DOCSLIB.ORG

Understanding the Tibial Pedal Anatomy: Practical Points for Clinical Presentation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Understanding the Tibial Pedal Anatomy: Practical Points for Clinical Presentation Understanding the Tibial Pedal Anatomy: Practical Points for Clinical Presentation Vlad A. ALEXANDRESCU MD, PhD. Consultant Vascular Surgeon C.H.U. Sart-Tilman Hospital, University of Liège, Belgium. Disclosures • No disclosures No brand names are included in this presentation. No product promotion is inferred. The Vascular Anatomy of the Leg (91% Dominant patterns, 9% Variations): Calf: Foot: Closely related to the muscular compartments & skin distribution. 4 Compartments , 9 compartments , 3 individual vasc. bundles. > 16 dedicated bundles. Practical perspective: • Inf. Limb encloses: Harmonic vascular distribution, and holds • Graduated dichotomy => Increases the sectional area of distal flow ! • The Cross-section of two branches > than the surface of initial trunk, • Anatomical variations: do follow this balanced 3D topography! No random blood distribution (Dorsal / Plantar Territ.) ! See the main tibial tr TheThe Anteriormain Tibial Tibialand &PedalDorsalisarterialPedis trunks:line of flow : • Originates: At the Interosseus Membrane’s / The “Hook”, • Courses : within the anterior compartment of the lower leg & foot , • At the Extensor’s Retinaculum : => Transitions to the pedal flow , => A zone of fixity & blustery flow ! • Terminates / 1st. MT space => branching the Arcuate artery, & creates => the 1st. Dorsal MT artery & => the Deep Plantar artery. • All 3 => Large collat. (around 1 mm) > 80 ml /min. flow • Noted : +/- 9% Anatomical Variations , Same Harmonious distribution / the anterior Leg & Foot, For these cases: the Dorsal Arches derive mainly => Peroneal artery / only exceptionally from the PT ! Practical points : The posterior v vLargeSmallerDP collat.native: L collatat. Tarsal. : Med.arteries Tarsal(1 collat.mm) => (often connect < 0.5 ATmm) , Lat. Plantar circulation (PT flow) ! Correct healing at 3 months, v Can rarely compensate the plantar flow without Plantar - Directed Revascularization ! => may enhance correct healing for lateral foot wounds => via Indirect Revascularization ! via large (1mm) collaterals. Incomplete healing at 5 months, via these small collaterals. The Posterior Tibial & Plantar line of flow. : • Courses: the Deep Post. calf Compartment , • The Flexor’s Retinaculum => specific shear-stress zone : => Possible endothelial injuries by blowy flow , => A transition zone to the fixed plantar circulation ! • Bifurcates: Medial & Lateral Plantar aa. , • The Lat. Plant. a => large branch (1.5 mm.) & Creates the “deep” Plantar Arch and receives: the Deep Plantar Artery (from DP) => Important link / Wound - Oriented - Revasc via the “Arches Flow System” ! • Described : +/- 5% Anatomical Variations (mainly / Plantar level) 95% of these cases : the PT arises from the Peroneal ! (almost never directly from the AT) ! Flexion Extension Practical points : 1.2.3. The UsefulThe F IElexor’snterossxtensor’sfor the Reetinaculumus IRnterventionistMetinaculumembrane’szonezonepassage=>=> predict=> => difficult CTO recanalization strategy ! ++ Cited: Three “Challenging Zones” / Tibial flow concerning shear-stress + occlusions & heavy Ca : Concerning the Anterior Tibial artery , Concerning the Posterior Tibial artery , Alexandrescu V. et al. Angiosomes, a reliable approach. J Endovasc Ther. 2011. See the Peroneal Concerning the Anterior Tibial & Dors. Pedis junction , The Peroneal Artery : • Supplies: the Lateral Compartment of the leg, • Despite traveling : Deep Post. Compartment , • Ends => superficially / Lat. Calc. Branch (terminal-type branch, affords 30% / heel perfusion) , • Generates two important collaterals: The Ant. & Post. Communicants linked to the Ant. & Post. Tibial aa, • The Peroneal a. => provides effective rescue supply => R4 CLTI presentations. => questionable utility for salvage reperfusion / R5 forefoot angiosomes + wounds ! PT. AT. Practical points : ++ § Peroneal a. holds: Lesser Ca => Higher technical feasibility ! § However: modest=> support often named:(as single the - “patentBest A rteryvessel)” to in treat preserv / DFing context. => R5 - R6 , § In rare cases, both => FAorefootnt. & Post.