Kruse Rombout R, Doomernik Denise E, Maltha Kasper V, Kooloos Jan G M, Kozicz Tamas L, Reijnen Michel M P J
Department of Surgery, Isala Clinics, Zwolle, The Netherlands.
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands; Department of Anatomy, Radboud University Medical Center Nijmegen, The Netherlands.
J Surg Res. 2017 May 1;211:45-52. doi: 10.1016/j.jss.2016.11.068. Epub 2016 Dec 14.
The role of collateral artery circulation in the lower limb is under debate but clinically relevant, particularly when using covered stents for occlusive disease. Covered stents seem to outperform nitinol stents in extensive disease, but collaterals could be essential in case of acute thrombosis. In the present study, we describe the collateral pathways of the deep and superficial femoral artery (DFA, SFA) and the popliteal artery (PA), observed in human cadavers.
Ten fresh frozen cadaver legs were selected. The SFA and DFA were separately cannulated and injected with a different colored latex mixture simultaneously. After curing of the latex, the circulation was dissected thus visualizing the main arteries and their collateral vessels. The process was photographed and recorded, and collateral pathways were analyzed using a standardized vessel segmentation. The upper leg was divided in three regions, that is, the femoral triangle (F), the adductor canal (H), and the popliteal fossa (P) that, in turn, were split in three segments (1, 2, and 3, from proximal to distal).
Overall, 113 collateral vessels were found; 69 originated from the DFA, 34 from the SFA, and 10 from the PA. The majority of collaterals originating from the DFA terminated in the SFA (57%). Fifty-six of 113 collaterals (50%) ended in either the distal adductor channel (H3) or the proximal PA (P1). Another 28 collateral arteries (25%) had their origin in this segment (H3, P1) and mostly connected to the P2 and P3 segments. Forty-three collaterals of the DFA and H3 segment had a direct or indirect connection to below the knee muscles.
The majority of collaterals originate from the DFA, and the greater part of all collaterals has a connection with the H3-P1 segment. This observation may have clinical implications in the planning of endovascular procedures.
下肢侧支动脉循环的作用仍存在争议，但在临床上具有相关性，尤其是在使用覆膜支架治疗闭塞性疾病时。在广泛病变中，覆膜支架似乎优于镍钛诺支架，但在急性血栓形成的情况下，侧支循环可能至关重要。在本研究中，我们描述了在人体尸体中观察到的股深动脉和股浅动脉（DFA、SFA）以及腘动脉（PA）的侧支循环途径。
选取10条新鲜冷冻的尸体下肢。分别对SFA和DFA进行插管，并同时注入不同颜色的乳胶混合物。乳胶固化后，对循环系统进行解剖，从而观察主要动脉及其侧支血管。对该过程进行拍照和记录，并使用标准化的血管分割方法分析侧支循环途径。大腿上部被分为三个区域，即股三角（F）、收肌管（H）和腘窝（P），每个区域又依次分为三个节段（从近端到远端分别为1、2和3）。
总共发现113条侧支血管；其中69条起源于DFA，34条起源于SFA，10条起源于PA。起源于DFA的侧支血管大部分终止于SFA（57%）。113条侧支血管中有56条（50%）终止于远端收肌管（H3）或近端PA（P1）。另外28条侧支动脉（25%）起源于该节段（H3、P1），且大多与P2和P3节段相连。DFA和H3节段的43条侧支血管与膝下肌肉有直接或间接连接。
大多数侧支血管起源于DFA，并且所有侧支血管的大部分与H3 - P1节段相连。这一观察结果可能对血管内介入手术的规划具有临床意义。
