Compensating crural anastomoses in chronic critical limb ischaemia

Compensating crural anastomoses develop in patients with multi-level occlusion of the calf arteries in the course of atherosclerosis, arteriitis, diabetes, and in vascular malformations of the limbs. The peroneal artery is frequently the only patent calf vessel, especially in diabetic patients who have advanced tibial occlusive disease. The purpose of this study was to identify different types of compensating crural anastomoses in chronic critical limb ischaemia. Using combined anatomical-radiographic and statistical methods, 86 compensating crural anastomoses were studied in 59 specimens of lower limbs (amputated at the thigh) in the course of chronic critical ischaemia. Three types of compensating crural anastomosis and their components were identified. The most common type (55.8%) was the posterior tibioperoneal anastomosis. Less common (23.3%) was the intertibial anastomosis and least common (20.9%) the anterior tibioperoneal anastomosis. The posterior tibioperoneal anastomosis was concurrent with anterior tibioperoneal anastomosis in 26.3% of cases and with the intertibial anastomosis in 15.3% of cases. The great importance of the peroneal artery in the formation of natural crural collateral circulation should encourage vascular surgeons to consider peroneal bypasses.