DIAGNOSIS AND TREATMENT OF ACUTE PERONEAL ARTERY ISCHEMIA SYNDROME_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHEKang ,  ZHANGXiansheng , YINJie , GUOHongjie , CHENGGong , WANGWeiliang

Department of Vascular and Endovascular Surgery, PekingUniversity First Hospital, Beijing, 100034, P. R. China;

Corresponding author：

ZHANGXiansheng, Email: zxs66229@sina.com

Keywords：

Acute lower limb ischemia; Peroneal artery; Angiosome; Thrombolysis

DOI：

10.7507/1002-1892.20140276

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To put forward the concept of acute peroneal artery ischemia syndrome, and to study its typical clinical manifestations and imaging features so as to provide the basis of the evidence-based medicine for the diagnosis and treatment of acute peroneal artery ischemia. Methods Between October 2009 and December 2012, 3 cases (2 males and 1 female, aged 57, 68, and 71 years) of acute peroneal artery ischemia syndrome were treated. All the patients displayed typical three symptoms of "peroneal artery blood supply zone pale/red + severe pain of the gastrocnemius muscle + acute drop foot". Medical examination revealed that they all had localized tenderness in the lateral and inferior part of the gastrocnemius muscle, with decreasing of skin temperature. The pulse of dorsalis pedis artery and the posterior tibial artery on affected limbs could be felt. Blood coagulation function and biochemical assay showed that D-dimer, fibrinogen degradation products, creatine kinase, or myoglobin markedly elevated. Magnetic resonance angiography revealed proximal peroneal artery stenosis. All patients were treated with intravenous thrombolysis, anticoagulation, vasodilation, and improving circulation therapy. Results The symptoms of lower limb swelling, pain, and fatigue were improved obviously in all patients after treatment. Blood coagulation function and biochemical assay showed D-dimer, fibrinogen degradation products, creatine kinase, or myoglobin were gradually reduced. The patients were discharged at 9-13 days after treatments, without recurrence during the follow-up of 1year. Conclusion Acute peroneal artery ischemia syndrome is a special type of acute lower limb ischemia, with the three symptoms of "peroneal artery blood supply zone pale/red+ severe pain of the gastrocnemius muscle + acute drop foot" as the main characteristics and should be treated by early active anticoagulant and recanalization therapy.

Citation： SHEKang, ZHANGXiansheng, YINJie, GUOHongjie, CHENGGong, WANGWeiliang. DIAGNOSIS AND TREATMENT OF ACUTE PERONEAL ARTERY ISCHEMIA SYNDROME. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1273-1277. doi: 10.7507/1002-1892.20140276 Copy

