Accuracy and feasibility in building a personalized 3D printed femoral pseudoaneurysm model for endovascular training.

BACKGROUND: The use of three-dimensional(3D) printing is broadly across many medical specialties. It is an innovative, and rapidly growing technology to produce custom anatomical models and medical conditions models for medical teaching, surgical planning, and patient education. This study aimed to evaluate the accuracy and feasibility of 3D printing in creating a superficial femoral artery pseudoaneurysm model based on CT scans for endovascular training. METHODS: A case of a left superficial femoral artery pseudoaneurysm was selected, and the 3D model was created using DICOM files imported into Materialise Mimics 22.0 and Materialise 3-Matic software, then printed using vat polymerization technology. Two 3D-printed models were created, and a series of comparisons were conducted between the 3D segmented images from CT scans and these two 3D-printed models. Ten comparisons involving internal diameters and angles of the specific anatomical location were measured. RESULTS: The study found that the absolute mean difference in diameter between the 3D segmented images and the 3D printed models was 0.179±0.145 mm and 0.216±0.143mm, respectively, with no significant difference between the two sets of models. Additionally, the absolute mean difference in angle was 0.99±0.65° and 1.00±0.91°, respectively, and the absolute mean difference in angle between the two sets of data was not significant. Bland-Altman analysis confirmed a high correlation in dimension measurements between the 3D-printed models and segmented images. Furthermore, the accuracy of a 3D-printed femoral pseudoaneurysm model was further tested through the simulation of a superficial femoral artery pseudoaneurysm coiling procedure using the Philips Azurion7 in the angiography room. CONCLUSIONS: 3D printing is a reliable technique for producing a high accuracy 3D anatomical model that closely resemble a patient's anatomy based on CT images. Additionally, 3D printing is a feasible and viable option for use in endovascular training and medical education. In general, 3D printing is an encouraging technology with diverse possibilities in medicine, including surgical planning, medical education, and medical device advancement.

Evaluation of the arterial kink point during flexion of the hip: A dynamic angiographic study in iliac endofibrosis patients.

PURPOSE: The aim of the study was to determine the flexion point's location of the ilio-femoral arterial axis and its angulation. MATERIALS AND METHODS: Thirty-seven dynamic digital subtraction angiographies were analyzed and were included in the current study. Different lengths were measured, based on specific anatomical landmarks: the origin of the external iliac artery, the inguinal ligament and the bifurcation of the femoral artery. These lengths were measured in extension and during flexion of the hip in order to determine the flexion point of the artery. RESULTS: In extension, some physiological angulations of the external iliac artery were measured. During flexion of the hip joint, the distance from the kink point to the bifurcation of the common iliac artery was respectively 82 ± 21 mm (range 48-116) on the right side and 95 ± 20 mm (range 59-132) on the left side. The distance from the kink point to the inguinal ligament was respectively 38 ± 40 mm (range 12-138) on the right side and 26 ± 23 mm (range 8-136) on the left side. The distance from the kink point to the bifurcation of the femoral artery was respectively 45 ± 29 mm (range 15-107) on the right side and 27 ± 12 mm (range 10-66) on the left side. During flexion, the angulation of the flexion point of the ilio-femoral axis was 114 ± 18° (range 81-136°). CONCLUSIONS: The flexion point was located cranially to the inguinal ligament and below the departure of the external iliac artery.

The accessory vascularization of the tensor fasciae latae muscle: towards a new classification?

