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For the management of acute limb ischemia (ALI) and multilevel arterial occlusive disease, tibial bypass using the saphenous vein has been considered a mainstay due to the long-term durability in selected patients with acceptable saphenous veins and comorbid conditions. Traditionally, bypass using a varicose autogenous graft has been contraindicated due to the risk of late aneurysmal dilation and rupture. Here, we describe a patient who presented with ALI and received tibioperoneal trunk bypass using a varicose autogenous graft. The patient has been doing well during the 72-month follow-up without recurrent symptoms or revision. The follow-up images showed a favorably patent graft with mild aneurysmal changes at the valve cusp adjacent to the knee. If there are no other appropriate autologous veins for revascularization, a varicose autogenous vein graft may be a useful option for limb salvaging in selected patients with multilevel arterial occlusive diseases.

We present the case of a 68-year-old man with a tibioperoneal trunk mycotic pseudoaneurysm, a rarity in the modern age of antibiotics. We describe the patient's hospitalizations and workups that ultimately led to this diagnosis and our management with open ligation without bypass. This case highlights the importance of combining a thorough history and physical examination with laboratory and imaging data while keeping in mind a broad differential diagnosis.

Infrapopliteal artery aneurysms are rare, and tibioperoneal trunk aneurysms are even rarer. We herein report an unusual case of large tibioperoneal trunk pseudoaneurysm. The patient underwent successful endovascular exclusion of the pseudoaneurysm by coil embolization with stent assistance. The clinical features and management of tibioperoneal trunk aneurysms are also discussed in this article.

Arterial involvement in Behcet's disease is rare and the tibioperoneal trunk localisation is exceptional. We report the case of a young men with Behcet's disease and in whom the evolution to angiobehcet was unusual. The medical treatment and the therapeutic abstention were decided according to a bundle of argument.

Introduction. Acute limb ischemia is a severe disorder caused by a sharp drop in the arterial perfusion of the limb. It carries a threat to the limb’s function and viability. The issue of early recognition of acute limb ischemia in surgery is both important and difficult. The current guidelines recommend that patients with acute limb ischemia when the limb is viable should be urgently examined and treated. Restoring the blood flow in patients with acute limb ischemia is a priority, since a significant reduction in arterial perfusion can lead to limb amputation and life-threatening complications. In acute limb ischemia different treatment methods can be used, both open surgery and endovascular procedures. The treatment strategy depends on the localisation, duration of ischemia, neurological deficit, concomitant diseases and risks associated with treatment and its results. Endovascular procedures on the arteries of the lower leg are most often indicated to save a limb. Endovascular procedures on the arteries of the lower leg are indicated more often in patients with critical limb ischemia. Endovascular procedures when the condition is primary demonstrate good outcomes and high efficiency on the arteries of the lower extremities at all levels of the lesion.Materials and methods. This paper presents a clinical case of a successful endovascular procedure performed for the treatment of acute thrombosis of the arteries of the lower leg. Three stents were implanted, with a good angiographically confirmed outcome.Conclusion. Endovascular balloon angioplasty with stenting of the tibioperoneal trunk can result in good outcomes in patients with acute thrombosis of the arteries of the lower leg.

The popliteal artery courses from the adductor hiatus, where the superficial femoral artery ends, to the soleus arcade, immediately beyond which it divides into the anterior tibial artery and the tibioperoneal trunk. In about 10% of the cases, there are variations in the level of terminal branching or in the type of branching or in both. Knowledge of these variations is very important to avoid heavy complications both in vascular and orthopedic procedures.

We present a novel approach to endovascular thrombectomy using the Penumbra Indigo® Aspiration System with balloon assistance for a thromboembolic occlusion to the tibioperoneal trunk and tibial arteries causing acute limb ischemia. This technique allows for effective suction thrombectomy of distal vessels into a shorter, large-diameter aspiration catheter, thereby overcoming the limitations of the longer but smaller aspiration catheters.

Only a few cases of infrapopliteal aneurysms are reported in the literature. These are commonly associated with trauma, infection, and iatrogenic injuries and mostly present as pseudoaneurysms. We report the case of a 44-year-old man with Behcet disease and an 8-cm tibioperoneal trunk aneurysm and discuss the management options of these aneurysms.

Tibioperoneal trunk aneurysms are rare and the majority of them are pseudoaneurysms This report describes an unusual case of a pseudoaneurysm secondary to bacterial endocarditis diagnosed and treated several years previously. After ruling out ongoing infection, the patient was successfully treated by percutaneous covered stent implantation. In this scenario, the use of endovascular techniques offered a safe and effective alternative treatment.

