Occlusion Of Anterior Tibial Artery Research Articles

Late results of surgical treatment of critical ischemia of the lower extremities after one-staged direct revascularization

Objective. To optimize the tactics of surgical treatment in patients, suffering chronic ischemia of the lower extremities with the help of elaboration and introduction of a one-staged direct and indirect revascularization into clinical practice.
 Materials and methods. Analysis of the treatment results in 162 patients, suffering obliterating atherosclerosis of the lower extremities vessels, who were treated in stationary in Department of Vascular Surgery of Zakarpattya Regional Clinical Hospital named after Andriy Novak in 2015 - 2020 yrs. The patients were distributed in accordance to the lower extremities ischemia degree: ІІB – 7 (4.3%), ІІІA – 61 (37.7%), ІІІB – 58 (35.8%), ІV – 36 (22.2%). All the patients have had atherosclerotic affection of femoro-ankle-foot segment of the main arteries with preservation of central blood flow in aorto-iliac segment.
 Results. Occlusion of femoral artery was noted in all patients. Occlusion of anterior tibial artery was revealed most frequently – in 72% of the patients, than in fibular - in 42% of patients (p=0.00), and equally frequently with occlusion of posterior tibial artery – in 68% (p=0.61). The foot arteries were involved into the process in 51 (31.5%) patients. Affection of 2-3 arteries of the shin were registered more frequently, than occlusion of one artery – in 109 (67.3%) and 48 (26.5%) patients, accordingly. Occlusive-stenotic affection of popliteal artery have had 127 (78.4%) patients.
 Mostly frequent affection of the shin arteries was observed in basin of anterior tibial artery – in 67 (41.4%) patients, as well as in combined affection of anterior and posterior tibial arteries - in 45 (27.8%) patients. Іsolated affection of posterior artery was revealed in 36 (22.2%) patients. Combined affection of posterior tibial and fibular was observed in 14 (8.6%) patients.
 Conclusion. Efficacy of indirect revascularization after the arterial inflow restoration is more prognosticated, than efficacy of its isolated conduction in environment of chronic critical ischemia of the lower extremities. Combined application of direct and indirect revascularization guarantees more secure positive result in remote postoperative period and enhancement of the extremities preservation index.

Free Flap Reconstruction after Complications of Total Ankle Arthroplasty: Case Series and Review of the Literature

Background Postoperative complications of total ankle arthroplasty (TAA) include anterior surgical site dehiscence, hardware failure, infection, and amputation. Early intervention with free flap may provide TAA salvage. We report the largest series of failed TAA require microsurgical free tissue transfer, identify risk factors, and examine the long-term post-free flap outcomes. Materials and Methods This is a case series of consecutive patients from a single institution dedicated to limb salvage. Inclusion criteria included patients who underwent TAA with complications related to the index surgery and underwent microsurgical free tissue transfer. Nine patients were identified within the inclusion parameters. Results Patients presented with osteomyelitis 4 (44%), soft tissue infections 4 (44%), and wound dehiscence 1 (11%) following TAA. Three (33%) radial forearm free flaps and six (67%) anterolateral thigh flaps were used, with a 100% microsurgical success rate. Preoperative angiography revealed six (67%) patients with anterior tibial artery occlusion at the level of the ankle or below. Patients required an average of 2.7 ± 1 (range 1–4) operative débridements prior to free flap, with successful flap outcome and return to full weight bearing status in nine (100%) patients. The mean long-term lower extremity functional scale score was 62 out of 80 points. Conclusion Microsurgical free tissue transfer is an effective and favorable strategy to attain a stable soft tissue envelope for patients presenting with surgical site complications following TAA. We recommend early involvement with plastic surgery and endovascular angiography to evaluate the integrity of the anterior tibial artery.

The Case of a Job Well Done?