& m idC-ommunicantsfoot CLI lesions. may> provide good filing / arches ! The foot AG 5. The foot Anatomical Angiosomes4. & their collateral system : 6. 1. 3. 2. PT. Peroneal AT. (6) Postulated 30 Y ago> 1987 / J. Taylor => described 6 specific foot AGs ! 3=> PT, 2=> Peroneal, 1=> ATa. The Major role of Collaterals in the AG concept : § Neighboring AG linked => vast connection system: the “Choke - vessels” & the a-a. collateral network. § Even with (9% ) anatomical variations : the foot maintains a distinct Dorsal & Plantar collateral distribution ! § CLTI may distort “classical” AG-collateral borders ! § Important to assess: angiographic “visible” or “dormant” collaterals => may enable to orient reperfusion: intentional Wound Directed Revascularization ! Taylor J. Taylor J. AG collaterals are structured on “3- Levels” => “The C-V, the a-a comm, & the Cut. Perforating Arteries” / described (Taylor 2010) , “AllRecent these “controversies” branches have concerning topographicT opographic limb distribution - skin” panderforators completedistribution: the much as wider “independent“Circulatory AG / Physiological branches” - AG”, also “may explain” Pedal Arches : The “True redeemers” of the ischemic foot ! • ”The integrity of Dorsal & Plantar Arches => paramount importance for forefoot and mid-foot tissue recovery.” • Arches afford “Wound Targeted Revasc.” either via : “antegrade” , or “retrograde” perfusion ! § Both Foot arches => closely interconnected by : a) 4 Proximal & 4 Distal Perforating Arteries (half mm / diameter) , b) by The important Deep Plantar Artery / from the DP (high-volume, 1mm collat.) largely used via current “loop technique” + c) &by The Lateral & Medial Tarsal Arteries (half mm branches) , Arches Reperfusion => confirms / does not deny => Topographic Revascularization strategy ! Patent The arches topographic afford equivalent role of arches Healingwas revealedand by manyLimb AuthorsSalvage ” in results Surgicalas seriesDirect (Rashid)“AG” r evasc or Endovascularaccording to Zheng (/Osawa (500p.- )study)analyses ! The ForeFoot & Toes perfusion : • The Forefoot lesions : => About 37% of all / R. 5-6 presentations What this imply => Represent a crossroad of 3 AG (1 Dorsal & 2 Plantars) ! § Patency of Arches and Digital Arteries : => crucial / Forefoot healing ! => Best achieved since : > 2 Digital collaterals are permeable ! either by : Partial Digital aa. Thrombosis , What this implies in practical terms ? Toes necrosis / inevitable => since Thrombosis of > half digital collaterals occurs ! Complete (all 4) Digital aa. Occlusions ! &Complete Digital + Arches Thrombosis ! & The Hind-Foot & Heel collaterals: PT. Peron. • The Heel: owns specific “terminal - type” vascularization ! • Only 2 “Source- arteries” => PT. + Peroneal aa. • No direct a-a communicants, => the “Scarcest Collateral Zone” of the foot ! • Heel flow => Mainly relies on PT. (>70%) perfusion ! => No specific AT. connections ! Poor recovery by sole DP. reperfusion, The Highest Risk of amputation for R6 lesions ! Conclusion Thorough anatomical reevaluation of scattered tibial, pedal and collateral flow, may reword the committed clinician in topographic reperfusion of the lower limb, The Vascular Anatomy canwith be impressive strongly tissue’sdistortedhealingin the resultsmajority ! of CLTI presentations ! however THANK YOU ! The essential of this presentation, was reproduced in the appended article :.