Resumo Os aneurismas do tronco tibiofibular são raros e consistem principalmente em pseudoaneurismas. Os autores descrevem um caso incomum de pseudoaneurisma do tronco tibiofibular secundário a endocardite bacteriana diagnosticada e tratada vários anos antes. Após a exclusão de um processo infeccioso ativo, o paciente foi tratado com sucesso através do implante percutâneo de um stent recoberto. O tratamento endovascular, neste contexto, apresentou uma alternativa segura e eficaz. Abstract Tibioperoneal trunk aneurysms are rare and the majority of them are pseudoaneurysms This report describes an unusual case of a pseudoaneurysm secondary to bacterial endocarditis diagnosed and treated several years previously. After ruling out ongoing infection, the patient was successfully treated by percutaneous covered stent implantation. In this scenario, the use of endovascular techniques offered a safe and effective alternative treatment.

Background This report presents a case of surgical retrieval of a Celt ACD® vascular closure device (VCD) situated in the tibioperoneal trunk, following a failed attempt at deployment. Existing literature mostly recommends an endovascular approach when attempting to retrieve embolised VCDs. Case presentation A 55 year old male presented with right sudden right lower limb pain and numbness 1 week following a successful left retrograde superficial femoral artery (SFA) angioplasty. Computed tomography (CT) angiogram revealed that the Celt ACD® VCD had embolised in the right tibioperoneal trunk. An endovascular approach was initially attempted to retrieve the VCD; however, this was unsuccessful due to the small diameter of the target artery. Due to the failure of the endovascular approach, surgical exploration of the right tibioperoneal trunk was undertaken, which led to the successful retrieval of the embolised VCD. Conclusion The case presented herein demonstrates the critical need for swift and decisive surgical exploration of patients with suspected embolisation of Celt ACD® devices in smaller distal arteries. Our experience has led to the recommendation that, due to the sharp edges of the Celt ACD® accompanied with the small diameter of the occluded vessels, surgical exposure and retrieval is the safest option if endovascular retrieval is unsuccessful.

To describe and assess the safety of a technique for the percutaneous retrograde access to either the P3 segment of the popliteal artery or the tibioperoneal trunk (TPT) through the anterior muscle compartment of the leg to treat distal femoropopliteal chronic total occlusion (CTO).After a failed antegrade attempt of endovascular recanalization of a femoropopliteal CTO, 41 symptomatic patients (29 men; mean age of 75.8 ± 8.4 years) underwent a percutaneous retrograde access by means of the puncture of the TPT in 15 cases (36.6%) and of the P3 tract of popliteal artery in 26 cases (63.4%). The puncture was performed on the anterolateral aspect of the proximal leg through the anterior muscle compartment with the patient in a standard supine position. Access to the vessel was obtained with a sheathless approach. After retrograde recanalization and guidewire rendezvous, the distal wire was retrieved proximally and a standard antegrade endovascular intervention was carried out.Retrograde access was achieved successfully in all patients. Recanalization was carried out in 16 cases (39.0%) with an endoluminal technique and in 25 cases (61.0%) in a subintimal fashion. Hemostasis was successfully attained in 31 patients (75.6%) by inflating a blood pressure cuff at the calf. In 11 cases (26.8%), the hemostasis was accomplished instead by means of a low-pressure ballooning as a bailout strategy for small residual bleedings. The transcutaneous oximetry at the 1-month follow-up from the procedure was significantly increased compared with the preprocedural values (10.4 ± 6.8 vs 42.4 ± 18.7 mm Hg; P .01). No early or late postoperative access-related complications were observed at a mean follow-up of 12.6 ± 9.5 months.After a failed antegrade approach, the anterolateral retrograde puncture of the P3 or of the TPT is a valuable and safe technique to treat femoropopliteal CTOs in selected patients, regardless the distal spread of the lesion to the popliteal artery.

True infrapopliteal aneurysms occur very rarely; the majority of reported cases are secondary to trauma or infection. We report the development of a tibioperoneal trunk aneurysm 6 months after atherectomy and angioplasty and describe subsequent open surgical repair via a great saphenous vein bypass graft.