PURPOSE: The tensor fasciae latae (TFL) muscle is supplied by the lateral femoral circumflex artery (LCFA), arising from the deep femoral artery. However, it has been noted that there is also a consistent vascular anastomotic network. The aim of this study was to describe the accessory vascularization of the TFL muscle through a descriptive anatomical study, in order to hypothesize the feasibility of harvesting a TFL flap in the event of an injury to the main pedicle. In addition, we illustrate this hypothesis with a successful clinical case of Scarpa freconstruction following ligature of the deep femoral artery. METHODS: The description of the accessory vascularization was obtained by injecting dye into seven lateral femoral circumflex arteries (LCFA), six superficial circumflex iliac arteries (SCIA), and three inferior gluteal arteries (IGA). RESULTS: The TFL muscle was vascularized primarily by the LCFA. A vascular anastomotic network with the SCIA and the IGA was observed. After selective injection to the SCIAs and IGAs, the subsequent injection to the LCFA showed a diffusion of the TFL skin paddle with a perforasome overlapping between the different vascular territories. CONCLUSION: The ascending branch of the lateral femoral circumflex plays a dominant role in the vascularization of the TFL muscle. As a result of a periarticular anastomotic network of the hip, this artery establishes several connections with the proximal arteries. Consequently, in cases where blood flow through the LCFA is interrupted, it should be equally possible to harvest the TFL flap through its accessory vascularization.

Comparative Study of the Morphological Characteristics of Perforators of the Transverse and Descending Branches of the Lateral Circumflex Femoral Artery in Anterolateral Thigh Flap Surgery.

BACKGROUND: The anterolateral thigh flap (ALTF) is a kind of lateral thigh flap that uses branches of the lateral circumflex femoral artery (LCFA) as the vessel pedicle and is widely used in plastic surgery. During classic ALTF surgery, some perforators from the descending branch of the lateral circumflex femoral artery (LCFA-db) are hard to harvest due to their anatomical variants and individual differences; thus, it is necessary to design an appropriate alternative surgical plan. The transverse branch of the LCFA (LCFA-tb) has unique advantages and can be a potential complement to ALTF vascular pedicle selection. The aim of this study was to compare the difference in morphology between LCFA-db and LCFA-tb, and to verify the feasibility and clinical effect of ALTF with LCFA-tb as the source artery. METHODS: The morphological and clinical data of patients who underwent wound repair of the extremities with the ALTF pedicled with the LCFA-tb and LCFA-db were retrospectively analyzed. This study consisted of the clinical data of 62 patients who accepted an ALTF pedicled with LCFA-tb, and 45 patients accepted an ALTF pedicled with LCFA-db. RESULTS: A total of 68 cutaneous perforators originating from the LCFA-tb were found in the surgical field, of which 35 perforators were direct cutaneous perforators (51.5%), 28 perforators were septocutaneous perforators (41.2%), and 5 perforators were musculocutaneous perforators (7.3%). Seventy-four cutaneous perforators were found in the LCFA-db group. The proportions of septocutaneous perforators and musculocutaneous perforators were 23% and 77%, respectively, and the number of direct cutaneous perforators was 0. The harvest time of flaps pedicled with LCFA-tb was remarkably shortened. Regarding prognosis, there were no significant differences between the curative effects of the 2 types of flaps. CONCLUSIONS: This study verified that most LCFA-tb perforators are direct cutaneous perforators and that the piercing-in positions of LCFA-tb perforators on superficial fascia were higher than those of LCFA-db perforators. Furthermore, the ALTF pedicled with LCFA-tb can provide satisfactory soft tissue reconstruction and can be used as a useful supplement to the traditional flap design.

[Morphological study on the transverse branch of lateral femoral circumflex artery based on digital subtraction angiography].