Load more

Recommended publications
  • Netter's Musculoskeletal Flash Cards, 1E
    Netter’s Musculoskeletal Flash Cards Jennifer Hart, PA-C, ATC Mark D. Miller, MD University of Virginia This page intentionally left blank Preface In a world dominated by electronics and gadgetry, learning from fl ash cards remains a reassuringly “tried and true” method of building knowledge. They taught us subtraction and multiplication tables when we were young, and here we use them to navigate the basics of musculoskeletal medicine. Netter illustrations are supplemented with clinical, radiographic, and arthroscopic images to review the most common musculoskeletal diseases. These cards provide the user with a steadfast tool for the very best kind of learning—that which is self directed. “Learning is not attained by chance, it must be sought for with ardor and attended to with diligence.” —Abigail Adams (1744–1818) “It’s that moment of dawning comprehension I live for!” —Calvin (Calvin and Hobbes) Jennifer Hart, PA-C, ATC Mark D. Miller, MD Netter’s Musculoskeletal Flash Cards 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 NETTER’S MUSCULOSKELETAL FLASH CARDS ISBN: 978-1-4160-4630-1 Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this book may be produced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission in writing from the publishers. Permissions for Netter Art figures may be sought directly from Elsevier’s Health Science Licensing Department in Philadelphia PA, USA: phone 1-800-523-1649, ext. 3276 or (215) 239-3276; or e-mail [email protected].
    [Show full text]
  • The Deep Femoral Artery and Branching Variations: a Case Report Arteria Profunda Femoris Ve Dallarının Varyasyonu: Olgu Sunumu
    Cumhuriyet Tıp Dergisi Cumhuriyet Tıp Derg 2009; 31: 279-282 Cumhuriyet Medical Journal Cumhuriyet Med J 2009; 31: 279-282 The deep femoral artery and branching variations: a case report Arteria profunda femoris ve dallarının varyasyonu: olgu sunumu Vedat Sabancıoğulları, Mehmet İlkay Koşar, Ekrem Ölçü, Mehmet Çimen Department of Anatomy (Assist. Prof. V. Sabancıoğulları, MD; Assist. Prof. M. İ. Koşar, MD; Prof. M. Çimen, PhD), Cumhuriyet University School of Medicine, TR-58140, Sivas; and Department of Radiology (E. Ölçü, MD, Specialist in Radiology) Afşin State Hospital, TR-46500 Kahramanmaraş Abstract The deep femoral artery is the major branch of the femoral artery. Its branches and branching show various variations. For this reason, an extensive knowledge about the anatomy of the deep femoral artery is indeed important in vascular reconstructive surgery involving the groin. In this investigation, a case with variations of the deep femoral artery origin and branching has been presented. The case was a 45-year old male cadaver and the arterial variation was noted during routine dissection. The right and left origins of the deep femoral artery varied. When the midpoint of the inguinal ligament was taken as a reference, the right artery originated at 5.58 cm and the left artery at 2.22 cm. In the left, the ascending branch and transverse branch of the lateral circumflex femoral artery originated. At a joint root and the descending branch originated directly at the deep femoral artery. Also in the left, it was observed that there were eight perforating arteries. Keywords: Deep femoral artery, anatomic variation, cadaver Özet Arteria profunda femoris, arteria femoralis’in uyluğu besleyen en büyük dalıdır.
    [Show full text]
  • Reconstructive
    RECONSTRUCTIVE Angiosomes of the Foot and Ankle and Clinical Implications for Limb Salvage: Reconstruction, Incisions, and Revascularization Christopher E. Attinger, Background: Ian Taylor introduced the angiosome concept, separating the M.D. body into distinct three-dimensional blocks of tissue fed by source arteries. Karen Kim Evans, M.D. Understanding the angiosomes of the foot and ankle and the interaction among Erwin Bulan, M.D. their source arteries is clinically useful in surgery of the foot and ankle, especially Peter Blume, D.P.M. in the presence of peripheral vascular disease. Paul Cooper, M.D. Methods: In 50 cadaver dissections of the lower extremity, arteries were injected Washington, D.C.; New Haven, with methyl methacrylate in different colors and dissected. Preoperatively, each Conn.; and Millburn, N.J. reconstructive patient’s vascular anatomy was routinely analyzed using a Dopp- ler instrument and the results were evaluated. Results: There are six angiosomes of the foot and ankle originating from the three main arteries and their branches to the foot and ankle. The three branches of the posterior tibial artery each supply distinct portions of the plantar foot. The two branches of the peroneal artery supply the anterolateral portion of the ankle and rear foot. The anterior tibial artery supplies the anterior ankle, and its continuation, the dorsalis pedis artery, supplies the dorsum of the foot. Blood flow to the foot and ankle is redundant, because the three major arteries feeding the foot have multiple arterial-arterial connections. By selectively performing a Doppler examination of these connections, it is possible to quickly map the existing vascular tree and the direction of flow.
