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

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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Retrograde Surgical Cut-down Direct Thrombectomy as a Salvage Procedure for Acute Limb Ischemia With Below the Knee Thrombotic Occlusion: a Case Series

10.21203/rs.3.rs-739661/v1 ◽

2021 ◽

Author(s):

Ying-Sheng Li ◽

Ying-Ching Li

Keyword(s):

Limb Ischemia ◽

Posterior Tibial Artery ◽

Complete Revascularization ◽

Acute Limb Ischemia ◽

Salvage Procedure ◽

Posterior Tibial ◽

Tibial Artery ◽

Dorsalis Pedis Artery ◽

Below The Knee ◽

Surgical Thrombectomy

Abstract Background: Acute limb ischemia is a serious condition even in an era of highly comprehensive medical treatment. Despite the development of conservative and endovascular treatment, complete removal of the thrombus with antegrade thrombectomy via the femoral approach, especially in below-the-knee arteries, is still not possible. In addition, distal embolization of dislodged debris or thrombus during the procedure is another concern as this might cause severe complications, including amputation. Given the above-mentioned issues, retrograde surgical cut-down direct thrombectomy from the dorsalis pedis artery and posterior tibial artery could be an optimal option for complete revascularization in below-the-knee arteries. Case presentation: We present five cases where the limbs were preserved after retrograde surgical thrombectomy. The standard antegrade thrombectomy procedure with a conventional surgical approach from the common femoral artery was performed. All five patients underwent an intraoperative assessment of indications for dorsalis pedis artery and posterior tibial artery retrograde thrombectomy by the surgical cut-down method. After retrograde thrombectomy, direct evaluation of blood flow was the strongest evidence of revascularization. A retrograde angiogram showed revascularization of below-the-knee arteries. All five patients had successful salvage procedures that prevented major limb amputation. Conclusion: Retrograde surgical thrombectomy could be a salvage procedure for incomplete antegrade thrombectomy.

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Rupture of Posterior Tibial Artery Aneurysm in a Patient with von Recklinghausen's Disease

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.41.293 ◽

2012 ◽

Vol 41 (6) ◽

pp. 293-295

Author(s):

Mikito Inouchi ◽

Yu Shomura ◽

Michihiro Nasu ◽

Yukikatsu Okada

Keyword(s):

Artery Aneurysm ◽

Posterior Tibial Artery ◽

Von Recklinghausen’S Disease ◽

Von Recklinghausen's Disease ◽

Posterior Tibial ◽

Tibial Artery ◽

Recklinghausen's Disease ◽

Recklinghausen’S Disease

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True Giant Posterior Tibial Artery Aneurysm

Case Reports in Surgery ◽

10.1155/2012/695250 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Alessandro Robaldo ◽

Giacomo Di Iasio ◽

Gabriele Testi ◽

Patrizio Colotto

Keyword(s):

Surgical Management ◽

Unusual Case ◽

Surgical Intervention ◽

English Literature ◽

Artery Aneurysm ◽

Posterior Tibial Artery ◽

Diagnostic Evaluation ◽

Posterior Tibial ◽

Tibial Artery

We report an unusual case of true atherosclerotic posterior tibial artery (PTA) aneurysm without any apparent causative history. To our knowledge, in the English Literature only seven previously cases of true PTA aneurysms are reported. Due to its location, this lesion may require surgical intervention and removal. The presentation, the diagnostic evaluation, and the surgical management of the aneurysm are discussed.

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Posterior Tibial Artery Aneurysm

Vascular and Endovascular Surgery ◽

10.1177/1538574406292004 ◽

2006 ◽

Vol 40 (4) ◽

pp. 328-330 ◽

Cited By ~ 7

Author(s):

Stratton G. Danes ◽

A. David Drezner ◽

Patrick M. Tamim

Keyword(s):

Artery Aneurysm ◽

Posterior Tibial Artery ◽

Posterior Tibial ◽

Tibial Artery

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Posterior tibial artery aneurysm: a case report with review of literature

BMC Surgery ◽

10.1186/1471-2482-14-37 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 5

Author(s):

Jayesh Sagar ◽

Mathew Button

Keyword(s):

Case Report ◽

Artery Aneurysm ◽

Posterior Tibial Artery ◽

Review Of Literature ◽

Posterior Tibial ◽

Tibial Artery

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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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Retrograde Tibiopedal Access as a Bail-Out Procedure for Endovascular Intervention Complications

Case Reports in Vascular Medicine ◽

10.1155/2016/7519748 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Ahmed Amro ◽