Objective: To summarize the morphological characteristics of the transverse branch of lateral femoral circumflex artery (LFCA) using digital subtraction angiography (DSA) and explore its clinical significance. Methods: A retrospective observational study was conducted. From October 2020 to May 2021, 62 patients with soft tissue injuries in the extremities were hospitalized in Suzhou Ruihua Orthopedic Hospital, including 40 males and 22 females, aged from 20 to 72 years. DSA was performed in the lateral femoral region of patients before the anterolateral thigh flap transplantation, and in combination with imaging scale to observe and measure the general condition of the blood vessels and the occurrence (with the occurrence rate being calculated), source artery, location of the origin point, direction of course, and the location of the perforating point of the cutaneous perforator of the transverse branch of LFCA, and in addition to classify the morphological characteristics of the transverse branch. Results: DSA detection showed that the femoral artery, the deep femoral artery, and the branches of LFCA were clearly distinguishable in 62 patients. Transverse branches of LFCA were observed in 59 patients, including 52 cases with a single transverse branch, and 7 cases with double transverse branches. The occurrence rate of transverse branches was 95.2% (59/62). A total of 66 transverse branches of LFCA were observed, of which 3 originated from the deep femoral artery, and 63 originated from the LFCA. The origin point of the transverse branch was 6.5-12.7 cm away from the anterior superior iliac spine. The transverse branch which was approximately perpendicular to the long axis of the body, originated outwards, ran between the ascending branch of LFCA and the oblique branch of LFCA, and branched along the way, with the trunk running under the greater trochanter. The perforating point of the cutaneous perforator of the transverse branch was 8.0-18.0 cm away from the anterior superior iliac spine. In the classification of morphological characteristics of the transverse branch of LFCA, the most common type was the one that originated from the same trunk with other branches of LFCA, accounting for 50.0% (31/62), followed by the one that originated from the singular trunk of LFCA (12 cases) or deep femoral artery (3 cases), accounting for 24.2% (15/62); the special type accounted for 21.0% (13/62), including 7 cases of double transverse branches and 6 cases of the transverse branch originated from the same trunk with multiple other branches of LFCA; those with small/absent transverse branch only accounted for 4.8% (3/62). Among the above-mentioned common trunk relationship of two branches, those with shared trunk of ascending and transverse branches were most frequently observed, accounting for 77.4% (24/31); those with shared trunks of the transverse and oblique branches (5 cases) and the transverse and descending branches (2 cases) accounted for 22.6% (7/31) altogether. Conclusions: A high incidence rate of the transverse branch of LFCA is observed through DSA. The transverse branch originates from the lateral femoral artery approximately perpendicular to the long axis of the body, mainly from the same trunk with another main branch of LFCA, especially the ascending branch. This positioning analysis can provide an important reference for the design and resection of anterolateral femoral flaps.

Morphological study of branches of lateral femoral circumflex artery based on digital subtraction angiography.

In this study, the digital subtraction angiography (DSA) data were used to describe the number, course, and distribution of the branches of the lateral circumflex femoral artery (LCFA), in order to provide an imaging basis for the application of the anterolateral thigh flap pedicled with each branch of the LCFA. The number, location, direction, and distribution of the branches of the LCFA were analyzed by selective DSA angiography in 113 patients who needed an anterolateral thigh flap to repair the wound. LCFA usually originates from the deep femoral artery or femoral artery and routinely sends out four main branches: ascending branch, transverse branch, oblique branch, and descending branch. The ascending branch is about 45 °outward and upward with the horizontal axis of the body; the transverse branch is roughly parallel to the horizontal axis of the body to the outside of the thigh or slightly upward or downward; the oblique branch is about 45 °outward and downward to the body's long axis or horizontal axis and gradually turns parallel to the body's long axis; the 5∼10 cm at the beginning of the descending branch is parallel to the long axis of the body, and the internal and external branches are separated near the midpoint of the line between the anterior superior iliac spine and the lateral edge of the patella. It is of high reference value to use DSA technology to analyze the morphological characteristics of LCFA.

Microsurgical phalloplasty: Anatomical study evaluating the use of the external pudendal vessels as recipients.

