Pseudoobstruction of the anterior tibial artery

Lower extremity arteriography is customarily performed in the anteroposterior projection with the feet in forced plantar flexion. A case is reported showing "pseudoobstruction" of the anterior tibial artery at the ankle in this projection, which was not present with the foot in the neutral position for a lateral view. To confirm the positional nature of this phenomenon in younger patients, pulse tracings of five volunteers were obtained. These showed that pulsatile flow could be repeatedly abolished in the anterior tibial artery by plantar flexion of the foot. The anatomic causes for this phenomenon are discussed.