Alaa Gabi ◽

Adee Elhamdani ◽

Naveed Iqbal ◽

Mehiar El-Hamdani

Keyword(s):

Limb Salvage ◽

Femoral Artery ◽

Critical Limb Ischemia ◽

Superficial Femoral Artery ◽

Limb Ischemia ◽

Posterior Tibial Artery ◽

Covered Stent ◽

Posterior Tibial ◽

Tibial Artery ◽

Bail Out

Introduction. Retrograde pedal access has been well described in the literature as a secondary approach for limb salvage in critical limb ischemia (CLI) patients. In this manuscript we are presenting a case where retrograde tibiopedal access has been used as a bail-out procedure for the management of superficial femoral artery (SFA) intervention complications.Procedure/Technique. After development of a perforation while trying to cross the totally occluded mid SFA using the conventional CFA access, we were able to cross the mid SFA lesion after accessing the posterior tibial artery in a retrograde fashion and delivered a self-expanding stent which created a flap that sealed the perforation without the need for covered stent.Conclusion. Retrograde tibiopedal access is a safe and effective approach for delivery of stents from the distal approach and so can be used as a bail-out technique for SFA perforation.

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Endovascular Management of a Posterior Tibial Artery Aneurysm in Type IV Ehlers–Danlos Syndrome

EJVES Extra ◽

10.1016/j.ejvsextra.2004.05.001 ◽

2004 ◽

Vol 7 (6) ◽

pp. 74-75 ◽

Cited By ~ 1

Author(s):

S Kumar ◽

K Shreeram ◽

S.K Agarwal ◽

S.S Baijal ◽

S.R Phadke

Keyword(s):

Artery Aneurysm ◽

Posterior Tibial Artery ◽

Endovascular Management ◽

Ehlers Danlos Syndrome ◽

Posterior Tibial ◽

Tibial Artery ◽

Type Iv ◽

Danlos Syndrome

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Endovascular Distal Plantar Vein Arterialization in Dialysis Patients With No-Option Critical Limb Ischemia and Posterior Tibial Artery Occlusion: A Technique for Limb Salvage in a Challenging Patient Subset

Journal of Endovascular Therapy ◽

10.1177/1526602817750211 ◽

2017 ◽

Vol 25 (1) ◽

pp. 127-132 ◽

Cited By ~ 16

Author(s):

Roberto Gandini ◽

Stefano Merolla ◽

Jacopo Scaggiante ◽

Marco Meloni ◽

Laura Giurato ◽

...

Keyword(s):

Limb Salvage ◽

Critical Limb Ischemia ◽

Balloon Catheter ◽

Limb Ischemia ◽

Venous Access ◽

Posterior Tibial Artery ◽

Percutaneous Technique ◽

Posterior Tibial ◽

Tibial Artery ◽

Esrd Patients

Purpose: To detail a percutaneous technique for distal plantar venous arterialization in diabetic, end-stage renal disease (ESRD) patients with no-option critical limb ischemia (CLI). Technique: After failure of standard intraluminal recanalization attempts, a subintimal approach through the posterior tibial artery (PTA) is begun using a 0.014-inch, 190- or 300-cm-long guidewire supported by a 2-×20-mm, low-profile balloon catheter positioned a short distance behind the narrow “U-shaped” loop in the guidewire. Typically, heavy calcification in the distal tortuous segment of the PTA prevents reentry to the arterial true lumen; however, an entry in the distal lateral or medial plantar vein from a subintimal channel in the plantar artery can be intentionally pursued as a bailout technique, pointing the tip of the guidewire opposite to the arterial wall calcifications. Venous access is confirmed by contrast injection through the balloon catheter. Once the guidewire is advanced in the distal lateral or medial plantar vein and a plantar arteriovenous fistula (AVF) has been created, the AV anastomosis and the occluded PTA segment are dilated with 0.014-inch balloon catheters. The technique has been attempted in 9 consecutive diabetic, ESRD patients (mean age 69 years; 5 men) with no-option CLI; an AVF was created between the PTA and plantar vein in 7 patients. The mean TcPO2 at 1 month was 30±17 mm Hg (vs 7.3±2.2 at baseline). Six ulcers healed over an average of 21±4 weeks. Three of the 9 patients had below-knee amputations. Conclusion: Although further investigations are required, distal plantar venous arterialization may represent a promising technique to improve recanalization rates and limb salvage in diabetic ESRD patients with extremely calcified PTA occlusions.

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