The inferior epigastric artery (IEA) is commonly used as a recipient vessel in microsurgical phalloplasty but its use can be associated with abdominal parietal complications (hernia, bulging). To preclude such complications and avoid involvement of the femoral artery, we assessed an external pudendal artery (EPA) as a recipient vessel. We studied the disposition of the external pudendal system and its general anatomy. Then we compared the external diameter of the EPA to that of the first branches of the femoral artery. The most important point was to determine the location of the EPA through a reference line to facilitate a surgical approach. We then illustrated this preliminary study with a clinical case to check the reliability of the identified landmarks. Ten adult cadavers were dissected. The arteries of interest were part of a system consisting of either a common trunk or a duplicated system. The branches of the pudendal system arose from either the femoral artery or the deep femoral artery. On a horizontal reference line passing through the two pubic tubercles, we observed that 83% of EPAs arose between the reference line and 3 cm below it, at the level of a vertical axis centered on the femoral artery. The EPA could be suitable as recipient vessel in phalloplasty owing to its location, size, and ease of dissection. Using it instead of the IEA precludes abdominal parietal complications and reduces scarring in the recipient area.

Analysis of the Common Femoral Artery and Vein: Anatomical Morphology, Vessel Relationship, and Factors Affecting Vessel Size.

Background and Objectives: We aimed to analyze the morphology of the common femoral artery (CFA) and common femoral vein (CFV) and the anatomical relationship between the two blood vessels, and to investigate the factors that influence the size of these blood vessels. Materials and Methods: This retrospective study included 584 patients who underwent abdominal and pelvic computed tomography from 1 February to 28 February 2021. We measured the vessels at three regions on both lower extremities (inguinal ligament, distal vessel bifurcation, midpoint) and analyzed and classified the degree of overlap between the CFA and CFV into three types, as well as the factors affecting vessel size. Results: After comparing the femoral vessels according to location, it was confirmed that the CFA and CFV were larger distally than proximally on both sides (p < 0.001). The degree of overlap increased distally (p < 0.001) but was less at the middle (p < 0.001) and distal (p = 0.011) regions on the right side. It was found that the size of CFA and CFV were related to age, sex, and body mass index (BMI) and that malignancy also affects the CFA size. Conclusions: The morphology of the CFA and CFV was conical and increased distally. The degree of overlap between the two blood vessels also increased distally but was less on the right than on the left. Age, sex, and BMI are significant factors affecting the sizes of the CFA and CFV, and malignancy is associated with the CFA size.

Is there an athlete's artery? A comparison of brachial and femoral artery structure and function in male strength, power and endurance athletes.

OBJECTIVES: Exercise places physiological demands upon the cardiovascular system, subsequently leading to adaptations in structure and function. Different exercise modalities (endurance, strength and power) lead to distinct hemodynamic demands and, possibly, different patterns of adaptation. Our aim was to assess and compare brachial and femoral artery function and structure in elite level athletes engaged in endurance, strength and power sports. DESIGN: cross sectional comparison. METHODS: 30 male elite athletes (runners n=10, powerlifters n=11, weightlifters n=9) and 23 healthy controls were recruited. Brachial and femoral arterial diameters were assessed using ultrasound. Arterial function (brachial and femoral arteries) was determined using the flow mediated dilation (FMD) technique and body composition using body mass index (BMI) and body surface area (BSA). RESULTS: Weightlifters had significantly larger brachial arterial diameters compared to controls (4.39±0.34 vs 3.86±0.42mm, p<0.01). As weightlifter and power athletes had significantly higher body mass, BMI and BSA, we adjusted diameter for BSA. BSA-correction ameliorated differences in brachial artery resting diameters between athletes and controls. However, BSA-corrected femoral artery diameter was significantly larger in runners compared to controls (3.51±0.28 vs 3.25±0.34mm, p<0.05). There were no differences in brachial FMD between groups. Femoral artery FMD was significantly higher in runners and weightlifters compared to controls (p<0.05 for both groups). CONCLUSIONS: Heterogeneous, limb-specific structural and functional vascular adaptation is evident in athletes, which may be influenced by exercise modality. Further, vascular remodelling relates to differences in body shape, specifically body composition, which should be accounted for when comparing athletes.

The vascular exploration of the proximal femoral artery perforator region, an ideal donor site to choose cutaneous flaps of thin, supple, and glabrous skin: A cadaveric study.

