Artery Transposition Using Indocyanine Green for Tarsal Tunnel Decompression

Area of Science:

• Orthopedics
• Vascular Surgery
• Neurology

Background:

• Idiopathic tarsal tunnel syndrome (TTS) surgery often has limited effectiveness.
• The posterior tibial artery (PTA) can be compressed by the posterior tibial nerve (PTN) in TTS.
• Evaluating surgical outcomes using indocyanine green video angiography (ICG-VA) is novel.

Purpose of the Study:

• To evaluate a surgical technique for idiopathic TTS involving PTA decompression from the PTN.
• To assess the effectiveness of this procedure using ICG-VA.
• To determine the safety and efficacy of PTA transposition in TTS patients.

Main Methods:

• 12 elderly patients (70-87 years) with idiopathic TTS underwent PTA decompression and transposition under local anesthesia.
• A 2-cm incision allowed flexor retinaculum resection and PTA decompression from the PTN.
• ICG-VA was used intraoperatively and postoperatively to assess PTA patency and vasa nervorum integrity.

Main Results:

• No intraoperative or postoperative complications were reported.
• Postoperative ICG-VA confirmed uninterrupted PTA blood flow and intact vasa nervorum in all patients.
• All patients experienced symptom improvement following the procedure.

Conclusions:

• Surgical decompression and transposition of the PTA for idiopathic TTS is a simple, safe, and effective treatment.
• ICG-VA is a valuable tool for monitoring PTA patency and vasa nervorum during and after surgery for TTS.
• This technique offers a promising alternative for managing idiopathic TTS with improved patient outcomes.