The Infrapopliteal Arterial Occlusions Similar to Buerger Disease: Report of Two Cases

We herein present two cases that required the differential diagnosis of Buerger disease. Case 1 involved a 55-year-old male with a smoking habit who was admitted with ulcers and coldness in his fingers and toes. Angiography showed blockage in both the radial and posterior tibial arteries, which led to an initial diagnosis of Buerger disease. However, a biopsy of the right posterior tibial artery showed pathological findings of fibromuscular dysplasia (FMD). Case 2 involved a 28-year-old male with intermittent claudication who was examined at another hospital. Angiography showed occlusion of both popliteal and crural arteries, and the patient was suspected to have Buerger disease. However, computed tomography disclosed an abnormal slip on both sides of the popliteal fossa, and we diagnosed him with bilateral popliteal artery entrapment syndrome (PAES). These cases illustrate that other occlusive diseases, such as FMD and PAES, may sometimes be misdiagnosed as Buerger disease.

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Ultrasound in diagnosis of anatomical variation of anterior and posterior tibial arteries.

Medical Ultrasonography ◽

10.11152/mu.2013.2066.181.mzh ◽

2016 ◽

Vol 18 (1) ◽

pp. 64 ◽

Cited By ~ 4

Author(s):

Miao Zheng ◽

Chuang Chen ◽

Qianyi Qiu ◽

Changjun Wu

Keyword(s):

Anatomical Variation ◽

Posterior Tibial Artery ◽

Peroneal Artery ◽

Medial Malleolus ◽

Anterior Tibial Artery ◽

Tarsal Tunnel ◽

Posterior Tibial ◽

Tibial Artery ◽

Tibial Arteries ◽

Anterior Tibial

Aims: Knowledge about branching pattern of the popliteal artery is very important in any clinical settings involving the anterior and posterior tibial arteries. This study aims to elucidate the anatomical variation patterns and common types of anterior tibial artery (ATA) and posterior tibial arteries (PTA) in the general population in China. Material and methods: Anatomical variations of ATA, PTA, and peroneal artery were evaluated with ultrasound in a total of 942 lower extremity arteries in 471 patients. Results: Three patterns of course in the PTA were ultrasonographically identified: 1) PTA1: normal anatomy with posterior tibial artery entering tarsal tunnel to perfuse the foot (91.5%), 2) PTA2: tibial artery agenetic, and replaced by communicating branches of peroneal artery entering tarsal tunnel above the medial malleolus to perfuse the foot (5.9%), and 3) PTA3: hypoplastic or aplastic posterior tibial artery communicating above the medial malleolus with thick branches of peroneal artery to form a common trunk entering into the tarsal tunnel (2.4%). In cases where ATA was hypoplastic or aplastic, thick branches of the peroneal artery replaced the anterior tibial artery to give rise to dorsalis pedis artery, with a total incidence of 3.2 % in patients, and were observed more commonly in females than in males. Hypoplastic or aplastic termini of ATA and PTA, with perfusion of the foot solely by the peroneal artery, was identified in 1 case. In another case, both communicating branches of the peroneal artery and PTA entered the tarsal tunnel to form lateral and medial plantar arteries.Conclusions: Anatomical variation of ATA and PTA is relatively common in the normal population. Caution should be exercised with these variations when preparing a peroneal artery vascular pedicle flap grafting. Ultrasound evaluation provides accurate and reliable information on the variations.