    [Show full text]
  • Femoral Artery, Profunda Femoris Artery, Lateral Circumflex Femoral Artery, Medial Circumflex Artery, Femoral Triangle
    Basic Sciences of Medicine 2016, 5(1): 5-7 DOI: 10.5923/j.medicine.20160501.02 Anomalous Configuration of Medial and Lateral Circumflex Femoral Arteries Rajani Singh Department of Anatomy AIIMS Rishikesh, Rishikesh, India Abstract Normally profunda femoris artery arises from femoral artery below the inguinal ligament. Profunda femoris artery gives rise to lateral circumflex artery laterally and medial circumflex artery medially. But abnormal configuration of profunda femoris artery and its branches was observed in two cases in present study during dissection of lower limbs for teaching purpose in the department of Anatomy AIIMS Rishikesh, India. In one case, femoral artery trifurcated into medial circumflex, lateral circumflex and profunda femoris arteries. This finding is rare. In another case, common trunk arose from femoral artery which descended for 2.5 cm and gave medial circumflex artery. This common trunk descended further for 1 cm and bifurcated into lateral circumflex and profunda femoris arteries. This finding is new and unique and hence the case is reported. Knowledge of these variations will be of utmost importance to surgeons carrying out surgical procedures around the femoral triangle, to radiologists to avoid misinterpretation of radiographs and to anatomists for new and rare variants. Keywords Femoral artery, Profunda femoris artery, Lateral circumflex femoral artery, Medial circumflex artery, Femoral triangle 1. Introduction 2. Case Report Femoral artery (FA) is continuation of external iliac artery. Femoral triangles of two female cadavers embalmed in Profunda femoris artery (PFA) originates from posterolateral 10% formalin were dissected for teaching undergraduate aspect of femoral artery about 3.5 cm below the inguinal medical students in the department of anatomy AIIMS ligament (IL) in femoral triangle [1].
    [Show full text]
  • Vascular Anatomy of the Lower Limbs Anatomy Team 434
    Vascular Anatomy of the Lower Limbs Anatomy Team 434 Color Index: If you have any complaint or ▪ Important Points suggestion please don’t ▪ Helping notes hesitate to contact us on: [email protected] ▪ Explanation OBJECTIVES ● List the main arteries of the lower limb. ● Describe their origin, course distribution & branches ● List the main arterial anastomosis ● List the sites where you feel the arterial pulse. ● Differentiate the veins of LL into superficial & deep ● Describe their origin, course & termination and tributaries ORIGIN FEMORAL ARTERY It is the main Arterial supply of the lower limb it is the LOCATION continuation of the external Behind the inguinal ligament in the midway iliac artery between Superior anterior iliac spine and the pubic symphysis . It ends at the opening of adductor magnus as the popliteal artery. It descends vertically towards the adductor RELATIONS tubercle -It terminates by passing through the adductor hiatus (in adductor magnus) and entering the popliteal space as the Popliteal artery. - In the front of hip joint→femoral artery - artery and vien inside the femoral sheath but the nerve outside the sheath - In the back of hip joint→siatic nearve - artery , vien and nerve inside femoral triangle . FEMORAL VEIN & ARTETY : ( See Figure 1 ) 1- At the inguinal ligament : it is located medially to the femoral artery 2- At the apex of the femoral triangle : it is located posteriorly to the femoral artery 3- At the opening of the adductor magnus : it is located laterally to the femoral artery 1 BRANCHES OF THE FEMORAL ARTERY(1) : ( See Figure 2 ) 2 3 1- Superficial Epigastric 2- Superficial Circumflex iliac 3- Superficial external pudendal 4- Deep external pudendal Figure Figure 1 5- Profunda femoris —(Deep artery of thigh) 2 Cannulation of Femoral Artery : It is used for left cardiac angiography.
