Anatomical courses of collateral circulations in patients with infrainguinal chronic lower extremity arterial occlusive disease.

OBJECTIVES This study aimed to identify the anatomical course of collateral vessels in chronic lower extremity arterial occlusive disease (LEAD) to optimize intramuscular injection sites for angiogenesis therapy. METHODS We retrospectively analyzed 35 limbs with superficial femoral artery (SFA) occlusion and 17 limbs with three crural artery occlusion using 1-mm slice contrast-enhanced computed tomography. Collateral vessels (≥1 mm) connecting the common femoral to popliteal arteries, and popliteal to foot arteries were identified. Donor and recipient arteries, and vessel courses were documented. RESULTS In SFA occlusion, 49 collateral vessels were identified. The deep femoral artery was the sole donor. Recipient arteries were predominantly the lateral (94%) and medial (6%) superior genicular arteries. 71% (35/49) of collaterals ran within the short head of the biceps femoris. In crural artery occlusion, 17 collaterals were found. Donor arteries included the peroneal (29%), posterior tibial (24%), and combinations thereof. Recipient arteries were the anterior tibial (53%), plantar (29%), and dorsalis pedis (18%). All collaterals coursed through the soleus muscle, with 35% traversing the posterior tibial muscle. CONCLUSIONS Collateral vessels in chronic LEAD exhibit preferential development within specific muscles. In SFA occlusion, collaterals develop predominantly within the short head of the biceps femoris, while in crural artery occlusion, collaterals develop within the soleus muscle. These findings suggest that targeted intramuscular injections, guided by anatomical knowledge of collateral pathways, may enhance angiogenesis therapy efficacy.

• Publication year

  2025

• Venue

  Annals of Vascular Surgery

• Publication date

  2025-04-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.1016/j.avsg.2025.03.019PMID 40216018
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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