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The Arterial Anatomy of the Lateral Ligament Complex of the Ankle: A Cadaveric Study

The American Journal of Sports Medicine ◽

10.1177/0363546518808060 ◽

2018 ◽

Vol 47 (1) ◽

pp. 138-143 ◽

Cited By ~ 2

Author(s):

Michelle M. Gosselin ◽

Jacob A. Haynes ◽

Jeremy J. McCormick ◽

Jeffery E. Johnson ◽

Sandra E. Klein

Keyword(s):

Vascular Anatomy ◽

Posterior Tibial Artery ◽

Vascular Supply ◽

Peroneal Artery ◽

Lateral Ligament ◽

Lateral Ankle ◽

Posterior Tibial ◽

Lateral Ligaments ◽

Anterior Branch ◽

Tibial Arteries

Background: Ankle sprains are the most common musculoskeletal injury in the United States. Chronic lateral ankle instability can ultimately require operative intervention to decrease pain and restore stability to the ankle joint. There are no anatomic studies investigating the vascular supply to the lateral ankle ligamentous complex. Purpose: To define the vascular anatomy of the lateral ligament complex of the ankle. Study Design: Descriptive laboratory study. Methods: Thirty pairs of cadaveric specimens (60 total legs) were amputated below the knee. India ink, followed by Ward blue latex, was injected into the peroneal, anterior tibial, and posterior tibial arteries to identify the vascular supply of the lateral ligaments of the ankle. Chemical debridement was performed with 8.0% sodium hypochlorite to remove the soft tissues, leaving casts of the vascular anatomy intact. The vascular supply to the lateral ligament complex was then evaluated and recorded. Results: The vascular supply to the lateral ankle ligaments was characterized in 56 specimens: 52 (92.9%) had arterial supply with an origin from the perforating anterior branch of the peroneal artery; 51 (91.1%), from the posterior branch of the peroneal artery; 29 (51.8%), from the lateral tarsal branch of the dorsalis pedis; and 12 (21.4%), from the posterior tibial artery. The anterior branch of the peroneal artery was the dominant vascular supply in 39 specimens (69.6%). Conclusion: There are 4 separate sources of extraosseous blood supply to the lateral ligaments of the ankle. In all specimens, the anterior talofibular ligament was supplied by the anterior branch of the peroneal artery and/or the lateral tarsal artery of the dorsalis pedis, while the posterior talofibular ligament was supplied by the posterior branch of the peroneal artery and/or the posterior tibial artery. The calcaneofibular ligament received variable contributions from the anterior and posterior branches of the peroneal artery, with few specimens receiving a contribution from the lateral tarsal or posterior tibial arteries. Clinical Relevance: Understanding the vascular anatomy of the lateral ligament complex is beneficial when considering surgical management and may provide insight into factors that lead to chronic instability.

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Anomalous origin of posterior tibial artery from anterior tibial artery: beware!

International Surgery Journal ◽

10.18203/2349-2902.isj20171159 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1461

Author(s):

Abheesh Varma Hegde ◽

Ann Sunny ◽

Sunil Joshi

Keyword(s):

Bypass Graft ◽

Surgical Flaps ◽

Posterior Tibial Artery ◽

Anomalous Origin ◽

Anterior Tibial Artery ◽

Tibial Osteotomy ◽

Posterior Tibial ◽

Tibial Artery ◽

Anterior Tibial ◽

The Right

A 64 year old diabetic, hypertensive male with claudication and rest pain in his left leg was found to have diffuse narrowing below the politeal artery in the left lower limb with good collaterals. There was bifurcation of the right popliteal artery above the knee joint and an anomalous origin of the right posterior tibial artery from the anterior tibial artery. Awareness of anotomical variations is important for evaluation of the lower extremity arteriograms, for vascular surgeons during reconstructions such as femorodistal bypass graft procedures and embolectomy, during surgical techniques such as arthroscopy, tibial osteotomy, vascular reconstruction grafts, plastic surgical flaps and catheterization procedures.

