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The level of bifurcation of peroneal artery and its implications for posterolateral approach to the ankle: a CT angiography study

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Abstract

Purpose

This study aims to provide data, with the use of computed tomography angiography, regarding the level of bifurcation of the peroneal artery to the anterior perforating branch and the lateral calcaneal branch, in relation to the osseous anatomic structures of the tibial plafond, the medial malleolus and the lateral malleolus.

Methods

The study included patients who underwent diagnostic computed tomography angiography of the lower extremities. Measurements were performed in two-dimensional reconstructions and included the perpendicular distance from peroneal artery bifurcation into anterior perforating branch and lateral calcaneal branch to the lowest level of tibial plafond (D1), medial malleolus (D2) and lateral malleolus (D3). The distances were also normalized to the length of the tibia.

Results

Sixty patients and a total of 115 limbs were enrolled in this study. The mean distance ± standard deviation from peroneal artery bifurcation to tibial plafond (D1) was 4.33 ± 1.12 cm (normalized 0.12 ± 0.03) (range 2.54–8.26 cm), to medial malleolus (D2) was 5.53 ± 1.18 cm (normalized 0.16 ± 0.03) (range 3.27–9.5 cm) and to lateral malleolus (D3) was 6.53 ± 1.17 cm (normalized 0.18 ± 0.03) (range 4.71–10.2 cm), respectively. There was no significant difference between right and left limb measurements (p > 0.05). Females presented lower, but not statistically significant (p > 0.05), D1, D2 and D3 measurements compared to males.

Conclusion

The bifurcation of the peroneal artery takes place at lower level compared to previously published studies and consequently extreme caution should be exercised when performing the posterolateral approach to the ankle. This study adds to the understanding of the relevant vascular anatomy of the region and assists in performing the posterolateral approach to the ankle with safety.

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Funding

There was no funding for this work. It was not required.

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Authors and Affiliations

  1. Department of Radiology, University Hospital of Heraklion, Crete, Greece

    Nikolaos Galanakis, Michail E. Klontzas & Apostolos Karantanas

  2. Department of Orthopaedic Surgery, University Hospital of Heraklion, Crete, Greece

    Georgios M. Kontakis & Theodoros H. Tosounidis

  3. 4th TO.M.Y., Heraklion, Greece

    Barbara Sidiropoulou

Authors
  1. Nikolaos Galanakis
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  2. Michail E. Klontzas
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  3. Apostolos Karantanas
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  4. Georgios M. Kontakis
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  5. Barbara Sidiropoulou
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  6. Theodoros H. Tosounidis
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Contributions

NG: prepared the manuscript draft and performed the CTA measurements. MK: prepared the manuscript draft and performed the CTA measurements. AK: performed a critical review of the manuscript and conceived the presented idea. GK: performed a critical review of the manuscript. BS: assisted in analysis of the results. THT: contributed to the design and implementation of the research, to the analysis of the results and to the writing of the manuscript.

Corresponding author

Correspondence to Theodoros H. Tosounidis.

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The authors declare that they have no conflict of interest.

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This was obtained from our Hospital Ethics Committee.

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Galanakis, N., Klontzas, M.E., Karantanas, A. et al. The level of bifurcation of peroneal artery and its implications for posterolateral approach to the ankle: a CT angiography study. Surg Radiol Anat 43, 1697–1702 (2021). https://doi.org/10.1007/s00276-021-02800-y

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  • DOI: https://doi.org/10.1007/s00276-021-02800-y

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