To evaluate the possibil ity of collateral outflow tract of arterial sclerosis obstruction （ASO）and the prospect of cl inical appl ication. Methods The red emulsion was infused into the arteries of the above knee amputation of 10 fresh specimens. Then the pathological changes of the anterior tibial artery, posterior tibial artery and the popl iteal artery, and the contribution of these bole artery branch were observed. From September 2005 to April 2007, 5 patients with ASO were treated, unilateral lower l imb was involved in all cases. There were 3 males and 2 females, aged 68-81 years. The arteriography and Color Doppler ultrasound of lower l imbs showed that the femoral artery and the popl itealartery and the branches had no development. The exploratory operation on the popl iteal artery and the branches was carried out. Results The walls of the anterior tibial artery, posterior tibial artery, and the popl iteal artery were stiff and the lumens were filled with atheromatous plaque. The sural arteries opening to the bole artery was frequent. The collateral circulation at the knee perimeter was raritas rather affluent at the muscle group. All of the operations were successful, the skin temperature increased gradually after operation, and the degrees of blood oxygen saturation increased to 90%-100% at 6 hours from 0 before operation . After a follow-up of 3 to 12 months, the symptom improved obviously, rest pain disappeared, lower l imb ulcer healed. The Color Doppler ultrasound showed that most of the blood flow at the anastomotic stoma ejected into bypass circuit, and the blood flow at the distally posterior tibial artery and anterior tibial artery was l ittle. Conclusion The collateral outflow tract construction is feasible, it is an effective path after cl inical verification to solve the advanced stage ASO
Objective To investigate theory guidance for preoperative appraisal of advanced stage lower limb arteriosclerosis obliterans and clinical application of arteriae surales. Methods From September 2007 to June 2008, one hundred cases without obviously arteriosclerosis were collected to accepted color Doppler ultrasonography, and parameters of the arteriae surales were observed， such as location, macro-body morphous, caliber, and blood parameters value, meanwhile the caliber and blood parameters value of anterior tibial artery and posterior tibial artery were also measured. Results Detection rate of arteriae surales was 96% (96/100). Arteriae surales located midpiece sequentiae of popliteal fossa, and above flatfish tendinous arch, which in 89 cases were geminous branched from popliteal artery; in the remaining 7 cases, popliteal artery diverged a bole, walked 1-3 cm, then diverged two branches and ingressed gastrocnemius. Diameter and cross section area of arteriae surales were smaller than those of anterior tibial artery and posterior tibial artery (P＜0.05）, but peak flow rate of systolic phase, maximum positive direction flow rate of relaxing period and mean flow rate were not significantly differents between arteriae surales and anterior tibial artery or posterior tibial artery （P＞0.05）. The flow of geminous arteriae surales was 63.1% of anterior tibial artery, and 59.1% of posterior tibial artery. Conclusion Through the ultrasonic study, it is significant for clinical therapy to master the normal anatomy, blood parameters value and flow of arteriae surales.
Objective To provide the anatomical basis for detecting distal outflow tract in late atherosclerosis obliteration in lower extremities. Methods Ten lower extremities that were amputated above knees because of late atherosclerosis obliteration were used in this experiment. The blood vessels in the residual bodies were perfused to run blood vessel cast mould to observe the anatomical and pathological change of the popliteal artery, the anterior and posterior tibial arteries and their collateral vessels. The number and distribution of those collateral vessels were also observed. Results The popliteal artery, anterior and posterior tibial arteries were all occluded due to atherosclerosis. However, there were three types of those collateral arteries: ① Atheromatous plaque in bole stretched into collateral arteries and led to occlusion. ② Obliteration was only observed at the initial segment, with no obstruction at the distal end but extenuated. ③ The collateral arteries originated from the bole artery symmetrically, keeping communicative with each other through punctiform interspaces. The last two types were mainly distributed at the inferior segment of popliteal artery, the superior segment of anterior and posterior tibial arteries, forming vascular anastomosing network in the whole cnemis muscle group. Conclusion Un-obstructed collateral arteries in certain places can be still found, though atherosclerosis obliteration is formed in popliteal artery, anterior and posterior tibial arteries in lower extremities. Therefore, it may be possible to construct collateral outflow tracts if endo-membrane stripping operation is performed.