BACKGROUND: The thigh region is a well-known area for harvesting cutaneous flaps for microsurgery replacement, given the characteristics of the skin: thin, flexible, and glabrous. We investigated the vascular pattern of 32 cadaveric anteroproximal thighs for the possibility of an extended harvesting area, which we call the proximal femoral artery perforator region. MATERIALS AND METHODS: We injected colored, radio opaque latex in the external iliac artery and investigated the perforator branches from the superficial circumflex iliac, femoral common, superficial, and deep femoral (profunda femoris) arteries to the skin of the proximal femoral artery perforator region. This region was divided into 3 equal subregions (superior, medial, and lateral), and their perforators were counted and measured. RESULTS: There was no significant difference in the number of arterial pedicles across the three subregions: 30 superior, 35 inferolateral, and 27 inferomedial. The perforators had a cutaneous path in 81% of the cases, while 6% were musculocutaneous and 5% septocutaneous, without a significant difference in their proportion in the three subregions. The mean length and diameter of the pedicles were 5.39 ±â€¯2.1 cm and 1.07 ±â€¯0.4 mm, respectively, without significant differences in the three subregions. CONCLUSIONS: The proximal femoral artery perforator region is a suitable area to generate flaps of various sizes and shapes, as needed by the surgeon. All perforators were constant and possessed a sufficient diameter and length for a successful anastomosis during the surgical procedure. The donor site retains all technical advantages to successfully replace areas of glabrous skin.

Variation of pectineus muscle forming a hiatus.

Knowledge of the anatomic variations in the pectineus muscle is important for vascular surgeons to minimize complications following surgical approach to the distal part of the deep femoral artery. During routine dissection of the thigh, variations in the bilateral pectineus muscles were identified in an 82-year-old male cadaver. On both sides, the superficial and deep layers of the pectineus were divided at its distal part, forming a triangular-shaped hiatus between them and the femur shaft. Distally, the tendon of the superficial part intermingled with the tendon of the adductor longus. The tendon of the deep part was inserted into the pectineal line. On the right side, the deep femoral artery and its first perforating artery passed through the hiatus. On the left side, the deep femoral artery pierced the hiatus, and then, the first perforating artery was branched from the deep femoral artery. No reported case has described a pectineal hiatus. The variations observed in this study are an ontogenetic vestige of the two different origins of the pectineus. The insertion of the superficial layer into the adductor longus tendon suggests a close relationship between these muscles during prenatal development. Surgeons should be aware of the variation to minimize injury to the pectineus muscle while approaching the deep femoral artery.

Musculoseptocutaneous Perforator of Anterolateral Thigh Flap: A Clinical Study.

BACKGROUND: The anterolateral thigh flap is one of the most useful workhorse flaps for microsurgical reconstruction. However, it can pose a great challenge to surgeons because of its anatomical variability. As the technology advances, not only septocutaneous or musculocutaneous courses of anterolateral thigh perforators but also a hybrid musculoseptocutaneous perforator pattern have been identified on computerized imaging and on cadaveric study. However, there is a paucity of clinical study in the literature. The aim of this investigation was to identify the features of this pattern. METHODS: All patients undergoing anterolateral thigh flap harvest between September of 2017 and May of 2018 performed by a single surgeon are included. Every pulsatile perforator was dissected to document its location on the thigh, emerging location (septum/muscle), size, course, and origin. RESULTS: Thirty-seven patients with 115 perforators were identified. Ten percent of perforators were septocutaneous, 37 percent were musculoseptocutaneous, and 52 percent were musculocutaneous. Forty-seven percent of perforators emerged on the septum between the rectus femoris and the vastus lateralis. Eighty-one percent of patients had one or more perforators in the "hot zone." Medium and large perforators were more frequently located in the proximal and hot zones. All perforators originated from the vascular tree of the lateral circumflex femoral artery, with 10 percent originating from the transverse branch, 28 percent originating from the oblique branch, and 62 percent originating from the descending branch. CONCLUSIONS: A high proportion of musculoseptocutaneous perforators were identified. The clinical relevance of this is to be very cautious on the skin paddle design while harvesting the flap.