1.	Taylor GI, Pan WR.Angiosomes of the leg:anatomic study and clinical implications.Plast Reconstr Surg, 1998, 102(3):599-616.
2.	Neville RF, Attinger CE, Bulan EJ, et al.Revascularization of a specific angiosome for limb salvage:does the target artery matter? Ann Vasc Surg, 2009, 23(3):367-373.
3.	Kabra A, Suresh KR, Vivekanand V, et al.Outcomes of angiosome and non-angiosome targeted revascularization in critical lower limb ischemia.J Vasc Surg, 2013, 57(1):44-49.
4.	吴永沐, 丁训诏.100侧腓动脉与腓骨血供关系的研究.解剖学报, 1981, 12(1):20-26.
5.	Longo B, Sorotos M, Nicolotti M, et al.Retrospective analysis of incidence of peroneal artery hypoplasia in 101 free fibula transfers and new classification of popliteal branch anomalies.Injury, 2014, 45(2):394-398.
6.	Kishman L, Malin D, Nerone V, et al.Clinical implications of peroneal artery variation.Foot Ankle Spec, 2009, 2(3):135-139.
7.	Slaba S, Abi KS, Younan T, et al.Unusual variation of popliteal arterial branches:4 axes by early division of the peroneal artery.J Mal Vasc, 2007, 32(4-5):212-215.
8.	Attinger CE, Evans KK, Bulan E, et al.Angiosomes of the foot and ankle and clinical implications for limb salvage:reconstruction, incisions, and revascularization.Plast Reconstr Surg, 2006, 117(7 Suppl):261S-293S.
9.	Attinger C, Cooper P, Blume P, et al.The safest surgical incisions and amputations applying the angiosome principles and using the Doppler to assess the arterial-arterial connections of the foot and ankle.Foot Ankle Clin, 2001, 6(4):745-799.
10.	Alexandrescu V, Hubermont G.Primary infragenicular angioplasty for diabetic neuroischemic foot ulcers following the angiosome distribution:a new paradigm for the vascular interventionist? Diabetes Metab Syndr Obes, 2011, 4:327-336.
11.	Faglia E, Clerici G, Caminiti M, et al.Heel ulcer and blood flow:the importance of the angiosome concept.Int J Low Extrem Wounds, 2013, 12(3):226-230.
12.	Kabra A, Suresh KR, Vivekanand V, et al.Outcomes of angiosome and non-angiosome targeted revascularization in critical lower limb ischemia.J Vasc Surg, 2013, 57(1):44-49.
13.	McKeon KE, Wright RW, Johnson JE, et al.Vascular anatomy of the tibiofibular syndesmosis.J Bone Joint Surg (Am), 2012, 94(10):931-938.
14.	Ugrenovic SZ, Jovanovic ID, Kovacevic P, et al.Similarities and dissimilarities of the blood supplies of the human sciatic, tibial, and common peroneal nerves.Clin Anat, 2013, 26(7):875-882.
15.	Kadiyala RK, Ramirez A, Taylor AE, et al.The blood supply of the common peroneal nerve in the popliteal fossa.J Bone Joint Surg (Br), 2005, 87(3):337-342.
16.	Bonel HM, Saar B, Hoppe H, et al.MR angiography of infrapopliteal arteries in patients with peripheral arterial occlusive disease by using gadofosveset at 3.0 T:diagnostic accuracy compared with selective DSA.Radiology, 2009, 253(3):879-890.
17.	Haider CR, Glockner JF, Stanson AW, et al.Peripheral vasculature:high-temporal-and high-spatial-resolution three-dimensional contrast-enhanced MR angiography.Radiology, 2009, 253(3):831-843.
18.	Albayrak R, Saglam H, Emmiler M, et al.Large mycotic aneurysm of the peroneal artery.J Clin Ultrasound, 2007, 35(6):344-346.
19.	Ferrero E, Ferri M, Carbonatto P, et al.Endovascular treatment of a symptomatic mycotic aneurysm of the peroneal artery.Ann Vasc Surg, 2011, 25(7):982.e11-14.
20.	Miura T, Soga Y, Nobuyoshi M.Iatrogenic peroneal artery pseudoaneurysm treated by transluminal coil embolization.Cardiovasc Interv Thers, 2013, 28(1):128-130.
21.	Hirsch AT, Haskal ZJ, Hertzer NR, et al.ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic).Circulation, 2006, 113(11):e463-654.
22.	汤敬东, 钱水贤.急性下肢动脉栓塞治疗的决策探讨.中国血管外科杂志(电子版), 2012, 4(2):75-78.