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Leiomyosarcoma of the great saphenous vein

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.0077 ◽

2015 ◽

Vol 14 (2) ◽

pp. 186-188 ◽

Cited By ~ 1

Author(s):

Alexandre Campos Moraes Amato ◽

Ana Júlia de Deus Silva ◽

Ricardo Virgínio dos Santos ◽

Salvador José de Toledo Arruda Amato

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Immunohistochemical Analysis ◽

Excisional Biopsy ◽

Posterior Tibial Artery ◽

Artery Embolization ◽

Posterior Tibial ◽

Mitotic Figures ◽

The Right ◽

Anatomical Pathology

A 56-year-old male patient presented with a complaint of two painful, hard, palpable nodules in the right lower limb. A Doppler ultrasound scan revealed the presence of nodules, likely to be neoplastic. Computed angiography showed two solid hypervascular nodules in the right great saphenous vein, fed by branches of the posterior tibial artery. Embolization of the nodules using surgical cyanoacrylate was performed, followed by an excisional biopsy. Anatomical pathology and immunohistochemical analysis identified the nodule as a high-grade leiomyosarcoma, characterized by ten mitotic figures per ten high-power fields, necrosis and cell pleomorphism. Immunohistochemical analysis results were positive for caldesmon and desmin labeling. A second surgical procedure was performed to enlarge the free margins.

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Features Analysis of Lower Extremity Arterial Lesions in 162 Diabetes Patients

Journal of Diabetes Research ◽

10.1155/2013/781360 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

XiangJiang Guo ◽

YaXue Shi ◽

XiaoZhong Huang ◽

Meng Ye ◽

GuanHua Xue ◽

...

Keyword(s):

Lower Extremity ◽

Lower Limb ◽

Vascular Involvement ◽

Posterior Tibial ◽

Tibial Arteries ◽

Arterial Lesions ◽

High Prevalence ◽

Patients With Diabetes ◽

Crural Arteries ◽

Angiographic Findings

Objective. This study aimed to investigate the angiographic manifestations of lower extremity atherosclerotic steno-occlusive disease in patients with diabetes.Materials and Methods. A total of 162 patients with diabetes were enrolled in this study. The angiographic findings of lower extremity arterial lesions were evaluated according to location (iliac, femoral, popliteal, and crural artery), type (stenosis or occlusion), and length (<5 cm, 5–10 cm, and >5 cm).Results. A total of 131 of 162 (80.9%) diabetics showed multiple segmental lesions, and 19.1% (31/162) presented single segmental lesions in the lower extremity artery. Crural artery was the mainly involved location (39/162, 85.8%). Among the recorded 660 lesions of 162 cases, 437 (66.2%) were occlusion lesions, while 223 (33.8%) were stenosis lesions. Of 437 occlusion lesions, 308 lesions (70.5%) were in crural artery. More than 10 cm occlusion lesion (242/392, 61.7%) was the main manifestation in crural artery, especially in anterior (92/127, 67.2%) and posterior tibial arteries (91/124, 73.4%), which was higher than that in iliac artery (8/33, 24.2%), popliteal artery (53/157, 33.8%), and femoral artery (11/78, 14.1%).Conclusion. In diabetic subjects with lower limb artery ischemia, the vascular involvement is extremely diffuse and particularly severe in crural arteries, with high prevalence of more than 10 cm occlusion lesions.

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A Rare Case of Bilateral Posterior Tibial Artery Aneurysm Presenting as Unilateral Acute Limb Ischemia

Case Reports in Vascular Medicine ◽

10.1155/2019/5647380 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Andrew T. Hattam ◽

Mayur Krishnaswamy

Keyword(s):

Artery Aneurysm ◽

Limb Ischemia ◽

Posterior Tibial Artery ◽

Acute Limb Ischemia ◽

Surgical Decision ◽

Posterior Tibial ◽

Tibial Artery ◽

Tibial Arteries ◽

Aneurysm Thrombosis ◽

Patient Presentation

True aneurysms of the tibial arteries are extremely rare. Of the few previously described tibial artery aneurysms, there are scant reports of isolated true aneurysms of the posterior tibial artery (PTA). In this report, we describe the second documented case of bilateral true PTA aneurysms. Unique aspects of this case are that the aneurysmal PTA were the only patent tibial arteries bilaterally, the aneurysms were degenerative in nature, and initial patient presentation was due to aneurysm thrombosis causing acute foot ischemia. The clinical and radiological features of this case, as well as surgical decision making and management, are discussed.

