0:00

Moving on to our next variant, which is hypoplastic tibial arteries.

0:04

So this is actually a case of a 100-year-old female, and we're going

0:08

to ignore all the degrees of stenosis and calcifications, but just focus

0:12

on anatomy on this case. And so as we're focusing down the

0:16

aorta, it bifurcated into both common iliac arteries,

0:20

which are tortuous, that then bifurcated again into external and

0:24

internal iliac arteries. We're going to focus on the right side first.

0:29

And as we're scrolling down, we're going to focus on

0:33

this external iliac artery that has now become the common femoral

0:37

artery and bifurcated into the profunda femoral and the

0:41

superficial femoral artery.

0:43

As we're going down,

0:45

this superficial femoral artery, as it is leaving the

0:49

adductor hiatus, it is going to form the

0:53

popliteal artery.

0:55

And once it forms the popliteal artery right

0:57

here, it's going to give the branches as the

1:01

anterior tibial artery, a short tibial peroneal trunk.

1:05

And then this tibioperoneal trunk, as you can see, gives rise

1:09

to a very tiny, thready posterior tibial artery.

1:14

And really, we just have that anterior tibial artery and the

1:18

peroneal artery that go all the way down.

1:21

There are not many collaterals in this artery in this limb.

1:26

And this peroneal artery has gone all the way down, and then it

1:29

continues at the level of the ankle into the foot and becomes the

1:33

plantar artery.

1:35

Moving on to the left side.

1:38

So going back up here and kind of just starting over at that level of

1:42

that superficial femoral artery, looking at that superficial femoral

1:46

artery as we're scrolling down, it's become the popliteal artery.

1:50

And then as it goes into the calf, this popliteal artery

1:54

bifurcates into the anterior tibial artery, and then

1:58

that tibioperoneal trunk. And again, here we see a

2:02

very small posterior tibial artery coming off, and that

2:06

just kind of peters out. We have a large-calibered anterior

2:10

tibial and this peroneal artery. This peroneal

2:13

artery continues down, and then at the level of

2:17

the ankle again, it gives rise to and

2:21

continues as the plantar artery all the way in the foot.

2:25

So now bilaterally, we've seen that this

2:29

patient, we're going to MIP it again and we're going to see it.

2:33

So this patient had that anterior tibial and the

2:37

peroneal artery that has come out, and a very thready

2:40

posterior tibial artery that doesn't really form

2:44

the plantar artery, and there are not many collaterals.

2:48

And so the fact that this is a gradual petering out, there aren't any

2:52

collaterals, and the fact that the peroneal is forming the

2:55

plantar is all suggestive that this patient has a

2:58

hypoplastic posterior tibial artery on both sides.

3:02

Now in this person, they were not undergoing evaluation for a free

3:06

fibular flap. This was just an incidental finding, and nevertheless,

3:10

it's important to know that even though we might say that this person has a

3:14

two-vessel runoff, that two-vessel runoff is not because one of the

3:18

arteries is occluded, but rather because they're congenitally

3:21

hypoplastic because the peroneal has essentially taken over the

3:25

work of that hypoplastic posterior tibial artery.