Usefulness of Waveform Analysis in Doppler Ultrasonography for Evaluation of Blood Flow in Dorsal Region in Patients with Anterior Tibial Artery Occlusion

Objectives The main factor in the healing of foot ulcers in diabetic patients is adequate perfusion. There is no consensus on whether direct or indirect revascularization is more effective in leg revascularization. At the centre of that debate, there is a disagreement about whether collateral circulation is sufficient or not. Our aim is to evaluate collateral circulation activity between angiosomes in the feet of diabetic patients by evaluating the level of occlusion in leg arteries and comparing the angiosome regions that have necrosis. Methods The study included 61 patients. All had undergone CT angiography to the lower extremity prior to any revascularization of the leg arteries between September 2014 and September 2016. Stenosis was evaluated on the anterior tibial artery, the posterior tibial artery and the peroneal artery up to the level of the ankle. The opening of the vessel wall at the narrowest part of the vessel was determined as a percentage. The areas with necrosis were determined according to the angiosomes of the posterior tibial artery, anterior tibial artery and peroneal artery vessels. Results Necrosis of the foot was most common in the posterior tibial artery angiosome. Necrosis in the posterior tibial artery angiosome was independent of the level of posterior tibial artery occlusion; however, it was associated with the occlusion of the anterior tibial artery ( p < 0.05). It was found that anterior tibial artery occlusion over 15% resulted in necrosis in the posterior tibial artery angiosome. Conclusions Collateral circulation between the anterior tibial artery and posterior tibial artery is active and there is almost always occlusion in the posterior tibial artery branches. The posterior tibial artery angiosome is fed by the collateral arteries of the anterior tibial artery even if there is no occlusion of posterior tibial artery at the level of the leg, so indirect revascularization on the anterior tibial artery is sufficient to provide foot circulation.

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Treatment of anterior tibial artery occlusion

The Lancet ◽

10.1016/0140-6736(91)91143-i ◽

1991 ◽

Vol 338 (8766) ◽

pp. 575

Author(s):

GeorgeG. Hartnell ◽

AnjanK. Banerjee ◽

Nicholas Hickey ◽

Richard Downing

Keyword(s):

Artery Occlusion ◽

Anterior Tibial Artery ◽

Tibial Artery ◽

Anterior Tibial ◽

Tibial Artery Occlusion

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Blood Flow In The Human Anterior Tibial Artery Following Ischemic Isometric Exercise

Medicine & Science in Sports & Exercise ◽

10.1249/00005768-200505001-01170 ◽

2005 ◽

Vol 37 (Supplement) ◽

pp. S222

Author(s):

Chris A. Kilmer ◽

Jeni A. Thompson ◽

J. Kevin Shoemaker ◽

Charles L. Rice ◽

Greg D. Marsh

Keyword(s):

Blood Flow ◽

Isometric Exercise ◽

Anterior Tibial Artery ◽

Tibial Artery ◽

Anterior Tibial

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Proximal tibial and fibular fractures complicated with popliteal artery occlusion due to an entrapped anterior tibial artery

Injury Extra ◽

10.1016/j.injury.2005.07.008 ◽

2006 ◽

Vol 37 (2) ◽

pp. 41-44

Author(s):

Aki Fukuda ◽

Hitoshi Hirata ◽

Rui Niimi ◽

Akimasa Morita ◽

Atsumasa Uchida

Keyword(s):

Popliteal Artery ◽

Artery Occlusion ◽

Anterior Tibial Artery ◽

Tibial Artery ◽

Anterior Tibial

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Doppler waveform analysis of the anterior tibial artery and posterior tibial artery for detecting early‒stage peripheral arterial disease

Nihon Toseki Igakkai Zasshi ◽

10.4009/jsdt.54.89 ◽

2021 ◽

Vol 54 (2) ◽

pp. 89-92

Author(s):

Junya Yoshida ◽

Junichiro Kajita ◽

Chinami Nagura ◽

Michito Nagura ◽

Yuji Nagura

Keyword(s):

Early Stage ◽

Arterial Disease ◽

Posterior Tibial Artery ◽

Waveform Analysis ◽

Anterior Tibial Artery ◽

Posterior Tibial ◽

Tibial Artery ◽

Anterior Tibial ◽

Doppler Waveform ◽

Peripheral Arterial

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Effects of Enhanced External Counterpulsation With Different Sequential Levels on Lower Extremity Hemodynamics

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.795697 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yahui Zhang ◽

Yujia Zhang ◽

Yinfen Wang ◽

Xiuli Xu ◽

Jing Jin ◽

...

Keyword(s):

Blood Flow ◽

Flow Velocity ◽

Posterior Tibial Artery ◽

Anterior Tibial Artery ◽

Posterior Tibial ◽

Tibial Artery ◽

Dorsalis Pedis Artery ◽

Level Sequence ◽

Anterior Tibial ◽

Enhanced External Counterpulsation

Objective: This study aimed to investigate acute hemodynamics of lower extremities during enhanced external counterpulsation with a three-level sequence at the hips, thighs, and calves (EECP-3), two-level sequence at the hips and thighs (EECP-2), and single leg three-level sequence (EECP-1).Methods: Twenty healthy volunteers were recruited in this study to receive a 45-min EECP intervention. Blood flow spectrums in the anterior tibial artery, posterior tibial artery, and dorsalis pedis artery were imaged by Color Doppler ultrasound. Mean flow rate (FR), area, pulsatility index (PI), peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MV), and systolic maximum acceleration (CCAs) were sequentially measured and calculated at baseline during EECP-3, EECP-1, and EECP-2.Results: During EECP-3, PI, PSV, and MV in the anterior tibial artery were significantly higher, while EDV was markedly lower during EECP-1, EECP-2, and baseline (all P < 0.05). Additionally, ACCs were significantly elevated during EECP-3 compared with baseline. Moreover, FR in the anterior tibial artery was significantly increased during EECP-3 compared with baseline (P = 0.048). During EECP-2, PI and MV in the dorsalis pedis artery were significantly higher and lower than those at baseline, (both P < 0.05). In addition, FR was markedly reduced during EECP-2 compared with baseline (P = 0.028). During EECP-1, the area was significantly lower, while EDV was markedly higher in the posterior tibial artery than during EECP-1, EECP-2, and baseline (all P < 0.05). Meanwhile, FR of the posterior tibial artery was significantly reduced compared with baseline (P = 0.014).Conclusion: Enhanced external counterpulsation with three-level sequence (EECP-3), EECP-2, and EECP-1 induced different hemodynamic responses in the anterior tibial artery, dorsalis pedis artery, and posterior tibial artery, respectively. EECP-3 acutely improved the blood flow, blood flow velocity, and ACCs of the anterior tibial artery. In addition, EECP-1 and EECP-2 significantly increased the blood flow velocity and peripheral resistance of the inferior knee artery, whereas they markedly reduced blood flow in the posterior tibial artery.

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