Variations of the arterial anatomy of the foot

Dorsalis pedis artery on the dorsum of the foot was studied to establish the standard description and any variation from normal in the branching pattern in lower limbs of 30 adult human cadavers. The dorsalis pedis artery was present in all 60 (100%) cases. The branching pattern of the artery had textbook description in 54 (90%) cases. In 6 (10%), variation in branching pattern was observed and typing of branching pattern was done as Type A, B and C. The arcuate artery was present in 55(91.7%) cases. High origin of arcuate artery was seen in 1(1.66%) case. Dorsal metatarsal arteries originated from arcuate artery.

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“…2. It arose directly from the dorsalis pedis artery in 90% and branched off the lateral tarsal artery in 10% [3].…”

Section: Discussionmentioning

confidence: 99%

High Origin of Arcuate Artery- A Case Report

et al. 2011

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“…The reasons for this discrepancy between angiographic and hemodynamic findings may be because of (1) the practical perfusion space of the tibial artery might encompass adjacent angiosomes beyond its immediate borders through branch vessels, choke vessels, and collateral vessels when the other tibial artery is disrupted; (2) severe concomitant disease of more distal arteries, such as the pedal artery, and its branches might hamper the effect of revascularization of the relevant tibial artery (primary source tibial artery); and (3) common anatomic variations in the arteries of the foot may conflict with the application of the 2D angiosome theory. 20,[25][26][27][28][29][30][31] Thus, because the definition of the angiosome can be used mistakenly among wound specialists, 32,33 an increasing appreciation of the original concept of angiosome and more recent ideas on the angiosome are crucial to steer the direction of contemporary infrapopliteal revascularization. From a clinical stand point, estimating the autonomous contribution of an individual arterial system to the foot microcirculation before intervention is an impossible task.…”

Section: -13mentioning

confidence: 99%

Effect of Single Tibial Artery Revascularization on Microcirculation in the Setting of Critical Limb Ischemia

Kawarada

Yasuda

Nishimura

et al. 2014

Circ: Cardiovascular Interventions

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Background-Benefits of 2-dimensional (2D) angiosome-oriented infrapopliteal revascularization remain controversial.The aim of this retrospective study was to clarify the effect of single tibial artery revascularization on the dorsal and plantar microcirculation of critically ischemic limbs based on skin perfusion pressure (SPP). Methods and Results-Fifty-seven interventions that only involved either anterior tibial artery (ATA) or posterior tibial artery (PTA) revascularization were included in this study. SPP was measured on the dorsal side (theoretically ATA perfusion area) and the plantar side (theoretically PTA perfusion area) before and after the procedure. Dorsal and plantar SPP increased significantly, from 33 (IQR 23-40.5) to 52 (IQR 32.5-65) mm Hg (P<0.0001) and 31.6±16.1 to 44.8±19.2 mm Hg (P=0.001) after ATA revascularization, respectively, and from 29.3±14.0 to 42.4±19.7 mm Hg (P=0.003) and 29.3±9.8 to 43.5±15.9 mm Hg (P<0.001) after PTA revascularization, respectively. Both ATA and PTA revascularization were not associated with any significant differences in ΔSPP between the dorsal and the plantar regions of the foot. Only 64% and 58% of ATA revascularization cases showed higher post-SPP and ΔSPP on the dorsal side than on the plantar side, respectively. Also, only 47% and 40% of PTA revascularization cases showed higher post-SPP and ΔSPP on the plantar side than on the dorsal side, respectively. Conclusions-Single tibial artery revascularization, whether of the ATA or PTA, yielded comparable improvements in microcirculation of the dorsal and plantar foot. Approximately half of the feet revascularized had a change in microcirculation that was not consistent with the 2D angiosome theory. (Circ Cardiovasc Interv. 2014;7:684-691.)

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“…Among these variants, hypoplastic or aplastic posterior tibial artery was encountered in 3.3% cases, whereas the anterior tibial trunk was absent in about 1.5% of instances [108]. The presence of highly emergent anterior tibial artery or irregular tibial trifurcation was described in 5.6-6% cases [109][110], while anomalous origins of the dorsalis pedis artery were encountered in 4.3-6% presentations [109,111]. Aberrant first dorsal metatarsal artery and appended first toe dominant irrigation was described in 8.1% cases [112], parallel variants of the arcuate artery in 5% [113], and modified courses of the plantar arch and plantar arteries in 5% of presentations [114].…”

Section: Does Topographic Wdr Allow Unrestricted Anatomical Applicatimentioning

confidence: 99%

“…They also seem to play a pivotal role in intentional "wound-directed" revascularization and appropriate tissue regeneration [35,[96][97][98]118]. These vessels assemble the foot arches, (acknowledging eventual 5-9% anatomical variations, Section 6.3) [108][109][110][111][112][113][114], the metatarsal perforators, the anterior communicants, and other sizable arterial-arterial branches such as the dorsal foot-to-plantar, or the peroneal-to-posterior tibial rescue heel collaterals (level III of perfusion) [35,101].…”

Section: Compensatory Collateral Systems Relying the Foot Angiosomes mentioning

confidence: 99%

Ischemic Ulcer Healing: Does Appropriate Flow Reconstruction Stand for All That We Need?

Alexandrescu¹,

Triffaux²

2016

Wound Healing - New Insights Into Ancient Challenges

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During the recent decades, soaring progresses in vascular disease knowledge, particularly in critical limb ischemia (CLI) treatment, enhanced novel diagnostic and interventional strategies with high serviceableness in patient's selection, arterial recanalization, and dedicated ischemic ulcer follow-up. However, despite undeniable advances in medical technology and clinical judgment, limb salvage, the ambulation recovery, and patient's survival seem only scarcely affected in this heterogeneous CLI group, particularly concerning the diabetic and renal patients. Innovative strategies such as "end artery occlusive disease" treatment or "wound-targeted revascularization" were equally proposed by following the angiosomal anatomical distribution associating individual foot collateral assessment in a unified macro-and micro-circulatory judgment. However, despite encouraging clinical results, prospective evidence still lacks on this concern. It also appears that specific wounds could not always stand for the lowest perfusion areas according to current CLI criteria, since severe neuropathy, inflammatory swelling, local infection, and skin trauma may add complementary hindrances to tissue viability.The present chapter endeavor to summarize main available treatment principles for ischemic ulcer recovery that every modern practitioner eventually disposes in an updated contemporary view."

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Variations of the arterial anatomy of the foot

Cited by 103 publications

References 25 publications

High Origin of Arcuate Artery- A Case Report

High Origin of Arcuate Artery- A Case Report

Effect of Single Tibial Artery Revascularization on Microcirculation in the Setting of Critical Limb Ischemia

Ischemic Ulcer Healing: Does Appropriate Flow Reconstruction Stand for All That We Need?

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