1
|
Giri SK, Rajpoot A, Suba S, Jain M. The "Lost" Peroneal Vessel - A Rare Anatomical Variation in Free Fibula Flap Harvest. J Orthop Case Rep 2023; 13:103-107. [PMID: 38162350 PMCID: PMC10753656 DOI: 10.13107/jocr.2023.v13.i12.4096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/08/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Vascularized free fibula flap is one of the commonly used flaps in autologous soft-tissue and osseous reconstructions in the modern era. While there is abundant literature available on the variable branching pattern and course of the popliteal artery, tibial arteries, and dorsalis pedis artery, there is a paucity of text available on the not-so-common peroneal vessels. Case Report A case of a 60-year-old male who was diagnosed with carcinoma of buccal mucosa with involvement of the mandible of the right side was planned for wide local excision with modified radical neck dissection and resurfacing of the resultant defect using a contralateral free fibula osseocutaneous free flap. Intraoperatively, the peroneal vessels were noted to have a premature termination along the lateral border of distal one-third of the fibula, after giving a communicating branch to an anterior tibial artery. The flap was raised based on the same pedicle, without ligating any distal portion of the vessel. Reconstruction of the defect and post-operative recovery was uneventful. Full flap survival was observed. Conclusion We report this case as this vascular "anomaly" is one of its kind and has been oblivious to the literature and practicing microsurgeons globally.
Collapse
Affiliation(s)
- Sanjay Kumar Giri
- Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Akanksha Rajpoot
- Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Santanu Suba
- Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mantu Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| |
Collapse
|
2
|
Srivatsav A, Eilers L, Montero M, Stapleton G. Percutaneous treatment of an iatrogenic femoral arteriovenous fistula from an accessory arterial branch: a case report and review of the literature. Cardiol Young 2023; 33:2678-2680. [PMID: 37850452 DOI: 10.1017/s1047951123003645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Vascular access-related complications are an important consideration in patients undergoing cardiac catheterisation. Patients with CHD are increasingly undergoing percutaneous treatment for suitable procedures as an alternative, less invasive option to surgical intervention. As such, recognition and treatment of these complications are becoming increasingly important. We present a case of a patient with repaired Tetralogy of Fallot who developed a femoral arteriovenous fistula and femoral artery pseudoaneurysm arising from an accessory arterial branch following percutaneous Harmony valve implantation, both of which were treated endovascularly with placement of a stent.
Collapse
Affiliation(s)
- Ashwin Srivatsav
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Lindsay Eilers
- Department of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
| | - Miguel Montero
- Department of Vascular Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Gary Stapleton
- Department of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|
3
|
Hu Y, Yang Q, Zhang J, Peng Y, Guang Q, Li K. Methods to predict osteonecrosis of femoral head after femoral neck fracture: a systematic review of the literature. J Orthop Surg Res 2023; 18:377. [PMID: 37217998 DOI: 10.1186/s13018-023-03858-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Femoral neck fracture (FNF) is a very common traumatic disorder and a major cause of blood supply disruption to the femoral head, which may lead to a severe long-term complication, osteonecrosis of femoral head (ONFH). Early prediction and evaluation of ONFH after FNF could facilitate early treatment and may prevent or reverse the development of ONFH. In this review paper, we will review all the prediction methods reported in the previous literature. METHODS Studies on the prediction of ONFH after FNF were included in PubMed and MEDLINE databases with articles published before October 2022. Further screening criteria were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This study highlights all the advantages and disadvantages of the prediction methods. RESULTS There were a total of 36 studies included, involving 11 methods to predict ONFH after FNF. Among radiographic imaging, superselective angiography could directly visualize the blood supply of the femoral head, but it is an invasive examination. As noninvasive detection methods, dynamic enhanced magnetic resonance imaging (MRI) and SPECT/CT are easy to operate, have a high sensitivity, and increase specificity. Though still at the early stage of development in clinical studies, micro-CT is a method of highly accurate quantification that can visualize femoral head intraosseous arteries. The prediction model relates to artificial intelligence and is easy to operate, but there is no consensus on the risk factors of ONFH. For the intraoperative methods, most of them are single studies and lack clinical evidence. CONCLUSION After reviewing all the prediction methods, we recommend using dynamic enhanced MRI or single photon emission computed tomography/computed tomography in combination with the intraoperative observation of bleeding from the holes of proximal cannulated screws to predict ONFH after FNF. Moreover, micro-CT is a promising imaging technique in clinical practice.