    [Show full text]
  • Vascular Anatomy of the Lower Limb
    Vascular anatomy of the lower limb Musculoskeletal block- Anatomy-lecture 17 Editing file Objectives Color guide : Only in boys slides in Green Only in girls slides in Purple ✓ List the main arteries of the lower limb. important in Red ✓ Describe their origin, course distribution & branches. Doctor note in Blue Extra information in Grey ✓ List the main arterial anastomosis ✓ List the sites where you feel the arterial pulse. ✓ Differentiate the veins of the lower limb into superficial & deep. ✓ Describe their origin, course & termination and tributaries. For best understand check this:https://youtu.be/JNczJx2ju3I ➢ Is the main arterial supply to the lower limb Femoral artery ➢ It is the continuation of the external iliac artery Beginning Relations Terminations Branches It enters the thigh In the femoral triangle the Terminates by passing The femoral artery supplies: lower behind the inguinal artery is superficial covered through the adductor canal abdominal wall, thigh & external ligament point only by skin & fascia. (deep to sartorius) genitalia through the following (midway between the Posterior: Hip joint, It exits the canal by passing branches: anterior superior iliac separated from it by psoas through the adductor hiatus 1- superficial epigastric spine & the symphysis muscle and becomes the popliteal 2- superficial circumflex iliac pubis Medial: femoral vein. artery 3- superficial external pudendal Lateral: femoral nerve & its 4- deep external pudendal branches 5- profunda femoris (deep artery of thigh) Inguinal ligament Cannulation of FA: because of the superficial position of the femoral artery, it is used for left cardiac angiography. A long catheter is inserted percutaneously into the artery and passed up the external iliac artery, common iliac artery , aorta to the left ventricle.
    [Show full text]
  • Intriguing Variations of Dorsalis Pedis Artery with Clinical Correlations P
    Scholars International Journal of Anatomy and Physiology Abbreviated Key Title: Sch Int J Anat Physiol ISSN 2616-8618 (Print) |ISSN 2617-345X (Online) Scholars Middle East Publishers, Dubai, United Arab Emirates Journal homepage: https://scholarsmepub.com/sijap/ Original Research Article Intriguing Variations of Dorsalis Pedis Artery with Clinical Correlations P. J. Barot1, P. R. Koyani2* 1Tutor, Department of Anatomy, P. D. U. Medical College, Rajkot, Gujarat, India 2 Assistant Professor, Department of Anatomy, P. D. U. Medical College, Rajkot, Gujarat, India DOI: 10.36348/SIJAP.2019.v02i12.001 | Received: 24.11.2019 | Accepted: 04.12.2019 | Published: 06.12.2019 *Corresponding author: P. R. Koyani Abstract Objective: Dorsalis pedis artery represents the continuation of anterior tibial artery distal to level of ankle joint. The dorsalis pedis angiosome encompasses the entire dorsal aspect of foot through its branches eg. Medial tarsal, Lateral tarsal, Arcuate and 1st dorsal metatarsal arteries. Dorsalis pedis artery variation have been reported in past. Evaluation of dorsalis pedis artery pulsation is useful clinical test for assessing peripheral arterial diseases. Dorsalis pedis artery is the main source of blood supply to foot. Knowledge about origins, course, distribution and branching pattern is important for angiographers, vascular surgeons and reconstructive surgeons who operate upon these region. Method: Study of dorsalis pedis artery was done in forty dissected lower limbs of unknown sex and age from department of anatomy, PDUMC, RAJKOT. Result: In our study normal course and branching pattern of dorsalis pedis artery was found in 87.5% cases. Variation in branching pattern of dorsalis pedis artery was found in 12.5% cases.
    [Show full text]
  • Product Information
    G30 Latin VASA CAPITIS et CERVICIS ORGANA INTERNA 1 V. frontalis 49 Pulmo sinister 2 V. temporalis superficialis 50 Atrium dextrum 3 A. temporalis superficialis 51 Atrium sinistrum 3 a A. maxillaris 52 Ventriculus dexter 4 A. occipitalis 53 Ventriculus sinister 5 A. supratrochlearis 54 Valva aortae 6 A. et V. angularis 55 Valva trunci pulmonalis 7 A. et V. facialis 56 Septum interventriculare 7 a A. lingualis 57 Diaphragma 9 V. retromandibularis 58 Hepar 10 V. jugularis interna 11 A. thyroidea superior VASA ORGANORUM INTERNORUM 12 A. vertebralis 59 Vv. hepaticae 13 Truncus thyrocervicalis 60 V. gastrica dextra et sinistra 14 Truncus costocervicalis 61 A. hepatica communis 15 A. suprascapularis 61 a Truncus coeliacus 16 A. et V. subclavia dextra 62 V. mesenterica superior 17 V. cava superior 63 V. cava inferior 18 A. carotis communis 64 A. et V. renalis 18 a A. carotis externa 65 A. mesenterica superior 19 Arcus aortae 66 A. et V. lienalis 20 Pars descendens aortae 67 A. gastrica sinistra 68 Pars abdominalis® aortae VASA MEMBRII SUPERIORIS 69 A. mesenterica inferior 21 A. et V. axillaris 22 V. cephalica VASA REGIONIS PELVINAE 22 a A. circumflexa humeri anterior 72 A. et V. iliaca communis 22 b A. circumflexa humeri posterior 73 A. et V. iliaca externa 23 A. thoracodorsalis 74 A. sacralis mediana 24 A. et V. brachialis 75 A. et V. iliaca interna 25 A. thoracoacromialis 26 A. subclavia sinistra VASA MEMBRI INFERIORIS 27 V. basilica 76 Ramus ascendens a. circumflexae femoris 28 A. collateralis ulnaris superior lateralis 29 A. ulnaris 77 Ramus descendens a.
