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Corkscrew Collateral Vessels in Buerger Disease: Vasa Vasorum or Vasa Nervorum
Ahmet Baş1, Atilla S Dikici1, Fatih Gülşen1
1Departments of Interventional Radiology, Istanbul University, Cerrahpasa Faculty of Medicine, Fatih, Istanbul 34098, Turkey.
Insights
In Buerger disease, corkscrew collateral vessels around an occluded popliteal artery originate from the tibial nerve's vasa nervorum. This finding was confirmed using Doppler ultrasound and MR imaging alongside digital subtraction angiography.
Area of Science:
- Vascular Surgery
- Radiology
- Medical Imaging
Background:
- Buerger disease is characterized by inflammation and thrombosis of small and medium-sized arteries and veins.
- Corkscrew collateral vessels are a common finding around occluded arteries in Buerger disease, but their origin has been debated.
Purpose of the Study:
- To determine the origin of "corkscrew" collateral vessels in patients with Buerger disease.
- To compare findings from Doppler ultrasound (US) and magnetic resonance (MR) imaging with digital subtraction angiography (DSA).
Main Methods:
- Retrospective identification of 42 Buerger disease patients between January 2013 and June 2015.
- Prospective Doppler US and MR imaging of 15 patients with popliteal artery occlusion on DSA.
- Inclusion of 10 patients with suitable imaging characteristics for final analysis.
Main Results:
- Twelve lower limbs from 10 patients (9 men, 1 woman; mean age 41±10 years) were analyzed.
- Corkscrew collateral vessels seen on DSA were identified on US and MR imaging in 9 out of 10 patients.
- The origin of these vessels was identified as the vasa nervorum of the tibial nerve in nine patients.
Conclusions:
- Corkscrew collateral vessels in Buerger disease, particularly around an occluded popliteal artery, arise from the tibial nerve's vasa nervorum.
- This contrasts with the vasa vasorum of the popliteal artery as the source when the artery is occluded.
Purpose:
To investigate the origin of "corkscrew" collateral vessels around the occluded popliteal artery in patients with Buerger disease by Doppler ultrasound (US) and magnetic resonance (MR) imaging in tandem with digital subtraction angiography (DSA).
Materials And Methods:
Between January 2013 and June 2015, 42 patients diagnosed with Buerger disease were identified retrospectively. Patients in whom occlusion of the popliteal artery was found on DSA of the lower extremity were subjected to Doppler US and MR imaging prospectively. Fifteen of 42 patients were identified as having the required characteristics, of whom 10 participated in the present study.
Results:
Ten patients with occlusion of the popliteal artery were selected for inclusion, and 12 lower limbs of these patients were investigated. The study cohort comprised one woman and nine men with a mean age of 41 years ± 10 (standard deviation; range, 39-58 y). Corkscrew collateral vessels identified on DSA examinations were also identified on secondary imaging (Doppler US and MR imaging) in all patients except one in whom the popliteal artery was reconstituted after short-segment occlusion. The origin of the corkscrew collateral vessels was identified as the vasa nervorum of the tibial nerve in nine patients.
Conclusions:
Data from the present study suggest that corkscrew collateral vessels at the knee level in patients with Buerger disease originate from the vasa nervorum of the tibial nerve rather than the vasa vasorum of the popliteal artery if the latter is occluded.
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