Collapse
Affiliation(s)
- Yi Hu
- Department of Orthopaedics, The First People's Hospital of Changde City, Changde, China
| | - Qin Yang
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jun Zhang
- Department of Orthopaedics, The First People's Hospital of Changde City, Changde, China
| | - Yu Peng
- Department of Orthopaedics, The First People's Hospital of Changde City, Changde, China
| | - Qingqing Guang
- Department of Orthopaedics, The First People's Hospital of Changde City, Changde, China
| | - Kaihu Li
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China.
| |
Collapse
|
4
|
Touré T, Kanté A, Moussa AK, Ba B, Ongoïba N. Rare variations of origin and course of the medial circumflex femoral artery: Report of 3 cases. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
5
|
Morita S, Yamamoto T, Kamoshida K, Yamazaki H, Yatabe M, Ichihara A, Sakai S. High Deep Femoral Artery Bifurcation Can Disturb Safe Femoral Venous Access: CT Assessment in Patients Who Underwent Femoral Venous Access Under Doppler Ultrasound Guidance. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2021; 6:29-36. [PMID: 35909911 PMCID: PMC9327428 DOI: 10.22575/interventionalradiology.2021-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/28/2021] [Indexed: 06/15/2023]
Abstract
PURPOSE To retrospectively evaluate the variations of deep femoral artery (DFA) bifurcation on computed tomography (CT) and technical success in femoral venous access. MATERIALS AND METHODS CT images of 353 patients who underwent adrenal venous sampling were evaluated. Height with relation to the inferior border of the femoral head and direction of DFA bifurcations were classified as follows: type L, low bifurcation; type H1, high lateral bifurcation; type H2, high posterior to posterolateral bifurcation; type H3, high posteromedial bifurcation; and type H4, high medial bifurcation crossing in front of the femoral vein. Technical success and complications during femoral venous access were also evaluated. RESULTS The frequencies of types L, H1, H2, H3, and H4 were 82.7%, 9.1%, 6.9%, 0.4%, and 0.9%, respectively. In 92.2% of type H1 and 69.4% of type H2, the superior femoral artery displaced medially by the high DFA partially overlapped the femoral vein. Upon the inclusions of H3 and H4, in 14.4% of cases, the high DFAs could obstruct the access route to the femoral vein. Using Doppler ultrasound guidance, no significant differences were observed in the rates of success for puncture in the first attempt (84.5% vs. 75.4%, p = 0.122) and accidental arterial puncture (1.0% vs. 0%, p = 1.00) between low and high DFA bifurcations, respectively. CONCLUSIONS High DFA bifurcation is observed in 17.3% of patients and could obstruct the access route to the femoral vein. This can be evaluated using Doppler ultrasound guidance to avoid accidental arterial puncture during femoral venous access.
Collapse
Affiliation(s)
- Satoru Morita
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, Japan
| | - Takahiro Yamamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, Japan
| | - Kumi Kamoshida
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, Japan
| | - Hiroshi Yamazaki
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, Japan
| | - Midori Yatabe
- Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University Hospital, Japan
| | - Atsuhiro Ichihara
- Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University Hospital, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, Japan
| |
Collapse
|
6
|
Usami T, Takada N, Nishida K, Sakai H, Iwata H, Sekiya I, Ueki Y, Murakami H, Kuroyanagi G. Banding with lesser trochanter fragment using nonabsorbable tape in trochanteric femoral fractures. SICOT J 2021; 7:33. [PMID: 34009117 PMCID: PMC8132597 DOI: 10.1051/sicotj/2021032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/13/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Trochanteric femoral fracture is one of the most common fractures in the elderly. Trochanteric femoral fracture with involvement of the lesser trochanter is considered unstable and recognized as having a poor prognosis. However, fixation of lesser trochanter fragment is scarce because of technical difficulties. In this study, we reported the simple surgical procedure and the effect of using nonabsorbable tape in lesser trochanter fixation. Methods: From January 2014 to December 2017, 114 patients treated with proximal intramedullary nailing for trochanteric fractures with the lesser trochanter fragment were reviewed. Among patients enrolled in this study, 73 were followed up until radiographic bone union, of which 26 were treated with lesser trochanter fragment banding (group B) and 47 without banding (group N). Radiographs and/or computed tomography images were used to evaluate bone union of the lesser trochanter fragment at three months postoperatively. Results: The bone union of the lesser trochanter fragment was achieved in 24 cases (92%) in group B and 30 cases (64%) in group N. Compared with group N, group B showed a significantly increased number of mild and moderate deformities but decreased number of severe deformity and nonunion (P < 0.001). Postoperative complications were not observed in both groups. Conclusions: From the viewpoint of increasing lesser trochanteric bone union ratio, fixation of the lesser trochanter fragment using nonabsorbable tape in the treatment of trochanteric fractures could be an effective procedure.
