A cadaveric study showing the anatomical variations in the branches of the dorsalis pedis artery at the level of the ankle joint and its clinical implication in ankle arthroscopy

Abstract

INTRODUCTION Pseudoaneurysm formation following ankle arthroscopy is a rare but potentially catastrophic complication. The placement of anterior ankle portals carries inherent risk to the superficial and deep peroneal nerves, as well as to the dorsalis pedis artery. Anatomical variations in the dorsalis pedis and the presence of branches at the joint line may increase the risk of vascular injury and pseudoaneurysm formation during arthroscopy. There is limited anatomical evidence available regarding the branches of the dorsalis pedis artery, which occur at the point at which they cross the ankle joint. OBJECTIVES The objective of the study was to describe the frequency and direction of branches of the dorsalis pedis crossing the ankle joint. MATERIALS AND METHODS Nineteen cadaveric feet were carefully dissected to explore the course of the dorsalis pedis artery, noting in particular the branching pattern at the joint line. RESULTS Eleven of the nineteen feet had a branch of the dorsalis pedis artery that crossed the level of the ankle joint. Out of these, six were lateral, four medial and one bilateral. Eight of the eleven specimens had one branch at, or just before, the level of the joint. Two specimens had two branches and one had three branches crossing the ankle, which were all in the same direction, crossing laterally to the main trunk of the dorsalis pedis. CONCLUSIONS Our study demonstrated high rates of branching of the dorsalis pedis artery at the level of the ankle joint. The role of these branches in pseudoaneurysm formation during anterior hindfoot surgery remains unclear.

Safety of neurovascular structures in ankle arthroscopy: cadaveric study

“…Ankle joint related symptoms and complaints are very common these days and so arthroscopy of ankle joint has increased popularity in present time because it may be use to diagnose as well as treat ankle pathologies. The anatomical structures at ankle joint shows wide variations in terms of course and distance hence they become more prone for injury during ankle arthroscopy through any of anterior arthroscopic portals [2,3] . Reported complication rates for this procedure have ranged from 0% to 25% [4,5,6,7,8,9] .…”

Examination of the Origin and Branching Direction of the Anterior Medial Malleolar Artery From the Anterior Tibial Artery: A Cadaveric Study

“…11 Dubreuil-Chambardel 3 and Ballmer et al 6 reported that the AMMA was identified in 84% of 235 specimens and in 80% of 30 fresh cadavers, respectively. Moreover, Parikh et al 12 reported that 14 of 19 feet (73.6%) in their study had no medial branch of the dorsalis pedis artery that crossed the level of the AJL. Our findings are not similar to those results.…”

“…We believe that simply avoiding the main arterial trunk would be insufficient to prevent formation of a pseudoaneurysm, because individual susceptibility and existing comorbidities of the patient might contribute to this rare complication in the minor vasculature. [12][13][14] The overlooked branches of the ATA, such as the AMMA, should be examined more carefully on enhanced CT before anterior ankle arthroscopy although there might be too much variability to change the location of the portals.…”

A study on perforating peroneal artery

“…Williams Parikh et al, recommend anatomical knowledge about the communications and branching pattern of PP around the ankle, prior to any operative procedures in this region, because it is the main artery that gives branches over the ankle other than DPA (17). Vascular injuries at the ankle may involve ATA (18), PP19 or DPA (20). As quoted by Feliciano and his co-authors when a vascular injury is handled appropriately and in time, percentage of success rate will be high (21).…”