Infrapopliteal mycotic aneurysm resulting from endocarditis is rare, with only a few reported cases. We describe the case of a 28-year-old male patient who was suffering with pain and edema in the right leg. The ultrasound revealed an aneurysm of the right tibioperoneal trunk and a deep vein thrombosis (DVT). The patient was admitted and developed acute congestive heart failure, being diagnosed with possible endocarditis. A pseudo-aneurysm was revealed by arteriography. Aggressive antibiotic treatment was initiated, and open surgery confirmed a mycotic pseudo-aneurysm of the tibioperoneal trunk. To our knowledge, this is the 8th case reported of an infected aneurysm in this particular location. Aneurisma micótico infra-poplíteo resultante de endocardite infecciosa é raro, com apenas alguns casos relatados. Descrevemos o caso de um paciente de 28 anos do sexo masculino que apresentou dor e edema na perna direita. A ultrassonografia demonstrou um aneurisma do tronco tíbio-fibular e trombose venosa profunda do membro inferior direito. O paciente foi internado e desenvolveu falência cardíaca aguda, sendo diagnosticado de endocardite bacteriana. Um pseudo-aneurisma foi evidenciado na arteriografia. Antibioticoterapia agressiva foi iniciada e cirurgia aberta confirmou um pseudo-aneurisma micótico do tronco tibio-fibular. Para o nosso conhecimento, este é o oitavo caso relatado de aneurisma infectado localizado especificamente nesta região.

Aneurysms of the tibioperoneal trunk and anterior tibial artery are extremely rare. There are only a few case reports of this entity, for which the majority are secondary to prior trauma or bacteremia and endocarditis. We describe a case of spontaneous pseudoaneurysms of the right anterior tibial artery and tibioperoneal trunk. The pseudoaneurysms were thrombosed on follow-up computed tomography angiography and the patient has been asymptomatic. The patient is being treated conservatively and remains asymptomatic at 1 year of follow-up.

Embryonic development of arteries of the lower limb results from the union of dorsal and ventral systems, explaining many variations at different levels. Some of these are important to recognize during the radiological exam because they can affect therapeutic management. These variations are most often bilateral and symmetrical predominating at the popliteal and subpopliteal levels. Lippert classified them into three types: normal level of popliteal arterial branching, high division of popliteal artery, hypoplastic or aplastic branching with altered distal supply. The length of the tibioperoneal trunk may also vary, rarely measuring more than 5 cm. We report a case combining three variations, two of them previously described in the literature and the third one not yet reported: our patient presented four arteries due to early bifurcation of the peroneal artery.

True aneurysms of the tibioperoneal trunk are rare. Given the scarcity of reports, the clinical presentation and treatment is not well defined. This is a case report of a 50-year-old male patient presenting with severe lower extremity swelling and compartment syndrome with neurological compromise secondary to a tibioperoneal trunk aneurysm. He was also noted to have discrete ipsilateral popliteal and dorsalis pedis artery aneurysms. Given the location and size of the aneurysm, the severe leg swelling, and venous hypertension, aneurysmorrhaphy or aneurysm sac excision with arterial reconstruction was prohibitively dangerous. Thus, following fasciotomies, a hybrid repair utilizing a saphenous vein superficial femoral to anterior tibial artery bypass along with coil embolization of the aneurysm sac was performed. The patient recovered full function of his leg and follow-up computed tomography angiogram demonstrated thrombosis and regression of the aneurysm sac with a patent bypass.

Summary Knowledge of the normal anatomic characterization of the popliteal artery and its branches is essential as a guide in vascular surgery below the knee. Using radiologic, digital and statistical methods tibioperoneal trunks were studied on 76 preoperative arteriograms, visualizing bilateral configurations of the popliteal artery division, from 46 men and 30 women, with aorto-iliac occlusive disease. The aim of this study has been to evaluate tibioperoneal trunks as to typological (types, frequency of existence, gender and syntopic dimorphisms) and angiometric (length, internal diameter and capacity) aspects. The statistical analysis of tibioperoneal trunks (types, angiometric parameters) did not reveal any gender or syntopic dimorphisms ( p ⩾ 0.05 ). In both the posterior tibioperoneal trunk (89.47%) or the anterior tibioperoneal trunk (7.89%) short and long ones were found. High correlation coefficients of the symmetry of the left and right vascular patterns were observed ( r = 0.80 – 0.83 ). In 2.64% of cases tibioperoneal trunks were absent. Two types of posterior tibioperoneal trunk were longer ( p ⩽ 0.01 ) but they were thinner ( p ⩽ 0.05 ) than similarly named types of anterior tibioperoneal trunk. In anterior and posterior tibioperoneal trunks of the short type the diameter of the vessel was statistically larger ( p ⩽ 0.05 ) than in its long type. The largest capacity was found in the long type and the smallest in the short type of anterior tibioperoneal trunk ( p ⩽ 0.01 ). These findings have implications in vascular grafting below the knee.

