). At 6 months, 2 of 21 patients (9.5%) required revascularization interventions. CONCLUSION. Treatment of BTK-PAD with imaging guided Pantheris SV atherectomy device appears to be safe, with low rate of TLR at 6 months. Future multicenter randomized trials are needed to confirm these findings.

Distal Retrograde Access for Infrainguinal Arterial Chronic Total Occlusions: A Prospective, Single Center, Observational Study in the Office-Based Laboratory Setting

Distal Retrograde Access for Infrainguinal Arterial Chronic Total Occlusions: A Prospective, Single Center, Observational Study in the Office-Based Laboratory Setting

Effects of Whole-Body Vibration-Assisted Training on Lower Limb Blood Flow in Children With Myelomeningocele.

This study investigated the effectiveness of whole-body vibration (WBV) training incorporated into a conventional physiotherapy (PT) program (WBV-assisted training) in improving blood flow in the lower limbs and range of motion in the lower limb joints of children with myelomeningocele (MMC). A total of 31 children with MMC (7–15 years old) underwent a 6 weeks treatment program consisting of 2 weeks of conventional PT followed by 4 weeks of WBV-assisted training. The assessment comprised two parts: evaluation of lower limb joint range of motion and Doppler ultrasonography of the superficial femoral, popliteal, and anterior tibial arteries and was performed three times for each of the participants (at baseline, after 10 sessions of PT but before WBV-assisted training, and after 20 sessions of WBV-assisted training). Our results showed that WBV-assisted training significantly improved lower limb circulation in patients with MMC, increasing velocity and reducing resistivity in all tested arteries. Moreover, WBV-assisted training alleviated lower-extremity contractures, especially of the knee. Thus, WBV-assisted training is effective as an adjunctive rehabilitation program for improving functional mobility in children with MMC.

Anatomic characterization of the tibial and fibular nutrient arteries in humans.

The location of nutrient foramina has been extensively studied in long bones; however, accurate information on the origin and extra-osseous course of the nutrient artery remains clearly defined in some long bones, although it is crucial to protect the nutrient arteries during operative procedures. In this study, we elucidated the origin and extra-osseous course of tibial and fibular nutrient arteries based on the 54 cadaveric legs. The tibial nutrient artery typically arose from the posterior tibial artery. Some of the tibial nutrient arteries arose from the anterior tibial, popliteal, and fibular arteries. The tibial nutrient artery arose from these parent arteries as a long descending branch. It penetrated the most proximal portion of the tibialis posterior or flexor digitorum longus to enter the tibial nutrient foramen. The fibular nutrient artery arose from the fibular artery as a short descending branch in all the cases. The fibular nutrient artery penetrated the flexor hallucis longus to enter the fibular nutrient foramen. Our present and previous findings provide new insight into the anatomical characteristics for the nutrient arteries in the long bones of upper and lower extremities. Namely, the nutrient arteries of the long bones go away from the elbow or knee to enter the nutrient foramina.

Variations in the origin, course and branching pattern of dorsalis pedis artery with clinical significance

Pulsations of the dorsalis pedis artery are commonly used to evaluate the peripheral arterial diseases like thromboangiitis obliterans (TAO) or Buerger’s disease, in lower limbs. Dorsalis pedis artery is a direct extension from the anterior tibial artery and major vascular supply for the dorsum of the foot. But arterial variations in lower limbs are common due to rich distal anastomoses around the ankle joint. Absence of dorsalis pedis arterial pulse does not indicate peripheral arterial disease always as it is sometimes replaced by the enlarged perforating branch of peroneal artery, it may be absent or very thin, deviate laterally on the dorsum of foot. Aim of the present study is to observe the variations in origin, course and branching pattern of dorsalis pedis artery because of its clinical significance. During routine dissection of lower limbs for undergraduates we came across rare variations in the dorsalis pedis artery in its origin, course and branching pattern. Normal anatomic description was found in 27 limbs. In 13 specimens we noted variations, includes bilateral anomalous origin of dorsalis pedis artery, bilateral lateral deviation of dorsalis pedis artery, double dorsalis pedis artery, trifurcation of dorsalis pedis artery and absence of arcuate artery. Knowledge about the arterial variations around the ankle is important to orthopaedic, vascular surgeons and radiologists to prevent complications during surgical interventions.

Lower limb salvage in patients older than 75 years old affected of soft tissue sarcoma: beyond the limits

Microsurgical procedures were initially believed to be feasible only in younger patients. On the one hand, operative times may be prolonged, and on the other, older patients usually present with other comorbidities. However, without the option of microsurgical reconstructive procedures, the only curative treatment for patients with bone and soft tissue sarcomas in the lower extremity is limb amputation. This was a retrospective observational study of two cohorts of patients (group A, > 75 years old, n = 20; and group B, < 75 years old, n = 21) to compare their outcomes after lower limb salvage surgery. Selection criteria included all patients who underwent free flap reconstruction after sarcoma resection in the lower limb between 2017 and 2019. Exclusion criteria included smoking, severe comorbidities, inability to ambulate, or inadequate vessels in the preoperative image studies. Length of stay, complications, and rates of flap failure, recurrence, and amputations were compared. Average age, BMI, and presence of other comorbidities for groups A and B were 80 and 61 years old, 26 and 24 kg/m2, and 50 and 45%, respectively. Most patients (53%) had leg defects and were reconstructed with an ALT flap (60%) anastomosed to the anterior tibial artery (60%). Flap failure was observed in one group A patient. The average surgical time was 9 h. The patients followed 10 days of total bed rest and a dangling protocol was started on day 11. The mean hospital stay was 16 days and patients underwent physical therapy afterward. Postoperative surgical and medical complications in groups A and B occurred in 7/20 and 2/21, and 5/20 and 5/21 patients (25%), respectively. Age or ASA status had no effect on the incidence of complications. Radiotherapy was given postoperatively in all patients. At 1-year follow-up, all patients were alive; 27% had a recurrence or metastatic disease. The amputation rate was 25% and 0% in groups A and B, and was the only variable that reached statistical significance (p = 0.021). Based on our findings, limb salvage surgery can be performed successfully in selected old patients with lower limb sarcomas. It should be considered as a treatment option in this group of patients as it offers a safe alternative to amputation with an acceptable risk of complications, good flap success rates, and functional outcomes. Level of evidence: Level III, therapeutic; risk/prognostic study.