Arterial branching pattern of the rabbit femoral artery.

Rabbits have highly developed hindlimb muscles, whereas their bones are fragile, thus resulting in frequent hindlimb fractures. To repair these fractures, it is important to understand the arterial branching pattern of the femoral artery, as it provides the main blood supply to the hindlimb. Since the descriptions from prior studies are insufficient, the aim of the present study was to determine the detailed arterial branching pattern of the rabbit femoral artery. Therefore, to address this issue, we examined 30 male and 20 female New Zealand White rabbits after colored latex injections into the femoral artery. Results showed that the femoral artery gave rise to the pudendoepigastric trunk, along with the deep femoral, lateral circumflex femoral, superficial caudal epigastric, saphenous, descending genicular, and proximal and middle caudal femoral arteries, in conjunction with frequent individual variations. In all the observed halves, the last branch from the femoral artery was the distal caudal femoral artery. Individual variations in the branching pattern of these arteries occurred independently in the proximal and the distal portions of the femoral artery, and they were, respectively, categorized into four and three major types based on the number of the branching levels along the proximodistal axis of the femoral artery. The individual variations in the arterial branching pattern of the rabbit femoral artery that were demonstrated in the present study may provide an important anatomical basis for refining the orthopedic surgical procedure in the rabbit.

The vascularization of the peroneal tendons: An anatomic study.

BACKGROUND: Arterial vascularization is intimately related to the peroneal tendon ruptures. Our purpose is to describe the vascular anatomy of peroneal tendons and assess differences in the vascularization patterns between peroneus brevis tendon (PBT) and peroneus longus tendon (PLT). METHODS: Anatomical study of 22 cadaveric lower extremities. We exposed tendons' vascularization by injecting latex. To systematize the vascular description, we considered four anatomical regions in the PBT and six in the PLT. RESULTS: Vascularization was supplied by the peroneal, anterior tibial and lateral plantar arteries and from the deep plantar arch through the vincula connecting the tendons. No avascular areas were found in the PLT. 22.7% of specimens had avascular areas in the PBT. Two visual vascularization patterns were found (arcuate and weblike). Increasing age and a web-like vascularization were associated with a lower number of blood vessels at the tendons' post malleolus area. CONCLUSION: Peroneal tendons are well vascularized throughout their course, running through a common vincula, with vascularization provided by various arteries. Avascular areas were observed in the PBT, but none at the PLT.

Profunda femoris artery perforator flaps: a detailed anatomical study.

The thigh region has many perforators when compared to the other areas in the body. Surgeons have disregarded the posterior thigh region as a potential donor site for perforator flap surgeries, presumably owing to the positioning difficulties of the patients during the intervention and inadequate anatomical information. The purpose of this study was to provide comprehensive data concerning the profunda femoris artery. Perforator flaps on an anatomical basis, and to describe anatomical landmarks, easing topographical flap dissection in various combinations. Eleven fresh cadaver thighs were obtained from different individuals using the Willed Body Program. The mean age was 43.5 years (29-63), and the male/female ratio was 7/4. We evaluated each cutaneous perforator for localization, diameter, source artery, numbers, length, and type (musculocutaneous or septocutaneous).We observed at least two perforators in all thighs in the study. Medial perforators consisted of 74.5% musculocutaneous and 25.5% septocutaneous perforators. Lateral perforators consisted of 68.3% septocutaneous perforators and 31.7% musculocutaneous perforators. Positioning difficulties of the patient during surgery and inadequate anatomical information cause surgeons to avoid this area. However, surgeons may easily perform these flaps in reconstructive surgery as a local or free flap with substantial success.

Surgical anatomy of the lateral circumflex femoral artery branches: Contribution to the blood loss control during hip arthroplasty.