    [Show full text]
  • SŁOWNIK ANATOMICZNY (ANGIELSKO–Łacinsłownik Anatomiczny (Angielsko-Łacińsko-Polski)´ SKO–POLSKI)
    ANATOMY WORDS (ENGLISH–LATIN–POLISH) SŁOWNIK ANATOMICZNY (ANGIELSKO–ŁACINSłownik anatomiczny (angielsko-łacińsko-polski)´ SKO–POLSKI) English – Je˛zyk angielski Latin – Łacina Polish – Je˛zyk polski Arteries – Te˛tnice accessory obturator artery arteria obturatoria accessoria tętnica zasłonowa dodatkowa acetabular branch ramus acetabularis gałąź panewkowa anterior basal segmental artery arteria segmentalis basalis anterior pulmonis tętnica segmentowa podstawna przednia (dextri et sinistri) płuca (prawego i lewego) anterior cecal artery arteria caecalis anterior tętnica kątnicza przednia anterior cerebral artery arteria cerebri anterior tętnica przednia mózgu anterior choroidal artery arteria choroidea anterior tętnica naczyniówkowa przednia anterior ciliary arteries arteriae ciliares anteriores tętnice rzęskowe przednie anterior circumflex humeral artery arteria circumflexa humeri anterior tętnica okalająca ramię przednia anterior communicating artery arteria communicans anterior tętnica łącząca przednia anterior conjunctival artery arteria conjunctivalis anterior tętnica spojówkowa przednia anterior ethmoidal artery arteria ethmoidalis anterior tętnica sitowa przednia anterior inferior cerebellar artery arteria anterior inferior cerebelli tętnica dolna przednia móżdżku anterior interosseous artery arteria interossea anterior tętnica międzykostna przednia anterior labial branches of deep external rami labiales anteriores arteriae pudendae gałęzie wargowe przednie tętnicy sromowej pudendal artery externae profundae zewnętrznej głębokiej
    [Show full text]
  • Assessment of the Pedal Arteries with Duplex Scanning
    ARTIGO DE REVISÃO ISSN 1677-7301 (Online) Avaliação das artérias podais ao eco-Doppler Assessment of the pedal arteries with Duplex Scanning Luciana Akemi Takahashi1 , Graciliano José França1, Carlos Eduardo Del Valle1 , Luis Ricardo Coelho Ferreira2 Resumo A ultrassonografia vascular com Doppler é um método não invasivo útil no diagnóstico e planejamento terapêutico da doença oclusiva das artérias podais. A artéria pediosa dorsal é a continuação direta da artéria tibial anterior e tem trajeto retilíneo no dorso do pé, dirigindo-se medialmente ao primeiro espaço intermetatarsiano, onde dá origem a seus ramos terminais. A artéria tibial posterior distalmente ao maléolo medial se bifurca e dá origem às artérias plantar lateral e plantar medial. A plantar medial apresenta menor calibre e segue medialmente na planta do pé, enquanto a plantar lateral é mais calibrosa, seguindo um curso lateral na região plantar e formando o arco plantar profundo, o qual se anastomosa com a artéria pediosa dorsal através da artéria plantar profunda. A avaliação das artérias podais pode ser realizada de maneira não invasiva com exame de eco-Doppler, com adequado nível de detalhamento anatômico. Palavras-chave: ultrassonografia Doppler; artérias da tíbia; procedimentos cirúrgicos vasculares. Abstract Vascular Doppler ultrasound is a noninvasive method that can help in diagnostic and therapeutic planning in case of pedal arterial obstructive disease. The dorsalis pedis artery is the direct continuation of the anterior tibial artery and follows a straight course along the dorsum of the foot, leading medially to the first intermetatarsal space, where it gives off its terminal branches. The posterior tibial artery forks distal to the medial malleolus and gives rise to the lateral plantar and medial plantar arteries.