Collapse
Affiliation(s)
- Takuya Usami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601 Aichi, Japan
| | - Naoya Takada
- Department of Orthopaedic Surgery, Kainan Hospital, Yatomi, 498-8502 Aichi, Japan
| | - Kazuki Nishida
- Center for Advanced Medicine and Clinical Research Nagoya University Hospital, Nagoya, 466-8560 Aichi, Japan
| | - Hiroaki Sakai
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601 Aichi, Japan
| | - Hidetoshi Iwata
- Department of Orthopaedic Surgery, Kainan Hospital, Yatomi, 498-8502 Aichi, Japan
| | - Isato Sekiya
- Department of Orthopaedic Surgery, Kainan Hospital, Yatomi, 498-8502 Aichi, Japan
| | - Yoshino Ueki
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601 Aichi, Japan - Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601 Aichi, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601 Aichi, Japan
| | - Gen Kuroyanagi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601 Aichi, Japan - Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601 Aichi, Japan
| |
Collapse
|
7
|
Kalinin RE, Suchkov IA, Klimentova ÉA, Shanaev IN. [Clinical anatomy of deep femoral vessels in the area of femoral triangle]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:17-23. [PMID: 33825724 DOI: 10.33529/angio2021107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM The purpose of this study was to specify the anatomy of the deep femoral artery and deep femoral vein within the femoral triangle. MATERIAL AND METHODS The study was based on the data of anatomical dissection of vessels in the area of the upper third of the femur (20 specimens ) and ultrasonographic duplex angioscanning of patients undergoing routine examination of the vascular system (40 patients, 50 lower extremities). Ultrasonography was performed using linear and convex transducers (frequency 3-13 and 3-5 MHz). RESULTS In the majority of cases, the deep femoral artery originated from the common femoral artery: in 100% of cases in anatomical dissection and in 98% according to the findings of ultrasound duplex angioscanning. Two trunks of the deep femoral artery were revealed in 14% of cases. The findings of ultrasound duplex angioscanning and those of anatomical dissection demonstrated a high origin of the deep femoral artery in 8% and 10% of cases, respectively. In the majority of cases, the deep femoral artery originated from the posterior surface of the common femoral artery: in 46% of cases on ultrasound duplex angioscanning and in 60% of cases in anatomical dissection; along the posterior lateral surface: in 36% according to the data of ultrasound duplex angioscanning and in 40% on dissection. The origin of the deep femoral artery from the medial surface of the common femoral artery was encountered in 8% cases and in 6% of cases was associated with formation of an atypical saphenofemoral junction. One patient was found to have the origin of one of the trunks of the deep femoral artery from the anterior surface of the common femoral artery. Two trunks of the deep femoral vein were revealed in 84% of cases. The proximal trunk flowed into the femoral vein from the lateral surface immediately beneath the ostium of the deep femoral artery, and the distal trunk - 1-1.5 cm lower from the posterior medial side of the femoral vein. CONCLUSION The knowledge of variant anatomy of deep femoral vessels is very important for decreasing the risk of iatrogenic lesions during surgical manipulations and false-negative results of diagnostic manipulations. If possible, it is always necessary to preoperatively assess variant anatomy of deep femoral vessels (real-time assessment of topography of vessels by means of ultrasound duplex angioscanning, preoperative marking of vessels).