BACKGROUND: The lateral circumflex femoral artery (LCFA) branches encountered during anterior and lateral hip approaches; although vessels' haemostasis is suggested in surgical textbooks, literature is scarce regarding their topography. The current study defines the exact location of the LCFA and its branches, based on osseous landmarks, as well as their size and possible variants, providing helpful information for intraoperative identification and demonstrating the magnitude of potential haemorrhage during hip surgery. METHODS: Twenty-three human cadavers (46 lower limbs) were dissected. The LCFA branching pattern was recorded. The distances of the LCFA origin and its first branch from the anterior superior iliac spine (ASIS) were measured. Length and width of the LFCA, LCFA ascending and transverse branches (LCFAab and LCFAtb) were calculated and compared to the ipsilateral ulnar artery (UA) width, which was served as a comparative guide. RESULTS: The LFCA origin was located 106.9 ± 17.5 mm distal and 65.6 ± 14.7 mm medial to the ASIS, while the LFCA first branch origin was 115.1 ± 24.3 mm distal and 48.2 ± 14.3 mm medial to the ASIS. The mean lengths of the LCFA, LCFAab and LCFAtb were 23.2 ± 12.6 mm, 44.8 ± 14.9 mm and 42.3 ± 13.6 mm, respectively. Their mean widths were 4.3 ± 1.0 mm, 2.9 ± 0.9 mm and 2.7 ± 0.7 mm, respectively, while the mean UA width was 2.7 ± 0.4 mm. CONCLUSION: The surgeon may detect the LCFA and its branching, at a mean distance of 110 mm (range 100-126 mm), distal to the ASIS. The LCFAab and LCFAtb widths are similar to the UA width. Meticulous knowledge of the branching pattern topography and vessels' size may contribute to a successful management of the intraoperative blood loss.

Development of an ultrasound-capable phantom with patient-specific 3D-printed vascular anatomy to simulate peripheral endovascular interventions.

PURPOSE: Today, ultrasound-guided peripheral endovascular interventions have the potential to be an alternative to conventional interventions that are still X-ray and contrast agent based. For the further development of this approach, a research environment is needed that represents the individual patient-specific endovascular properties as realistically as possible. Aim of the project was the construction of a phantom that combines ultrasound capabilities and the possibility to simulate peripheral endovascular interventions. MATERIAL AND METHODS: We designed a modular ultrasound-capable phantom with exchangeable patient specific vascular anatomy. For the manufacturing of the vascular pathologies, we used 3D printing technology. Subsequently, we evaluated the constructed simulator with regards to its application for endovascular development projects. RESULTS: We developed an ultrasound-capable phantom with an exchangeable 3D-printed segment of the femoral artery. This modality allows the study of several patient-specific 3D-printed pathologies. Compared to the flow properties of a human artery (male; age 28) the phantom shows realistic flow properties in the duplex ultrasound image. We proved the feasibility of the simulator by performing an ultrasound-guided endovascular procedure. Overall, the simulator showed realistic intervention conditions. CONCLUSIONS: With the help of the constructed simulator, new endovascular procedures and navigation systems, such as ultrasound-guided peripheral vascular interventions, can be further developed. Additionally, in our opinion, the use of such simulators can also reduce the need for animal experiments.

Collateral circulation of the femoral and genicular systems in human lower limbs is highly uncommon.

