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Collateral circulation in distal occlusion of lower limb arteries: an anatomical study and statistical research in 40
C Macchi1, C Catini, F Giannelli
1Department of Human Anatomy and Histology, University of Study of Florence, Italy.
Insights
This study reveals how blood flow is rerouted in elderly patients with lower limb arterial blockages. The posterior tibialis artery is most affected, with popliteal occlusions causing the most significant blood flow issues.
Area of Science:
- Vascular Medicine
- Radiology
- Geriatrics
Background:
- Lower limb arterial occlusion is common in the elderly, impacting mobility and quality of life.
- Understanding collateral circulation is crucial for managing peripheral artery disease.
- Previous studies have focused on various aspects, but detailed hemodynamic analysis in an elderly cohort is needed.
Purpose of the Study:
- To investigate the collateral circles and their hemodynamic significance in distal lower limb arterial occlusions in an elderly population.
- To identify the most frequently occluded arteries and the patterns of collateral compensation.
- To assess the hemodynamic impact of different arterial occlusions using the Windsor Index.
Main Methods:
- Study included 40 elderly subjects (20 men, 20 women) with symptomatic lower limb arteriopathy (Fontaine's stage II).
- Combined Contrast Angiography and Color Doppler Echography were used to visualize the lower limb arterial district.
- Hemodynamic compromission was quantified using the Windsor Index (IW).
Main Results:
- Tibialis arteries were most frequently occluded: posterior tibialis (37.5%) and posterior tibialis (30%).
- Popliteal artery occlusions showed the highest hemodynamic compromission (mean IW = 34.3%), followed by anterior tibialis, peroneal, and posterior tibialis arteries.
- Specific collateral pathways were identified for occlusions at different arterial levels (popliteal, anterior tibialis, posterior tibialis, peroneal).
Conclusions:
- The study elucidates the compensatory collateral pathways in elderly patients with lower limb arterial occlusions.
- Posterior tibialis artery occlusions are most prevalent, while popliteal occlusions present the most severe hemodynamic compromise.
- No significant gender differences were observed in the hemodynamic significance of occlusions.
Abstract:
The collateral circles and their hemodynamic significance in distal lower limb arterial occlusion have been described in an elderly population. Overall 40 subjects (20 men and 20 women; age range 66-83) with symptomatic lower limb arteriopathy (Fontaine's stage II) have been studied combing Contrast Angiography and Color Doppler Echography of the lower limb arterial district. In our population, the results showed that the tibialis arteries were the vessels most often involved in arterial occlusion (posterior tibialis a., 15 cases = 37.5%, posterior tibialis a., 12 cases = 30%), followed by the peroneal a. (8 cases = 20%) and by the popliteal a. (5 cases, 12.5%). In the occlusion of the popliteal artery the collateral circle was mainly established through the deep femoral a., the great anastomotic a., the recurrent posterior tibialis a., and from the articular supero-lateral a. In the occlusion of the anterior tibialis artery the collateral circulation was ensured through the collateral posterior tibialis as. and through the collateral perineal as. In the occlusion of the posterior tibialis a., the collateral circle was established through the great anastomotic a., through the branchers of the arterial circle of the ankle and from the perforating plantar as. (anterior tibial a.). Finally, in the occlusion of the peroneal a., the collateral circulation was only represented by branches of the arterial circle of the ankle. The hemodynamic compromission, measured by the Windsor Index, was the highest for popliteal occlusions (mean IW = 34.3%). Occlusions of the anterior tibialis a. (mean IW. = 35.48%), of the peroneal a. (mean IW = 44.71%), and of the posterior tibialis a. (mean IW = 55.44%) showed progressively lower hemodynamic compromission. Gender differences in hemodynamic significance at each level of occlusion were not significant.