The Aberrant Anterior Tibial Artery and its Surgical Risk

Jang, Yohan; Nguyen, Khoa; Rocky, Saenz

doi:10.12788/ajo.2018.0057

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…29 Similarly, when using a saw during an open approach, favorable positioning (knee flexion to move the popliteus artery posterior) is easy and recommended but unreliable on its own, 20 and anatomic variation occurs. 30 Especially for HTO, encircling the bone with retractors prevents adjacent soft-tissue laceration, not only from the saw blade tip but also from the oscillations, 31 which can cause arterial pseudoaneurysm even if true laceration does not occur. 23 Irrigation during drilling and sawing reduces temperature 32 but can obscure visibility so may be more convenient in spurts between active power utilization.…”

Section: Discussionmentioning

confidence: 99%

Avoiding Compartment Syndrome, Vascular Injury, and Neurologic Deficit in Tibial Osteotomy: An Observational Study of 108 Limbs

Hoellwarth,

Geffner,

Fragomen

et al. 2023

JAAOS Glob Res Rev

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Introduction: Tibial deformities are common, but substantial concern may be associated with corrective osteotomy regarding major complications reported in classic literature. Such studies chiefly focused on high tibial osteotomy, with relatively little investigation of other areas and types of deformity. The primary aim of this study was to identify the rate of compartment syndrome, vascular injury, nerve injury, and other major complications after elective tibial osteotomy. Methods: One hundred eight tibia osteotomies performed during 2019 to 2021 were evaluated, representing all tibia osteotomies except situations of existing infection. A retrospective chart review was performed to identify patient demographics, surgical indications, anatomic location of osteotomy, fixation used, and complications prompting additional surgery. Results: The most common osteotomy locations were high tibial osteotomy (35/108 = 32%, 32/35 = 91% medial opening, and 3/35 = 9% medial closing), proximal metaphysis (30/108 = 28%), and diaphysis (32/108 = 30%). The most common fixation was plate and screw (38/108 = 35%) or dynamic frame (36/108 = 33%). Tranexamic acid was administered to 107/108 = 99% of patients and aspirin chemoprophylaxis was used for 83/108 = 86%. A total of 33/34= 97% of anterior compartment prophylactic fasciotomies were performed for diaphyseal or proximal metaphysis osteotomies. No events of compartment syndrome, vascular injury, nerve injury, or pulmonary embolism occurred. One patient required débridement to address infection. Additional surgery for delayed/nonunion occurred for nine segments (8%). Additional surgery for other reasons were performed for 10 segments (9%), none resulting in reduced limb function. Conclusion: Tibial osteotomy can be safely performed for a variety of indications in a diverse range of patients, without a notable risk of the most feared complications of compartment syndrome, vascular injury, and neurologic deficit. Prophylactic fasciotomy and reducing postoperative bleeding using tranexamic acid, along with location-specific safe surgical techniques, may help prevent major complications and thereby facilitate optimized deformity care.

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Section: Discussionmentioning

confidence: 99%

Avoiding Compartment Syndrome, Vascular Injury, and Neurologic Deficit in Tibial Osteotomy: An Observational Study of 108 Limbs

Hoellwarth,

Geffner,

Fragomen

et al. 2023

JAAOS Glob Res Rev

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“…This methodology was in line with similar studies. 8 , 14 , 19 The novelty of this study is that we compared the distance between the proximal and distal branches in patients who underwent TKA.…”

Section: Discussionmentioning

confidence: 99%

Proximal Branching of the Anterior Tibial Artery From the Popliteal Artery Increases the Risk of Vascular Injury During Total Knee Arthroplasty: A Retrospective Analysis Using Preoperative Magnetic Resonance Imaging and Intraoperative Findings

Kimura¹,

Takahashi

et al. 2022

Geriatr Orthop Surg Rehabil

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Introduction Arterial injury following total knee arthroplasty (TKA) can be life-threatening. There are some anatomical variations in the popliteal artery (PA) and its branches. In most cases, the PA branches into the anterior tibial artery (ATA) and posterior tibial artery (PTA), which are usually distal to the height of tibial resection in TKA. However, some cases show that the PA branches into the ATA and PTA proximal to the height of tibial resection in TKA. This study aimed to assess the distance from the posterior cortex of the proximal tibia to the anterior wall of the PA or ATA at the height of the tibial cut line, during TKA in the distal and proximal branch groups. Methods 129 patients (6 patients in the proximal branch group and 123 patients in the distal branch group) were enrolled for this study. For prediction of the distance from the posterior cortex of the proximal tibia to the anterior wall of the PA or ATA, preoperative sagittal and coronal magnetic resonance images and postoperative radiographs were evaluated. Results The distance between the posterior cortex of the proximal tibia and the anterior wall of the PA or ATA at the height of the tibial cut line was 1.8 ± 1.1 mm in the proximal branch group and 6.1 ± 2.6 mm in the distal branch group, which was significantly closer in the proximal group (P < .05). Discussion The rate of proximal branching was 4.7%. This study clarified that the proximal branching of the ATA from PA significantly decreased the distance between the posterior cortex of the proximal tibia and the anterior wall of the artery. Conclusions The proximal branch group has a high risk for arterial injury as the artery may be close to the saw, and appropriate retraction should be performed.

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“…The largest branch is characteristically the posterior tibial artery, beginning at the lower border of the popliteus muscle and coursing distally in the deep posterior compartment of the lower leg. Several previous investigations have discussed aberrant courses of the anterior tibial and peroneal branches of the popliteal artery [12][13][14] . To date, few studies have discussed atypical variations of the posterior tibial artery.…”

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confidence: 99%

Anomalous Posterior Tibial Artery Course—Anatomic Considerations for the Posterolateral Ankle Approach

Perugini

Passias

Pelz

et al. 2023

JBJS Case Connector

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Case:We report a unique anatomical case of an anomalous course of the posterior tibial artery found on dissection during the posterolateral approach to the ankle. To the best of our knowledge, no such case has been documented.Conclusion:The vascular bundle consistent with that of the posterior tibial artery and vein was encountered in the far lateral aspect of the deep posterior compartment, which suggests physicians should proceed with caution when performing the posterolateral approach to the ankle so as to avoid iatrogenic injury of this named anatomic structure.

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The Aberrant Anterior Tibial Artery and its Surgical Risk

Cited by 5 publications

References 12 publications

Avoiding Compartment Syndrome, Vascular Injury, and Neurologic Deficit in Tibial Osteotomy: An Observational Study of 108 Limbs

Avoiding Compartment Syndrome, Vascular Injury, and Neurologic Deficit in Tibial Osteotomy: An Observational Study of 108 Limbs

Proximal Branching of the Anterior Tibial Artery From the Popliteal Artery Increases the Risk of Vascular Injury During Total Knee Arthroplasty: A Retrospective Analysis Using Preoperative Magnetic Resonance Imaging and Intraoperative Findings

Anomalous Posterior Tibial Artery Course—Anatomic Considerations for the Posterolateral Ankle Approach

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