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

Tonogai, Ichiro; Hayashi, Fumio; Tsuruo, Yoshihiro; Sairyo, Koichi

doi:10.1177/1938640018768046

Cited by 4 publications

(6 citation statements)

References 13 publications

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“…Barium sulfate suspension (Barytester, Fushimi Pharmaceutical Co Inc, Marugame, Japan) was injected into the external iliac artery with firm manual pressure, as previously described. 8-11 Enhanced lower extremity multislice CT images (Somatom Emotion 16; Siemens Healthcare, Erlangen, Germany) were obtained in 1.0-mm-thick axial slices. Images were reviewed at the bone window setting (window, 2200; level, 200) with the ankle in the neutral position.…”

Section: Methodsmentioning

confidence: 99%

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The Origin of the Anterior Lateral Malleolar Artery From the Anterior Tibial Artery: A Fresh Cadaveric Study

Tonogai

Hayashi

Tsuruo

et al. 2019

Foot & Ankle Specialist

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The anterior lateral malleolar artery (ALMA), which usually originates from the anterior tibial artery (ATA), courses transversely and laterally, passing under the extensor digitorum longus and peroneus tertius tendons. Variations in the origin of the ALMA from the ATA can occur. Branches of the ATA, such as the ALMA, are prone to pseudoaneurysm. This study reviewed the origin of the ALMA from the ATA and aimed to identify problems in anterior ankle arthroscopy that might cause injury to the ALMA. Enhanced computed tomography scans of 24 feet of 24 fresh cadavers (13 males, 11 females; average age 78.1 years) were assessed. The limb was injected with barium sulfate suspension through the external iliac artery; the origin of the ALMA from the ATA on the sagittal plane was recorded. The origin was at the ankle joint level in 4 specimens and below the ankle joint in 17 specimens. The distance from the ankle joint to the branching point of the ALMA on the sagittal plane was 5.2 mm distal to the joint. The level of origin of the ALMA from the ATA was established. Instruments should not be inserted from the distal direction when placing anterolateral portals. Levels of Evidence: Level IV, cadaveric study

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Section: Methodsmentioning

confidence: 99%

“…1,4-7 Although the level of origin of the AMMA has been previously reported, no study has described the level of origin of the ALMA using enhanced computed tomography (CT) in fresh cadavers. 8…”

mentioning

confidence: 99%

The Origin of the Anterior Lateral Malleolar Artery From the Anterior Tibial Artery: A Fresh Cadaveric Study

Tonogai

Hayashi

Tsuruo

et al. 2019

Foot & Ankle Specialist

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“…The vessels were flushed with warm normal saline solution through a plastic catheter placed in the external iliac artery. Next, barium sulfate suspension (Barytester®, Fushimi Pharmaceutical Co., Inc., Marugame, Japan) was injected into the external iliac artery with firm manual pressure, as described in our previous report [18][19][20][21]. Enhanced multi-slice CT images (Somatom Emotion 16, Siemens Healthcare, Erlangen, Germany) of the lower extremities were obtained in 1.0-mm-thick axial slices.…”

Section: Methodsmentioning

confidence: 99%

Distances from the deep plantar arch to the lesser metatarsals at risk during osteotomy: a fresh cadaveric study

Tonogai

Hayashi

Tsuruo

et al. 2018

Journal of Foot and Ankle Research

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BackgroundThe deep plantar arch is formed by anastomosis of the lateral and deep plantar arteries. Osteotomy of the lesser metatarsals is often used to treat metatarsalgia and forefoot deformity. Although it is known that some blood vessels supplying the lesser metatarsals are prone to damage during osteotomy, there is little information on the distances between the deep plantar arch and the three lesser metatarsals. The aims of this study were to identify the distances between the deep plantar arch and the lesser metatarsals and to determine how osteotomy could damage the arch.MethodsEnhanced computed tomography scans of 20 fresh cadaveric feet (male, n = 10; female, n = 10; mean age 78.6 years at the time of death) were assessed. The specimens were injected with barium via the external iliac artery, and the distance from the deep plantar arch to each lesser metatarsal was measured on axial and sagittal images.ResultsThe shortest distances from the deep plantar arch to the second, third, and fourth metatarsals in the axial plane were 0.5, 2.2, and 2.8 mm, respectively. The shortest distances from the distal epiphysis to a line passing through the deep plantar arch perpendicular to the longitudinal axis of the lesser metatarsal in the sagittal plane were 47.0, 45.7, and 46.4 mm, respectively, and those from the tarsometatarsal joint were 23.0, 21.0, and 18.6 mm. The deep plantar arch ran at the level of the middle third, within the proximal portion of this third in 11/20 (55.0%), 7/20 (35.0%), and 5/16 (31.2%) specimens, respectively, and at the level of the proximal third in 9/20 (45.0%), 13/20 (65.0%), and 11/16 (68.8%).ConclusionsOverpenetration into the medial and plantar aspect of the second metatarsal or the proximal and plantar aspect of the fourth metatarsal during shaft or proximal osteotomy could easily damage the deep plantar arch. Shaft or proximal osteotomy approximately 45–47 mm proximal to the distal epiphysis or 18–23 mm distal to the tarsometatarsal joint on the plantar aspect could interrupt blood flow in the deep plantar arch.

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“…Pseudoaneurysms at the level of the ankle joint are rare and can develop following an ankle sprain, ankle fracture or as a complication after ankle arthroscopy [ 25 ]. There are case reports of pseudoaneurysms involving the anterior tibial artery occurring after ankle arthroscopic surgery [ 25 , 26 ]. The dosalis pedis artery (DPA) is the continuation of the anterior tibial artery and passes through the anterior surface of the ankle joint.…”

Section: Anatomy Of the Neurovascular Supply To The Ankle Jointmentioning

confidence: 99%

“…Researchers performed a study on anatomical variation of the branching pattern of the DPA and found a wide variation in the location of arterial branches crossing the ankle joint [ 27 ]. Few other researchers studied the origin, branching pattern and direction of the anterior medial malleolar artery (AMMA), conducting the study on Japanese cadavers using computed tomography (CT) imaging [ 25 ]. The results showed variations in the origin of the AMMA at the level of the ankle joint line, below the ankle joint line and above the ankle joint line.…”

Section: Anatomy Of the Neurovascular Supply To The Ankle Jointmentioning

confidence: 99%

The comprehensive review of the neurovascular supply of the ankle joint: clinical implications

2020

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The rupture of ligament in the lateral part of ankle joint is a common injury and can lead to chronic ankle instability and lead to ankle osteoarthritis. Ankle arthroscopy is considered as a standard option to treat various ankle problems due to the need for only minimal incisions and fewer complications when compared to open surgery. However, there are complications associated with arthroscopic surgery e.g. damage to the anatomical structures around the portal placement areas. The present review provides anatomical knowledge of the superficial and deep neurovascular structures in the ankle region. These structures are important when ankle surgery is performed in order to avoid any intraoperative injury and prevent any complication following surgery.

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

Abstract: Level IV: Cadaveric study.

Cited by 4 publications

References 13 publications

The Origin of the Anterior Lateral Malleolar Artery From the Anterior Tibial Artery: A Fresh Cadaveric Study

The Origin of the Anterior Lateral Malleolar Artery From the Anterior Tibial Artery: A Fresh Cadaveric Study

Distances from the deep plantar arch to the lesser metatarsals at risk during osteotomy: a fresh cadaveric study

The comprehensive review of the neurovascular supply of the ankle joint: clinical implications

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