Tortuosity and Pulsatility of the Tibial Artery - Two Case Reports of a Rare Etiology of Tarsal Tunnel Syndrome.

Tarsal tunnel syndrome is a neuropathic compression of the tibial nerve and its branches on the medial side of the ankle. It is a challenging diagnosis that constitutes symptoms arising from damage to the posterior tibial nerve or its branches as they proceed through the tarsal tunnel below the flexor retinaculum in the medial ankle, easily forgotten and underdiagnosed. Neural compression by vascular structures has been suggested as a possible etiology in some clinical conditions. Tibial artery tortuosity is not that rare, but only that it affects the nerve can cause tarsal tunnel syndrome. Therefore, a study care must be taken to avoid false-positive errors.

Blood supply and arteriography of the pelvic limb of the Southern caracara (Caracara plancus) and great egret (Ardea alba).

The aim of this study was to compare the arterial vascularization of the pelvic limb between southern caracara (Caracara plancus) and great egret (Ardea alba) by dissection and radiographic examinations. Five specimens of caracaras (three males and two females), and seven great egrets (five males and two females) were used. Barium sulphate and latex suspension were injected into the left ventricle of the birds. The radiographs were taken with the pelvic limbs in the ventrodorsal, dorsoplantar, mediolateral and lateromedial recumbency. Thereafter, the material was fixed in a 10% solution of formaldehyde and dissected. The pelvic limb received its arterial supply from two main vessels, the ischiatic and external iliac arteries. The ischiatic artery presented to be the principal artery of pelvic limb in the caracara and great egret. Several branches arised from the ischiatic and external iliac arteries were described. No gender differences were observed in both species. The caracara and great egret showed arteries similar to those reported for the ostrich and domestic fowl. According to the results of this study, it is suggested that the caracara has a pelvic limb with more arterial branches and larger arterial diameter than the great egret, which is probably related to the specific behaviour of these birds, since the caracara is a bird that exercise more their pelvic limbs to capture its prey when compared with the great egret.

Síndrome do aprisionamento da artéria tibial anterior: relato de caso / Anterior tibial artery entrapment syndrome: case report

A claudicação intermitente é uma queixa geralmente relacionada com oclusão arterial secundária a doença aterosclerótica. Entretanto, em pacientes jovens com queixa de claudicação, outras causas devem ser pesquisadas, como a síndrome do aprisionamento da artéria poplítea, síndrome compartimental crônica, compressões ósseas e arterites. Os autores relatam o caso de um paciente com claudicação intermitente devido à compressão extrínseca da artéria tibial anterior pela membrana interóssea, diagnosticada através de angiorressonância durante manobras de dorsiflexão do pé. A paciente foi tratada com sucesso através da liberação do fator compressivo, evoluindo com melhora dos sintomas.

Lower extremity intermittent claudication is usually related to atherosclerotic disease. The most common non-atherosclerotic causes are arterites, chronic compartmental syndrome, bone compression, and popliteal entrapment syndrome. The authors report a case of a patient with intermittent claudication related to anterior tibial artery entrapment caused by the interosseous membrane. Magnetic resonance angiography showed compression of the anterior tibial artery during dynamic maneuvers and the patient was managed by releasing the cause of compression, resulting in relief from claudication.

Retrograde Proximal Anterior Tibial Artery Access for Treating Femoropopliteal Segment Occlusion: A Novel Approach.

Some challenges have been detected when there are long and complex lesions of femoropopliteal arterial occlusive disease, even with descriptions of the retrograde pedal approaches. The aim of this article is to describe the retrograde proximal anterior tibial artery access for treatment of femoropopliteal segment occlusion when antegrade recanalization failed (retrograde recanalization and rearranging the system into an antegrade position). Technical and clinical success was achieved in 100% of 4 cases, with an improvement of at least 2 Rutherford classes. Minor complication, small hematoma in an anterior compartment of the limb, occurred in 1 patient. No sign of compartmental syndrome was observed.

Carbon dioxide as a substitute for iodine contrast in arteriography during embolectomy.