Effect of recanalization of anterior tibial artery and peroneal artery on targeted angiosomes of posterior tibial artery in the foot through different aspects

Objective The purpose of this study is to evaluate the outcome of percutaneous transluminal angioplasty of ipsilateral peroneal artery and the anterior tibial artery for revascularization of targeted angiosomes in the vascular territory of posterior tibial artery (PTA) in the foot, through interconnecting branches, and the resulting effect on existing wound healing and limb salvage, in comparison with the effect of percutaneous transluminal angioplasty on PTA alone on revascularization and wound healing in these angiosomes. Patients and methods We included 80 patients for 80 angioplasty procedure (80 limbs) who were divided into two equal groups. Group A included patients with peroneal and anterior tibial patent vessel runoff, who were fit for percutaneous transluminal angioplasty for both vessels, whereas group B were candidates for PTA angioplasty. We studied the arterial supply in 80 limbs with TASC C-D lesions with follow-up along 1 year, all with PTA occlusion. Patients with single-vessel or three-vessel runoff were excluded from the study. Outcome measures included wound healing of targeted angiosomes of PTA with complete epithelialization of the affected lesion with or without secondary interventions such as debridement or skin grafting and limb salvage with absence of major amputation. Conclusions We found that recanalization of peroneal artery together with anterior tibial artery can supply angiosomes of PTA and accelerate wound healing through communicating branches in the foot with comparable outcome on wound healing and decreased incidence of major amputation to single recanalization of PTA as primary and secondary outcome, obviating the need for lengthy and more risky interventional procedure.

Primary retrograde distal access for endovascular interventions in patients with lower limb ischemia

To evaluate safety and technical efficiency of primary retrograde distal access for endovascular interventions in patients with lower limb ischemia. A prospective analysis included 25 endovascular procedures via primary retrograde distal access in 23 patients with chronic obliterating diseases of lower limb arteries. Occlusive lesion of femoral-popliteal segment was observed in 68% of cases, occlusion of at least one tibial artery was also found in 68% of cases. In 44% of cases, occlusive lesion was localized at several levels. Percutaneous intervention via anterior tibial artery or dorsalis pedis artery was performed in 68% of cases, posterior tibial artery - 24% of cases, peroneal artery - 8% of cases. We used 2 accesses in 92% of cases (the main one for intervention and additional one for angiography). In 8% of cases, intervention was carried out through a single access. Angiosome artery was punctured in 65% of cases. The only patent tibial vessel was used in 20% of cases. In 24% of cases, we performed antegrade recanalization of 'adjacent' tibial artery via distal access. Primary retrograde distal access was successfully performed in 100% of cases. Retrograde revascularization was not successful in all cases (successful recanalization rate 96%, retrograde intervention rate - 92%). Femoral access was performed in 8% of cases. Antegrade blood flow through at least one tibial artery was restored in all cases. Direct revascularization of the affected angiosome was performed in 15 patients with foot necrosis, indirect revascularization through collaterals - in 5 patients. Local complications of surgical access occurred in 12% of cases. Endovascular revascularization via primary retrograde distal access was technically effective in most cases. There were no complications with systemic consequences.

Hemodinamika femoro-poplitealne by-pass hirurgije metodom analize konačnih elemenata

Objective. Femoropopliteal bypass is indicated in the advanced stage of peripheral arterial occlusive disease. The indications for surgical treatment are determined on the basis of a clinical exam, "ankle-brachial index" and angiographic findings. Using the finite element analysis method, three-dimensional models can be made based on angiography, and these models can be used to measure different physical quantities and calculate the value of the "ankle-brachial index". The aim of this paper is to show the hemodynamics of arteries by using the finite element analysis method based on preoperative and postoperative angiography, as well as physical quantities that can be measured in this way. Methods. This case shows the hemodynamics of femoropopliteal bypass in the preoperative and postoperative models. The models obtained by finite element analysis show: pressure, shear stress, velocities, and streamlines. The pressure, i.e. the "ankle-brachial index", was compared with the values measured on the patient, while the other three values were compared preoperatively and postoperatively. Results. Postoperatively, higher values of pressure and "ankle-brachial index" were measured on the patient and on the models. Wall shear stress and velocity values were reduced in postoperative models. The streamlines showed a dominant anterior tibial artery. Conclusion. The values of physical quantities measured on patient and on the models obtained by the finite element analysis method correlate significantly. Some physical quantities could indicate the "weak points" of a particular model.

Treatment of posttraumatic infrapopliteal pseudoaneurysm with a physician-modified covered stent

Infrapopliteal pseudoaneurysms can occur after trauma. In recent years, endovascular repair has been increasingly used to treat infrapopliteal pseudoaneurysms. Nevertheless, there has been no covered stent specifically for small peripheral vessels. Here, we report a case of a 65-year-old male with a pseudoaneurysm of the anterior tibial artery which was managed with a physician-modified covered stent. 6 months after the procedure, the mass had completely disappeared and the vascular anatomy of the calf is well preserved.