Collapse
Affiliation(s)
- R E Kalinin
- I.P. Pavlov Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - I A Suchkov
- I.P. Pavlov Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - É A Klimentova
- I.P. Pavlov Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - I N Shanaev
- I.P. Pavlov Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| |
Collapse
|
8
|
The vascular exploration of the proximal femoral artery perforator region, an ideal donor site to choose cutaneous flaps of thin, supple, and glabrous skin: A cadaveric study. J Plast Reconstr Aesthet Surg 2021; 74:1999-2004. [PMID: 33526359 DOI: 10.1016/j.bjps.2020.12.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/12/2020] [Accepted: 12/20/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The thigh region is a well-known area for harvesting cutaneous flaps for microsurgery replacement, given the characteristics of the skin: thin, flexible, and glabrous. We investigated the vascular pattern of 32 cadaveric anteroproximal thighs for the possibility of an extended harvesting area, which we call the proximal femoral artery perforator region. MATERIALS AND METHODS We injected colored, radio opaque latex in the external iliac artery and investigated the perforator branches from the superficial circumflex iliac, femoral common, superficial, and deep femoral (profunda femoris) arteries to the skin of the proximal femoral artery perforator region. This region was divided into 3 equal subregions (superior, medial, and lateral), and their perforators were counted and measured. RESULTS There was no significant difference in the number of arterial pedicles across the three subregions: 30 superior, 35 inferolateral, and 27 inferomedial. The perforators had a cutaneous path in 81% of the cases, while 6% were musculocutaneous and 5% septocutaneous, without a significant difference in their proportion in the three subregions. The mean length and diameter of the pedicles were 5.39 ± 2.1 cm and 1.07 ± 0.4 mm, respectively, without significant differences in the three subregions. CONCLUSIONS The proximal femoral artery perforator region is a suitable area to generate flaps of various sizes and shapes, as needed by the surgeon. All perforators were constant and possessed a sufficient diameter and length for a successful anastomosis during the surgical procedure. The donor site retains all technical advantages to successfully replace areas of glabrous skin.
Collapse
|
9
|
Yamamoto Y, Uchiyama H, Onuki M. An Unusual Variational Anatomy of the Medial Circumflex Femoral Artery: A Case Report of a Post-catheterization Femoral Arteriovenous Fistula. Cureus 2020; 12:e6734. [PMID: 32133257 PMCID: PMC7034769 DOI: 10.7759/cureus.6734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The medial circumflex femoral artery (MCFA) typically presents as a major branch of the profunda femoris artery or it can also directly originate from the common femoral artery. Many anatomical variations of the MCFA have been described due to their clinical significance. We herein report a case of an unusual anatomical variation of the MCFA crossing anterior to the femoral vein that led to iatrogenic arteriovenous fistula formation after cardiac catheterization. The identification of such rare vascular anatomical variations is of great importance when attempting femoral arterial or venous puncture in order to minimize unnecessary complications.
Collapse
Affiliation(s)
- Yohei Yamamoto
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, JPN
| | - Hidetoshi Uchiyama
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, JPN
| | - Masahiro Onuki
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, JPN
| |
Collapse
|
10
|
Masculinizing Genital Surgery: An Imaging Primer for the Radiologist. AJR Am J Roentgenol 2020; 214:W27-W36. [DOI: 10.2214/ajr.19.21597] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
11
|
Andronic O, Nakano N, Daivajna S, Board TN, Khanduja V. non-arthroplasty iliopsoas impingement in athletes: a narrative literature review. Hip Int 2019; 29:460-467. [PMID: 30942093 DOI: 10.1177/1120700019831945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Iliopsoas impingement occurs secondary to a tight iliopsoas tendon that causes impingement during movement. This review presents current aspects regarding the diagnosis of iliopsoas impingement and also exposes the readers to the possible anatomic and clinical variations together with the available treatment options. METHODS We conducted a narrative literature review with regard to non-arthroplasty iliopsoas impingement. RESULTS Iliopsoas impingement is characterised by a distinct pattern of labral pathology, with anteriorly localised labral damage, that does not extend to the anterosuperior portion of the acetabulum. Anterior groin pain and intermittent catching, snapping or popping of the hip are common symptoms. Non-specific focal tenderness is often found over the iliopsoas tendon at the level of the anterior aspect of the joint. The 'C-sign' and Impingment test are usually positive. Dynamic ultrasonography is also useful for confirming the diagnosis. Initial management of painful iliopsoas impingement should be conservative. When patients continue to have pain, an ultrasound-guided injection can provide relief and predict the response to the surgical release. For patients who have recurrent pain after local injection of steroids, arthroscopic release has shown to achieve effective results. CONCLUSIONS Although different treatment options for iliopsoas impingement are emerging, the current standard of therapy is conservative followed by an arthroscopic tenotomy if necessary. Young adult hip surgeons should always keep this differential in mind in a patient presenting with groin pain and mechanical symptoms.