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Close-by Islanded Posterior Tibial Artery Perforator Flap: For Coverage of the Ankle Defect

Journal of Korean Society for Microsurgery ◽

10.15596/arms.2016.25.2.37 ◽

2016 ◽

Vol 25 (2) ◽

pp. 37-42

Author(s):

Sujin Bahk ◽

SeungHwan Hwang ◽

Chan Kwon ◽

Euicheol C. Jeong ◽

Su Rak Eo

Keyword(s):

Perforator Flap ◽

Posterior Tibial Artery ◽

Posterior Tibial ◽

Tibial Artery ◽

Artery Perforator

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The Distally Based Posterior Tibial Artery Flap

Clinics in Podiatric Medicine and Surgery ◽

10.1016/j.cpm.2020.05.003 ◽

2020 ◽

Vol 37 (4) ◽

pp. 671-680

Author(s):

William C. Perry ◽

Suhail Masadeh ◽

Alessandro Thione

Keyword(s):

Posterior Tibial Artery ◽

Posterior Tibial ◽

Tibial Artery ◽

Distally Based

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Sudden Unexpected Death Associated with Arrhythmogenic Cardiomyopathy: Study of the Cardiac Conduction System

Diagnostics ◽

10.3390/diagnostics11081323 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1323

Author(s):

Giulia Ottaviani ◽

Graziella Alfonsi ◽

Simone G. Ramos ◽

L. Maximilian Buja

Keyword(s):

Fibromuscular Dysplasia ◽

Ventricular Myocardium ◽

Conduction System ◽

Cardiac Conduction ◽

Future Research ◽

Cardiac Conduction System ◽

Arrhythmogenic Cardiomyopathy ◽

Unexpected Death ◽

The Past ◽

The Right

A retrospective study was conducted on pathologically diagnosed arrhythmogenic cardiomyopathy (ACM) from consecutive cases over the past 34 years (n = 1109). The anatomo-pathological analyses were performed on 23 hearts diagnosed as ACM (2.07%) from a series of 1109 suspected cases, while histopathological data of cardiac conduction system (CCS) were available for 15 out of 23 cases. The CCS was removed in two blocks, containing the following structures: Sino-atrial node (SAN), atrio-ventricular junction (AVJ) including the atrio-ventricular node (AVN), the His bundle (HB), the bifurcation (BIF), the left bundle branch (LBB) and the right bundle branch (RBB). The ACM cases consisted of 20 (86.96%) sudden unexpected cardiac death (SUCD) and 3 (13.04%) native explanted hearts; 16 (69.56%) were males and 7 (30.44%) were females, ranging in age from 5 to 65 (mean age ± SD, 36.13 ± 16.06) years. The following anomalies of the CCS, displayed as percentages of the 15 ACM SUCD cases in which the CCS has been fully analyzed, have been detected: Hypoplasia of SAN (80%) and/or AVJ (86.67%) due to fatty-fibrous involvement, AVJ dispersion and/or septation (46.67%), central fibrous body (CFB) hypoplasia (33.33%), fibromuscular dysplasia of SAN (20%) and/or AVN (26.67%) arteries, hemorrhage and infarct-like lesions of CCS (13.33%), islands of conduction tissue in CFB (13.33%), Mahaim fibers (13.33%), LBB block by fibrosis (13.33%), AVN tongue (13.33%), HB duplicity (6.67%%), CFB cartilaginous meta-hyperplasia (6.67%), and right sided HB (6.67%). Arrhythmias are the hallmark of ACM, not only from the fatty-fibrous disruption of the ventricular myocardium that accounts for reentrant ventricular tachycardia, but also from the fatty-fibrous involvement of CCS itself. Future research should focus on application of these knowledge on CCS anomalies to be added to diagnostic criteria or at least to be useful to detect the patients with higher sudden death risks.

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