Mycotic aneurysms involving infrapopliteal arteries are rare. Ruptured infrapopliteal aneurysms are particularly uncommon and represent a surgical or endovascular emergency. We describe a case of 51-year-old male who presented with a 12-cm ruptured aneurysm of the tibioperoneal trunk 5 years after an episode of bacterial endocarditis. Our surgical approach included using extremity exsanguination and tourniquet to control hemorrhage during aneurysm ligation, followed by successful arterial reconstruction. Review of the English literature suggests that this is the largest ruptured infrapopliteal aneurysm reported.

Mycotic aneurysm affecting the tibioperoneal trunk is very rare. Only a few articles have reported bilateral mycotic aneurysms of the tibioperoneal trunk in the English literature. A 46-year-old man was suffering from consecutive bilateral mycotic aneurysms involving the tibioperoneal trunks after mitral-valve replacement for infective endocarditis. Each aneurysm was treated separately by a surgical approach, which included resection of the aneurysm, debridement of infectious tissue and arterial reconstruction using reversed saphenous vein graft. There was no recurrence of infection, and the graft remains patent. This is the first case of bilateral arterial reconstructions successfully performed for the tibioperoneal trunks.

The objective of this study was to assess the utility of peripheral computed tomography angiography (CTA) using 64-multidetector computed tomography (64-MDCT) in the detection of variations in branching patterns of the popliteal artery. The peripheral CTAs of 742 limbs in 342 patients who underwent peripheral CTA using 64-MDCT of the lower extremity due to various reasons were retrospectively reviewed. The anatomical variations in popliteal artery branching were assessed in 636 limbs from the same cohort of patients. Five hundred fifty-three (87 %) limbs had the usual branching pattern (type IA). Variations in the branching pattern of the popliteal artery were seen in 83 (13 %) limbs. The most common anatomical variation was trifurcation of the popliteal artery in 27 (4.2 %) limbs, with anterior tibial, posterior tibial, and peroneal arteries arising together with no true tibioperoneal trunk (type IB). The presence of variations in the anatomy of the popliteal artery could be of radiological and surgical importance in orthopedic interventions and various vascular surgery procedures. Peripheral CTA using MDCT is a suitable imaging modality for noninvasive evaluation of lower extremity arteries, and it may become the preferred method for evaluating variations in popliteal artery branching.

Summary We report the case of a 43 years-old man with a acute limb ischaemia due to the thrombosis of a tibioperoneal trunk aneurysm secondary to arterialfibroplasia. We review the literature, diagnostic methodology is discussedandthe different therapeutic options are revised.

Introduction: Pseudoaneurysms of the tibioperoneal trunk are rare and can be limb threatening. There are various treatment options to seal pseudoaneuryms both percutaneously and via open surgery. Case report: Description of the case of a large tibioperoneal trunk pseudoaneurysm that has been successfully treated by coil embolization in a patient with a previous endocarditys. Conclusion: Endovascular treatment of pseudoaneurysm should be considered as an alternative treatment option to open surgery. © 2010 Wiley-Liss, Inc.

Lactobacillus species are gram-positive aerobic bacteria that are ubiquitous and generally nonpathogenic inhabitants of the oral cavity, gastrointestinal tract, and female genital tract. Lactobacilli have been reported to cause various infections in immunocompetent and immunocompromised hosts. We hereby report a case of a mycotic aneurysm of the tibioperoneal trunk as a complication of Lactobacillus casei endocarditis.

The best treatment strategy for below the knee bifurcation disease is not known. We present first two cases with successful implantation of dedicated coronary bifurcation sirolimus eluting stent BiOSS Lim (Balton, Poland) in complex bifurcation and trifurcation lesions of tibioperoneal trunk. Both implantations were uncomplicated with sustained short-term result at 30-day control Duplex ultrasound and remarkable clinical improvement. Our report demonstrates feasibility and short-term effectiveness of implantation of dedicated coronary bifurcation stent in below-the-knee bi- and tri-furcations.

An acute occlusion of the tibio-peroneal trunk, due to gunshot wound injury in a young woman is presented. Delineation of the injury was determined during wound exploration. The wounded vessel was resected and arterial reconstruction was achieved by contralateral non-reversed greater saphenous vein graft interposition pretreated with blind valvulotomy. A large venous tributary allowed a bifurcated graft to be constructed. This case describes the technique of bifurcated non-reversed venous grafting, which has not been reported in an acute trauma scenario. The advantages of the method are discussed.