Collapse
Affiliation(s)
- Octavian Andronic
- 1 Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Naoki Nakano
- 2 Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | - Sachin Daivajna
- 3 Department of Orthopaedics, Peterborough City Hospital, Peterborough, UK
| | - Tim N Board
- 4 Department of Orthopaedics, Wrightington Hospital, Wigan, UK
| | - Vikas Khanduja
- 2 Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| |
Collapse
|
12
|
Olewnik Ł, Łabętowicz P, Podgórski M, Polguj M, Ruzik K, Topol M. Variations in terminal branches of the popliteal artery: cadaveric study. Surg Radiol Anat 2019; 41:1473-1482. [PMID: 31134299 PMCID: PMC6853856 DOI: 10.1007/s00276-019-02262-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/20/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Identifying the branching pattern of the popliteal artery (PA) is a vital step in planning radiological and surgical procedures involving the anterior and posterior tibial and fibular arteries. The aim of this study was to characterize the course and morphology of the terminal branches of the PA. MATERIALS AND METHODS The anatomical variations in the branching patterns of the anterior and posterior tibial and fibular arteries were examined in 100 lower limbs fixed in a 10% formalin solution. A dissection of the popliteal region of the leg was carried out according to a pre-established protocol, using traditional techniques. Morphometric measurements were then obtained twice by two researchers. RESULTS In most cases (72%) the PA divides to form the anterior tibial artery (ATA) and a common junction for the posterior tibial and fibular arteries (type I), which further splits into the fibular artery and the posterior tibial artery (PTA). This type was subdivided into two subgroups according to whether the ATA (subgroup a) or the common junction of the posterior tibial and fibular arteries (subgroup b) had the larger diameter. Other identified variations included division of the PA into the ATA and PTA-8% (type II), trifurcation-12% (type III), the division of the PTA into the ATA and FA-8% (type IV), and aplasia of the PTA-8% (type IV). CONCLUSION Although the typical PA branching type was observed, it can be classified further into two additional sub-types based on the diameter of the ATA and the common junction of the posterior tibial and fibular arteries.
Collapse
Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland.
| | - Piotr Łabętowicz
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Podgórski
- Department of Diagnostic Imaging Lodz, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Kacper Ruzik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
13
|
Kahn CI, MacNeil M, Fanola CL, Whitney ER. Complex arterial patterning in an anatomical donor. TRANSLATIONAL RESEARCH IN ANATOMY 2018. [DOI: 10.1016/j.tria.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
|
14
|
Zlotorowicz M, Czubak-Wrzosek M, Wrzosek P, Czubak J. The origin of the medial femoral circumflex artery, lateral femoral circumflex artery and obturator artery. Surg Radiol Anat 2018; 40:515-520. [PMID: 29651567 PMCID: PMC5937904 DOI: 10.1007/s00276-018-2012-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 04/03/2018] [Indexed: 02/06/2023]
Abstract
Introduction The most significant blood vessel supplying the hip joint is the medial femoral circumflex artery (MFCA). MFCA with lateral femoral circumflex artery (LFCA) are the first branches of the deep femoral artery (DFA) or they originate directly from the common femoral artery (CFA) or superficial femoral artery (SFA). Purpose and methods We analyzed 100 CT angiogram of the hip region [72 men, 28 women; mean age 46.4 (14–80)] to assess the frequency of each type of division of the MFCA and LFCA from either the DFA or directly from the CFA or SFA. To assess the variations on each side in one individual we analyzed both hips in 73 patients [mean age 46.6 (14–80)]. Results Many different types of division have been described. The most frequent one in which both the MFCA and LFCA originate from the DFA, was observed in 50% of patients. In 31% of hips the MFCA originates from the CFA. In our study, a normal origin of the obturator artery from the internal iliac artery was observed in 67% of patients and an atypical origin, called corona mortis was observed in 33% of patients. Conclusions The deep branch of the MFCA is the main artery supplying the femoral head, it is at risk during surgical approach to the hip joint. The atypical anastomosis called corona mortis is also at risk while performing the approach to pubic bone. Therefore, knowledge of their topography is very important.