    [Show full text]
  • MORPHOLOGICAL STUDY of ORIGIN of PROFUNDA FEMORIS ARTERY in HUMAN CADAVERS G.A.Jos Hemalatha 1, K
    International Journal of Anatomy and Research, Int J Anat Res 2018, Vol 6(2.3):5360-63. ISSN 2321-4287 Original Research Article DOI: https://dx.doi.org/10.16965/ijar.2018.207 MORPHOLOGICAL STUDY OF ORIGIN OF PROFUNDA FEMORIS ARTERY IN HUMAN CADAVERS G.A.Jos Hemalatha 1, K. Arumugam *2. 1 Senior Assistant Professor, Department of Anatomy, Tirunelveli Medical College, Tirunelveli, Tamilnadu. 627007, India. *2 Senior Assistant Professor, Department of Anatomy, Tirunelveli Medical College, Tirunelveli, Tamilnadu. 627007, India. ABSTRACT Background: Profunda femoris artery (PFA) is the largest and deep branch from the femoral artery. It is the chief blood supply to the extensor (anterior), flexor (posterior) and adductor (medial) compartments of thigh. It is also called as Deep femoral artery. It is useful for many invasive and non invasive procedures like Doppler, ultrasonography, digital subtraction angiography arteriography and magnetic resonance imaging etc. Materials and methods: A total 10 embalmed formalin fixed cadavers (totally 20 lower limbs) allotted to the undergraduates of 2017-18 batch in the department of Anatomy, Tirunelveli Medical College, Tirumelveli is taken in the present study. Results: In all the 20 lower limb specimens PFA was originated from the femoral artery except one. In one specimen PFA originated directly from external iliac artery as the bifurcation of external iliac artery. Relation of PFA with femoral artery was postero lateral in 65% and lateral in 35%. Distance between the point of origin of PFA and mid-inguinal point was between 3.47cm to 4.55cm in 90 %. Conclusion: This study will be very helpful to the radiologists & surgeons to understand possible variations before planning different diagnostic and therapeutic interventions on the femoral artery and its branches.
    [Show full text]
  • Unusually Low Arcuate Artery in a Kenyan Cadaver Unusually Low Arcuate Artery in a Kenyan Cadaver
    CASE REPORT UNUSUALLY LOW ARCUATE ARTERY IN A KENYAN CADAVER Unusually Low Arcuate Artery in a Kenyan Cadaver Thomas Amuti, Kamau Njonjo, Innocent Ouko, Ibsen Ongidi, Julius Ogeng’o School of Medicine, University of Nairobi Correspondence to: Thomas Amuti, PO Box 30197-00100, Nairobi; email: [email protected] Summary The arcuate artery is one of the two major branches of the lateral and medial tarsal arteries had normal course in dorsalis pedis artery that supply the dorsum of the foot this foot. including interdigital spaces. The artery’s origin varies but in almost all cases it branches in the proximal third Keywords: Translational research; Dorsalis pedis of the dorsum of the foot. During routine dissection artery; Integration; Arcuate artery of the right foot in a black Kenyan, we encountered a Ann Afr Surg. 2020; 17(1):45–47. case where the artery was located and branched in the DOI: http://dx.doi.org/10.4314/aas.v17i1.12 distal third of the dorsum of the foot, at the level of the Conflicts of Interest: None metatarsophalangeal joint. This is much more distal than Funding: None previously reported in prevailing literature. This artery © 2020 Author. This work is licensed under the Creative did not give off any dorsal metatarsal arteries but gave Commons Attribution 4.0 International License. the digital arteries directly. The dorsalis pedis artery, Introduction been reported (1,4,10-13). High origin has also been The arcuate artery (AA) is usually a branch of the reported in several studies (6,12,14,15). Low origin/ dorsalis pedis artery (DPA) that arises anterior to location, however, is seldom reported.
    [Show full text]