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Collateral circulation of the femoral and genicular systems in human lower limbs is highly uncommon
Beeran Jethwa1, Ramaswamy Sharma1, Jordan Tanner1
1Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, USA.
Insights
Anastomosis between the descending branch of the lateral circumflex artery and the superior lateral genicular artery is uncommon in the thigh. This finding challenges anatomical texts and impacts free flap transfer surgery success.
Area of Science:
- Anatomy
- Vascular Surgery
- Surgical Research
Background:
- The descending branch of the lateral circumflex artery is crucial for thigh flap surgeries.
- Anastomosis with the superior lateral genicular artery is believed to provide collateral circulation for the superficial femoral artery (SFA).
- Existing anatomical literature suggests this anastomosis is consistently present.
Purpose of the Study:
- To investigate the actual prevalence and patterns of the anastomosis between the descending branch of the lateral circumflex artery and the superior lateral genicular artery.
- To compare arterial diameters to predict variations in anastomotic patterns and collateral circulation.
- To assess the implications for free and pedicle thigh flap transfer surgeries.
Main Methods:
- Dissection of 51 lower limbs to analyze arterial anatomy.
- Classification of anastomotic types and comparison of vessel diameters (descending branch of the lateral circumflex artery, SFA, profunda femoris artery, and common femoral artery).
- Normalization of vessel diameters to the common femoral artery (CFA) for sex and size independent analysis.
Main Results:
- Only 27.4% of dissected limbs exhibited any anastomosis between the studied arteries.
- A typical branching pattern was observed in 62.7% of limbs, but this did not guarantee an anastomosis.
- The superficial femoral artery (SFA) was relatively wider in limbs lacking anastomoses, potentially hindering collateral pathway formation.
Conclusions:
- The presence of collateral circulation via this specific anastomosis is significantly less common than traditionally described in anatomical texts.
- Variations in arterial diameters may correlate with the absence of these crucial anastomoses.
- Pre-operative assessment of viable anastomoses is critical for ensuring flap survival in thigh flap transfer surgeries.
Abstract:
The descending branch of the lateral circumflex artery is a septocutaneous vessel that is vital for free and pedicle thigh flap transfer surgeries when repairing tissue defects. It also forms an anastomosis with the superior lateral genicular artery to create a collateral pathway for circumventing occlusions in the superficial femoral artery (SFA). Many anatomical texts and atlases imply the persistence of this anastomosis. However, previous studies indicate variability in the source of the arteries that form the anastomosis, and have reported cases where an anastomosis does not exist. We hypothesized that variations from the conventional accepted pattern can be predicted by comparisons of arterial diameters, and that unconventional anastomoses may be present to facilitate collateral circulation to the limb. Fifty-one limbs were dissected and analyzed to establish the source of the descending branch of the lateral circumflex artery, classify the types of anastomoses, and compare the diameters of the descending branch of the lateral circumflex artery, the SFA and the profunda femoris artery to the common femoral artery (CFA). Vessel diameters were normalized to the diameter of the CFA to allow comparison of limbs from both sexes and to minimize the effects of cadaver size on correlating vessel size to the presence or absence of collateral circuits. We report that 62.7% of limbs (32/51) had typical branching patterns; however, only 27.4% of limbs (14/51) had any anastomosis to connect the proximal and distal regions of the thigh. Importantly, the SFA had a wider relative diameter in limbs without anastomoses than in limbs that had normal anastomoses, perhaps precluding the formation of a collateral pathway. Overall, collateral circulation of the lower limb was highly uncommon, in contrast to information inferred from anatomical texts. This study suggests the need for more thorough procedures for determining viable anastomoses prior to thigh flap surgeries to ensure flap survival.
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