Collapse
Affiliation(s)
- M Zlotorowicz
- Centre of Postgraduate Medical Education, Warsaw, Poland. .,Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, Gruca Teaching Hospital, Otwock, Poland.
| | - M Czubak-Wrzosek
- Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, Gruca Teaching Hospital, Otwock, Poland
| | - P Wrzosek
- Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, Gruca Teaching Hospital, Otwock, Poland
| | - J Czubak
- Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, Gruca Teaching Hospital, Otwock, Poland
| |
Collapse
|
15
|
Vuksanović-Božarić A, Abramović M, Vučković L, Golubović M, Vukčević B, Radunović M. Clinical significance of understanding lateral and medial circumflex femoral artery origin variability. Anat Sci Int 2018; 93:449-455. [PMID: 29500659 DOI: 10.1007/s12565-018-0434-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/21/2018] [Indexed: 11/30/2022]
Abstract
The common femoral artery (CFA) divides into the superficial femoral artery (SFA) and deep femoral artery (DFA). The lateral circumflex femoral artery (LCFA) and medial circumflex femoral artery (MCFA) are most often branches of the DFA, although a large number of different variations in their origin has been described. We performed microdissection on both lower limbs of 30 fetuses, gestational age from 7 to 10 lunar months. Our results show that the LCFA and MCFA usually arise from the DFA. In 78.3% of cases, the MCFA originated from the DFA. In 11.7% of cases, the MCFA originated from the CFA, and in 5% of cases from the SFA. One case showed a common trunk with the DFA. Also, the MCFA was missing in one case, and it had a common trunk with the LCFA in one case. In 83.3% of cases, the LCFA arose from the DFA and in 6.7% of cases from the CFA. In one case, it had a common trunk with the DFA, and in one case with the MCFA. In 3.3% of cases, the LCFA was missing. In 66.7% of cases, both arteries originated from the DFA, in 15% of cases one originated from the DFA and the other from the CFA or SFA. Our results are in accordance with some published studies but also differ from the outcomes of other studies. Comprehensive knowledge of different variation types is imperative in order to prevent complications during surgical and orthopedic interventions.
Collapse
Affiliation(s)
| | - Marija Abramović
- Department of Anatomy, Faculty of Medicine, University of Montenegro, Ljubljanska 1, 20000, Podgorica, Montenegro
| | - Ljiljana Vučković
- Department of Pathology, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Mileta Golubović
- Department of Pathology, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Batrić Vukčević
- Department of Anatomy, Faculty of Medicine, University of Montenegro, Ljubljanska 1, 20000, Podgorica, Montenegro
| | - Miroslav Radunović
- Department of Anatomy, Faculty of Medicine, University of Montenegro, Ljubljanska 1, 20000, Podgorica, Montenegro
| |
Collapse
|
16
|
Tomaszewski KA, Henry BM, Kumar Ramakrishnan P, Roy J, Vikse J, Loukas M, Tubbs RS, Walocha JA. Development of the Anatomical Quality Assurance (AQUA) Checklist: Guidelines for reporting original anatomical studies. Clin Anat 2016; 30:14-20. [DOI: 10.1002/ca.22800] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 09/30/2016] [Accepted: 10/04/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Krzysztof A. Tomaszewski
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Piravin Kumar Ramakrishnan
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Joyeeta Roy
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Marios Loukas
- Department of Anatomical Sciences; St. George's University; Grenada
| | | | - Jerzy A. Walocha
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| |
Collapse
|
17
|
Henry BM, Tomaszewski KA, Ramakrishnan PK, Roy J, Vikse J, Loukas M, Tubbs RS, Walocha JA. Development of the Anatomical Quality Assessment (AQUA) Tool for the quality assessment of anatomical studies included in meta-analyses and systematic reviews. Clin Anat 2016; 30:6-13. [DOI: 10.1002/ca.22799] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 09/30/2016] [Accepted: 10/04/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Brandon Michael Henry
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Krzysztof A. Tomaszewski
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Piravin Kumar Ramakrishnan
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Joyeeta Roy
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| | - Marios Loukas
- Department of Anatomical Sciences; St. George's University; Grenada
| | | | - Jerzy A. Walocha
- International Evidence-Based Anatomy Working Group; Krakow Poland
- Department of Anatomy; Jagiellonian University Medical College; Krakow Poland
| |
Collapse
|