Acute limb ischemia can be potentially harmful to the limb and life threatening. Renal failure is a possible outcome associated with release of products of ischemic limb reperfusion. Some authors reported the benefit of performing angiography after embolectomy, even though iodine contrast is also nephrotoxic. We report a case of embolectomy on a patient with renal insufficiency in whom carbon dioxide was used as a substitute for iodine contrast.

Clinical efficacy of successful angioplasty in critical ischemia--a cohort study.

BACKGROUND: To evaluate the impact of percutaneous angioplasty (PA), objectively assessed with duplex-ultrasound, on 3-year clinical outcome. METHODS: Thirty-nine patients with atherosclerotic disease successfully treated by PA were included (40 limbs). All patients had critical ischemia with rest pain and ischemic ulcers due to infrainguinal obstructions alone. The patients were submitted to duplex ultrasound examination on the day before and on the first or second day after the procedure. Peak systolic velocities (PSV) were recorded in the anterior tibial, posterior tibial, and fibular arteries at the level of distal third of the leg. All patients were followed for 3 years. Comparison between groups with good and bad results were based on perioperative VPS gradient (GPSV) of the mean of the VPS in the 3 arteries. After 3 years, a good result was defined as a patient having no pain and complete healing of a previous ulcer or minor amputations. RESULTS: Mean age was 68.5±8.1 years with no difference in demographic characteristics (P>0.05). In 26 cases, the long-term result was good. Healing time ranged from 4 to 130 weeks (median 26.5). Bad long-term results were observed in 12 cases. Two lesions remained unhealed despite patent angioplasty. In 10 cases, a second procedure was carried out (repeat angioplasty in 6 and bypass in 4). TransAtlantic Inter-Society Consensus (TASC) II category A/B registered better clinical success then TASC II category C/D (P<0.05) at 1-year follow-up but not at 3 years (P=0.36). Two-year limb salvage was 92.5%±4.2%. Primary patency was 52.5%±9.5% at 3 years. GVPS was 21.9 cm/sec in the good results group and 24.7 cm/sec in the bad results group (P>0.05). The quality of the initial result, as measured by GPSV, was not associated with long-term success (P>0.05). CONCLUSIONS: An initially successful procedure indicated by the degree of increased flow is not related to long-term durability and ulcer healing.

Importance of the arteriographic anatomy of the descending genicular artery and sural arteries in patients with atherosclerotic occlusion of the popliteal artery.

Bypasses to the descending genicular artery (DGA) or the medial sural artery (MSA) have been performed with acceptable rates of midterm success. The arteriographic appearance of the DGA, the MSA, and the lateral sural artery (LSA) was described and the applicability of bypass to these vessels was investigated. The arteriograms of 45 patients who had occlusion of the below-knee popliteal artery were analyzed to determine the presence, dominance, and extension of collaterals for each perigeniculate branch, which were used to assess the applicability of a perigeniculate bypass. A dominant perigeniculate artery was found in 26 arteriograms and corresponded to 13 DGAs, 9 MSAs, and 4 LSAs. Of 14 applicable perigeniculate bypasses, 2 would be an obligatory bypass and 12 would be an alternative to a conventional infrapopliteal bypass. Although rarely an obligatory solution, a bypass to a perigeniculate branch artery represents a valuable alternative.

Aneurisma verdadeiro bilateral de artéria tibial posterior / True bilateral aneurysm of the posterior tibial artery

Neste artigo, faz-se o relato de um caso de aneurisma verdadeiro bilateral da artéria tibial posterior em paciente de 57 anos. Os aneurismas surgiram em épocas diferentes. Os aspectos clínicos, diagnósticos e terapêuticos deste caso são discutidos. Este relato é importante, pois os autores não têm conhecimento de caso semelhante na literatura consultada.

Free flap with reversed arterial flow in the leg: case report.

A case of distal-third reconstruction of a leg with bone exposure is reported. A rectus abdominis muscle free flap, based on the inferior epigastric artery, was anastomosed to the distal stump of the anterior tibial artery with reversed flow. This technique is suggested as an option for microvascular reconstruction in the distal third of the leg. Anatomic and physiologic details are discussed.