Hi Norma, According to my very favorite albeit rather ancient 1972 copy of
JC Boulieu Grant's An Atlas of Anatomy, (Williams and Wilkins, Baltimore) an
absence of the PTA with compensatory enlargement of the peroneal artery
occurred in 5.2% of 211 limbs. The reverse condition, ie: absence of the
peroneal artery with enlargement of the PTA probably never occurs. He shows
that the distal PTA or malleolar artery is often a continuation of a
perforating branch of the peroneal. A peroneal perforating branch is also
commonly seen reconstituting the DP in case of ATA occlusion or simply a
continuation in cases in which the ATA fails to reach the ankle.
Bill Schroedter
Venice, Fl
_____
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Norma
Vandenberghe
Sent: Friday, December 03, 2010 6:09 PM
To: [log in to unmask]
Subject: Re: anatomic variation in the deep calf veins
Thank you!!! I thought I was alone on a strange planet!! Welcome aboard!
NormaV-
-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Craig Hume
Sent: Friday, December 03, 2010 3:01 PM
To: [log in to unmask]
Subject: Re: anatomic variation in the deep calf veins
Seen it yes. Seen a reference. No.
In arterial studies I get cross because the angiogram is always reported as
a proximal/mid PTA occlusion despite me showing them the absence of PT
vessels at that level on the US screen (usually with me dragging them by the
ear).
On Sat, Dec 4, 2010 at 9:38 AM, Norma Vandenberghe <[log in to unmask]>
wrote:
Has anyone out there in flownetland ever seen a venous anatomy variant that
I run across from time to time?
The anatomy starts out normal at the posterior tibial veins at the ankle but
just above the ankle both the artery and the veins dive to peroneal depth. I
think that there is sometimes a small peroneal branch coming from the foot
but I do not always see this. The single PTV/PerVs then course through the
calf (with the accompanying PTA/perA) and there is only the one artery from
the tibio-peroneal trunk and the one pair of veins joining the venous trunk
or popliteal veins. I have seen this maybe 5-6 times a year for probably 15
years now but have never found a description of it in anatomy variant
references. When I have done both legs for the study this variant is always
(usually?) unilateral with the normal posterior tibial and peroneal vessels
on the contralateral leg.
I had a patient like this yesterday; she had a calf vein deep vein
thrombosis that had been identified at another lab and was described as
being in both the peroneal and the posterior tibial veins, but search as I
might I could not see a second artery or a second pair of veins. I usually
don't mention the variant in the report but this one seems more important
since the previous study (3 days ago) called it in both veins. What I saw
was a prominent mid calf occlusive deep vein thrombosis (a single dilated
vein without flow) and the other lab reported non-occlusive deep vein
thrombosis in the left peroneal and posterior tibial veins.
Anybody???
NormaV-
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