1. Taylor GI, Pan WR.Angiosomes of the leg:anatomic study and clinical implications.Plast Reconstr Surg, 1998, 102(3):599-616.
2. Neville RF, Attinger CE, Bulan EJ, et al.Revascularization of a specific angiosome for limb salvage:does the target artery matter? Ann Vasc Surg, 2009, 23(3):367-373.
3. Kabra A, Suresh KR, Vivekanand V, et al.Outcomes of angiosome and non-angiosome targeted revascularization in critical lower limb ischemia.J Vasc Surg, 2013, 57(1):44-49.
4. 吴永沐, 丁训诏.100侧腓动脉与腓骨血供关系的研究.解剖学报, 1981, 12(1):20-26.
5. Longo B, Sorotos M, Nicolotti M, et al.Retrospective analysis of incidence of peroneal artery hypoplasia in 101 free fibula transfers and new classification of popliteal branch anomalies.Injury, 2014, 45(2):394-398.
6. Kishman L, Malin D, Nerone V, et al.Clinical implications of peroneal artery variation.Foot Ankle Spec, 2009, 2(3):135-139.
7. Slaba S, Abi KS, Younan T, et al.Unusual variation of popliteal arterial branches:4 axes by early division of the peroneal artery.J Mal Vasc, 2007, 32(4-5):212-215.
8. Attinger CE, Evans KK, Bulan E, et al.Angiosomes of the foot and ankle and clinical implications for limb salvage:reconstruction, incisions, and revascularization.Plast Reconstr Surg, 2006, 117(7 Suppl):261S-293S.
9. Attinger C, Cooper P, Blume P, et al.The safest surgical incisions and amputations applying the angiosome principles and using the Doppler to assess the arterial-arterial connections of the foot and ankle.Foot Ankle Clin, 2001, 6(4):745-799.
10. Alexandrescu V, Hubermont G.Primary infragenicular angioplasty for diabetic neuroischemic foot ulcers following the angiosome distribution:a new paradigm for the vascular interventionist? Diabetes Metab Syndr Obes, 2011, 4:327-336.
11. Faglia E, Clerici G, Caminiti M, et al.Heel ulcer and blood flow:the importance of the angiosome concept.Int J Low Extrem Wounds, 2013, 12(3):226-230.
12. Kabra A, Suresh KR, Vivekanand V, et al.Outcomes of angiosome and non-angiosome targeted revascularization in critical lower limb ischemia.J Vasc Surg, 2013, 57(1):44-49.
13. McKeon KE, Wright RW, Johnson JE, et al.Vascular anatomy of the tibiofibular syndesmosis.J Bone Joint Surg (Am), 2012, 94(10):931-938.
14. Ugrenovic SZ, Jovanovic ID, Kovacevic P, et al.Similarities and dissimilarities of the blood supplies of the human sciatic, tibial, and common peroneal nerves.Clin Anat, 2013, 26(7):875-882.
15. Kadiyala RK, Ramirez A, Taylor AE, et al.The blood supply of the common peroneal nerve in the popliteal fossa.J Bone Joint Surg (Br), 2005, 87(3):337-342.
16. Bonel HM, Saar B, Hoppe H, et al.MR angiography of infrapopliteal arteries in patients with peripheral arterial occlusive disease by using gadofosveset at 3.0 T:diagnostic accuracy compared with selective DSA.Radiology, 2009, 253(3):879-890.
17. Haider CR, Glockner JF, Stanson AW, et al.Peripheral vasculature:high-temporal-and high-spatial-resolution three-dimensional contrast-enhanced MR angiography.Radiology, 2009, 253(3):831-843.
18. Albayrak R, Saglam H, Emmiler M, et al.Large mycotic aneurysm of the peroneal artery.J Clin Ultrasound, 2007, 35(6):344-346.
19. Ferrero E, Ferri M, Carbonatto P, et al.Endovascular treatment of a symptomatic mycotic aneurysm of the peroneal artery.Ann Vasc Surg, 2011, 25(7):982.e11-14.
20. Miura T, Soga Y, Nobuyoshi M.Iatrogenic peroneal artery pseudoaneurysm treated by transluminal coil embolization.Cardiovasc Interv Thers, 2013, 28(1):128-130.
21. Hirsch AT, Haskal ZJ, Hertzer NR, et al.ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic).Circulation, 2006, 113(11):e463-654.
22. 汤敬东, 钱水贤.急性下肢动脉栓塞治疗的决策探讨.中国血管外科杂志(电子版), 2012, 4(2):75-78.

Chinese Journal of Reparative and Reconstructive Surgery

DIAGNOSIS AND TREATMENT OF ACUTE PERONEAL ARTERY ISCHEMIA SYNDROME

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content