Minimal invasive techniques for fracture repair are becoming more prevalent as increased experience is gained by orthopedic trauma surgeons worldwide, with minimal invasive plate osteosynthesis (MIPO) surgery being a popular one. In the current case report we describe a rare complication of fracture management, where anterior tibial artery occlusion occurred as a result of direct pressure by an LCP 4.5 mm plate inserted via MIPO technique. The case involves a 41-year-old man was brought to the emergency trauma room after sustaining a gunshot injury to the Lt tibia. the surgical team preformed a closed reduction and internal fixation with LCP 4.5 mm (Synthes) plate and screws through a lateral incision in a minimal invasive technique. In the recovery room, thirty minutes after the end of the first surgery, the patient developed acute leg ischemia and was rushed back into the operating room. After lateral fasciotomy and exploration, the tibial peroneal tract was found to be completely torn, with no pulse of the tibialis anterior artery, Thrombectomy was performed and a graft used. Even though, the ischemia continued and Selective angiography demonstrated the tibialis anterior pressed between the tibia and the plate with complete obstruction. The plate was immediately removed and the artery was reconstructed using the saphenous vein from the uninjured leg. Even though arterial complications after fracture management are rare, they do happen and one should keep them in mind and be vigilant for them, thus if they do occur, one can attend to them early.

Znaczenie diagnostyki obrazowej unaczynienia miejsca pobrania w planowaniu rekonstrukcji wolnym płatem strzałkowym

Free fibula flap is widely used in head and neck reconstruction. Imaging studies of the donor site can reveal vascular abnormalities and therefore prevent acute leg ischemia.Evaluation of the role of donor site vascular imaging studies for free fibula flap planing.Out of 35 free flap reconstructions performed in Otolaryngology Head and Neck Surgery Department in Medical University in Lublin in 2011-2012, there were 10 fibula flaps. Each patient had preoperative lower leg subtraction angiography performed.Lower leg angiography revealed vascular abnormalities in two out of 10 patients scheduled for free fibula flap transfer. One had dominant peroneal artery and second occlusion of anterior tibial artery. In both cases fibula was harvested from the other leg.Imaging studies reveal lower leg vascular abnormalities in 20% of cases thus facilitate surgical plans alternations and prevent serious complications in free fibula flap patients.

Simultaneous Massive Pulmonary Embolism and Thromboembolic Occlusion of the Anterior Tibial Artery in Cholangiocarcinoma: A Variation of the Trousseau Syndrome

Purpose: 67 Y/O African American female presented with poorly localized abdominal pain radiating to the back for one week. Patient also complained of decrease in appetite but did not complain of weight loss, nausea/vomiting, diarrhea/constipation. Past medical history was significant for hypertension, diabetic mellitus, asthma, nonobstructive coronary artery disease, diverticulosis and osteoarthritis, she was recently diagnosed with pulmonary embolism and discharged on lovenox and Coumadin. She denied smoking, alcohol or drugs. Clinical examination revealed a moderate built woman with left upper quadrant tenderness. No other abnormality was detected. Laboratory data revealed leukocytosis, moderate anemia, alkaline phosphate of 171, INR of 6.2. CT with pancreatic protocol showed pancreatic duct dilatation with atrophy of pancreas and multiple densities in the liver. On day five, the patient was found to have bluish discoloration of the right toe, a cold right foot and absent peripheral pulses. CT angiogram of right lower extremity showed occlusion of the right anterior tibial artery. Transesophageal echo showed no thrombus. CT angiogram of chest showed a large pulmonary embolus in the right main pulmonary artery with interval worsening of the pulmonary emboli. There was no evidence of aneurysm or stenosis in the aorta. Tumor markers revealed elevated CA 19-9 >12000 and CA 125 1479.6. Her condition quickly deteriorated, suffered a cardiac arrest and expired after an unsuccessful cardiac resuscitation. Subsequent autopsy revealed liver parenchyma infiltrated by poorly-differentiated adenocarcinoma with extensive necrosis consistent with cholangiocarcinoma. There was metastasis in the lung and pancreas. Conclusion: Clinicians are well aware of the connection between deep vein thrombosis, migrating thrombophlebitis and occult malignancy. This connection is the classic Trousseau syndrome. This case emphasizes the relation between thrombo embolic events and occult malignancy.