Is the Anterior Tibial Artery Safe During Ankle Arthroscopy?

Abstract

In 22 (6.2%) of the 358 cases, the ATA and its branches were located near the anterolateral ankle portal, which introduces the risk of vascular damage during arthroscopic surgery. Furthermore, the mean distance between the ATA and the joint capsule was only 2.3 ± 1.1 mm, and thus the ATA is very close to the anterior working space of the ankle joint. Careful preoperative evaluation and an intra-articular procedure may reduce the risk of vascular complications attributable to ankle arthroscopy.

The Distribution Pattern of the Neurovascular Structures for Anterior Ankle Arthroscopy to Minimize Structural Injury: Anatomical Study

“…However, little information is available regarding vascular damage during ankle arthroscopy, especially anatomical variations of the anterior tibial artery (ATA). According to a previous study [5], the ATA might be at risk from anterolateral portals during ankle arthroscopy. The present study found that the ATA and the perforating branch of the peroneal artery crossed the reference line at 49.6% and 22.0% of the reference line from the most prominent point of lateral malleolus, respectively (Table 4); the intersection points according to the x- and y -coordinates are shown in Table 5.…”

“…Son et al [5] also reported an anterior tibial artery injury rate of 4.3% during anterior ankle arthroscopy. Specifically, damage of the superficial peroneal nerve has been a focus of some authors.…”

“…The nature of the procedure and anatomical variations of the vessels are also intrinsic risk factors of anterior ankle arthroscopy [10]. These anatomical variations can lead to intraoperative complications and unexpected results [5]. …”

Ruptured Pseudoaneurysm of the Dorsalis Pedis Artery Following Ankle Arthroscopy

“…While similar cases of AT pseudoaneurysms exist in the literature, this particular case is notable for the location in the DP artery, the size of the pseudoaneurysm, late presentation, and eventual rupture. 2–8 …”

“…3,14 However, deviation of AT toward the anterolateral port site is present in 6.3% of patients, making pre-operative confirmation of vascular anatomy a crucial part of ankle arthroscopy. 8 Furthermore, in 2–12% of patients, the DP arises aberrantly from the peroneal artery. 15,16 In the case described above, existing scarring and the need to extend the typical arthroscopic portal site into an arthrotomy increased the risk that the artery wall would be damaged during removal of the osteophytes.…”