Popliteal artery branching patterns detected by digital substraction angiography

Abstract

Awareness of the anatomical variability determined by embryonic vascular development is important for radiologists and surgeons. Popliteal arterial variation may have clinical implications for vascular grafting, direct surgical repair, transluminal angioplasty, or embolectomy. Moreover, differentiating occlusion or arterial injury from variation depends on the clinician's knowledge of variations (1-10). Therefore, we aim to describe popliteal arterial variations. Materials and methodsThe femoral angiograms of 535 extremities (270 right, 265 left) in 350 consecutive patients who provided informed consent for the digital subtraction angiography (DSA) procedure were retrospectively examined. Of these, 226 limbs were evaluated bilaterally, and 83 limbs were evaluated unilaterally.The branching patterns were classified according to the system used by Kim et al. (Figs. 1a, 2a, 3a) (1). A normal level of popliteal branching (below the level of the tibial plateau) was classified as Type I. Type I was further divided into Type IA, in which the anterior tibial artery (AT) is the first branch, and the peroneal artery (PR) and posterior tibial artery (PT) arise from the tibioperoneal trunk (Fig. 1b); IB, in which there is no true tibioperoneal trunk and AT, PT, and PR arise within 0.5 cm (Fig. 1c); and IC, in which the PT is the first branch and AT and PR arise from the anterior tibioperoneal trunk (Fig. 1d).High division of the popliteal artery (at or above the level of the tibial plateau) was classified as Type II. This classification was further divided into Type IIA1, in which the AT arises above the knee and has a normal course (Fig. 2b); IIA2, in which the AT arises above the knee and has an initial medial curve (Fig. 2c); IIB, in which the PT is the first branch and arises above the knee joint, and the AT and PR have a common trunk (Fig. 2d); IIC, in which the PR is the first branch and arises above the knee joint, and the AT and PT have a common trunk; and IID, which involves high division of the popliteal artery with a trifurcation pattern and an AT with an initial medial course and a distal lateral course (Figs. 2e and 2f).Hypoplastic or aplastic branching with altered distal supply was classified as Type III. This group was further divided into Type IIIA, in which the PT is hypoplastic and the distal PT is replaced by the PR (Figs. 3b and 3c); Type IIIB, in which the AT is hypoplastic and the dorsalis pedis (PD) is replaced by the PR (Figs. 3d and 3e); and Type IIIC, in which the AT and PT are hypoplastic and the distal PT and DP are replaced by the PR (Figs. 3f and 3g). INTERVENTIONAL RADIOLOGY ORIGINAL ARTICLE Popliteal artery branching patterns detected by digital subtraction angiographyErtuğrul Mavili, Halil Dönmez, Güven Kahriman, Aysel Özaşlamacı, Nevzat Özcan, Kutay Taşdemir MATERIALS AND METHODSThe popliteal branching patterns were analyzed in 535 extremities (270 right, 265 left). Of these, 226 limbs were evaluated bilaterally, while 83 were evaluated unilaterally. The branching patterns were classifi...

A Morphological Study of Dorsalis Pedis Artery and Its Clinical Correlation

“…The proximal part then regresses. Primitive middle and distal segments of the sciatic artery persists to form definitive popliteal and peroneal arteries [9].…”

Anatomical Study of Popliteal Artery Branching Patterns and Surgical Considerations

“…Its frequency in the literature ranges from 6.0% (Davies et al, 1989) [22] to 1.5% (Kil & Jung, 2009) [8]. Not even studies with a lower prevalence of the pattern IA presented values as expressive as this study, such as Mavili et al in 2011, which found 84.4% for the common pattern and 5.4% for trifurcation [9]. Probably, this is due to the patterns of category II of Kim et al [6], high tibiofibular division of the popliteal artery branch, which is representative in the literature [6,8,9,14,16,23].…”

“…Not even studies with a lower prevalence of the pattern IA presented values as expressive as this study, such as Mavili et al in 2011, which found 84.4% for the common pattern and 5.4% for trifurcation [9]. Probably, this is due to the patterns of category II of Kim et al [6], high tibiofibular division of the popliteal artery branch, which is representative in the literature [6,8,9,14,16,23]. In some cases, it exceeds trifurcation, 4.5% for the high division and 3.2% for trifurcation (Day & Orme, 2006) [10].…”

“…peroneal artery (PR) [6][7][8][9][10][11][12][13][14][15]. However, it is possible to find variations with significant freque-ncy and its knowledge is critical whereas it guides a good medical practice for vascular surgeons and interventional radiologists [3,5,6,[14][15][16][17][18][19].…”

Functional Popliteal Artery Entrapment Syndrome: A Review of the Anatomy and Pathophysiology

“…Up to 75 variations of normal can occur [12], including branches above the knee joint, and hypoplastic branches. This combined with muscular entrapment will affect the pattern and severity of symptoms, and subsequent treatment options [12,13]. Therefore knowledge of the path of the popliteal artery and its branches is essential.…”