The descending branch of the lateral circumflex artery is a septocutaneous vessel that is vital for free and pedicle thigh flap transfer surgeries when repairing tissue defects. It also forms an anastomosis with the superior lateral genicular artery to create a collateral pathway for circumventing occlusions in the superficial femoral artery (SFA). Many anatomical texts and atlases imply the persistence of this anastomosis. However, previous studies indicate variability in the source of the arteries that form the anastomosis, and have reported cases where an anastomosis does not exist. We hypothesized that variations from the conventional accepted pattern can be predicted by comparisons of arterial diameters, and that unconventional anastomoses may be present to facilitate collateral circulation to the limb. Fifty-one limbs were dissected and analyzed to establish the source of the descending branch of the lateral circumflex artery, classify the types of anastomoses, and compare the diameters of the descending branch of the lateral circumflex artery, the SFA and the profunda femoris artery to the common femoral artery (CFA). Vessel diameters were normalized to the diameter of the CFA to allow comparison of limbs from both sexes and to minimize the effects of cadaver size on correlating vessel size to the presence or absence of collateral circuits. We report that 62.7% of limbs (32/51) had typical branching patterns; however, only 27.4% of limbs (14/51) had any anastomosis to connect the proximal and distal regions of the thigh. Importantly, the SFA had a wider relative diameter in limbs without anastomoses than in limbs that had normal anastomoses, perhaps precluding the formation of a collateral pathway. Overall, collateral circulation of the lower limb was highly uncommon, in contrast to information inferred from anatomical texts. This study suggests the need for more thorough procedures for determining viable anastomoses prior to thigh flap surgeries to ensure flap survival.

Feasibility of MRI based extracellular volume fraction and partition coefficient measurements in thigh muscle.

OBJECTIVE: This study aimed to assess the feasibility of extracellular volume-fraction (ECV) measurement, and time to achieve contrast equilibrium (CE), in healthy muscles, and to determine whether in-flow and partial-volume errors in the femoral artery affect measurements, and if there are differences in the partition coefficient (λ) between muscles. METHODS: T1 was measured in the biceps femoris, vastus intermedius, femoral artery and aorta of 10 healthy participants. This was repeated alternately between the thigh and aorta for ≥25 min following a bolus of gadoterate meglumine. λ was calculated for each muscle/blood measurement. Time to CE was assessed semi-quantitatively. RESULTS: 8/10 participants achieved CE. Time to CE = 19±2 min (mean ± 95% confidence interval). Measured λ: biceps femoris/aorta = 0.210±0.034, vastus intermedius/aorta = 0.165±0.015, biceps femoris/femoral artery = 0.265±0.054, vastus intermedius/femoral artery = 0.211±0.026. There were significant differences in λ between the muscles when using the same vessel (p < 0.05), and between λ calculated in the same muscle when using different vessels (p < 0.05). CONCLUSION: ECV measurements in the thigh are clinically feasible. The use of the femoral artery for the blood measurement is associated with small but significant differences in λ. ECV measurements are sensitive to differences between muscles within the healthy thigh. ADVANCES IN KNOWLEDGE: This paper determines the time to contrast equilibrium in the healthy thigh and describes a method for measuring accurately ECV in skeletal muscle. This can aid in the diagnosis and understanding of inflammatory auto-immune diseases.

There are no safe areas for avoiding the perforating arteries along the proximal part of the femur: A word of caution.

Knowledge about the variable course of the perforating arteries near the body of the femur is essential during surgical procedures (e.g., percutaneous cerclage wiring, plate osteosynthesis, Ilizarov technique). Our aims were to determine the number of perforating arteries, and to identify safe zones along the body of the femur within which perforating arteries are unlikely to pass toward the back of the thigh. The number of perforating arteries was determined in both legs of 100 formalin-fixed anatomic specimens of both sexes. The level of passage of perforating arteries near the body of the femur was measured in reference to a line from the anterior superior iliac spine to the medial femoral condyle. In each leg, two to seven perforating arteries were present. In 64% of legs, at least one artery divided into two to four branches before entering the back of the thigh. Thus, the total number of branches passing near the body of the femur varied between two to nine. Perforating arteries passed to the back of the thigh at every level between 14.0 and 36.5 cm from the anterior superior iliac spine (16-39% of the leg length). Within this distance, no safe zones along the body of the femur could be identified. The present study shows the high variability regarding number and course of the perforating arteries. Surgeons can be faced with an artery at every level on the posteromedial aspect of the body of the femur between 14.0 and 36.5 cm distally to the anterior superior iliac spine. Clin. Anat. 33:507-515, 2020. © 2019 Wiley Periodicals, Inc.