Anatomical Courses of Collateral Circulations in Patients with Infrainguinal Chronic Lower-Extremity Arterial Occlusive Disease.

BACKGROUND: This study aimed to identify the anatomical course of collateral vessels in chronic lower-extremity arterial occlusive disease to optimize intramuscular injection sites for angiogenesis therapy.

METHODS: We retrospectively analyzed 35 limbs with superficial femoral artery (SFA) occlusion and 17 limbs with 3 crural artery occlusion using 1-mm slice contrast-enhanced computed tomography. Collateral vessels (≥1 mm) connecting the common femoral to popliteal arteries, and popliteal to foot arteries were identified. Donor and recipient arteries, and vessel courses were documented.

RESULTS: In SFA occlusion, 49 collateral vessels were identified. The deep femoral artery was the sole donor. Recipient arteries were predominantly the lateral (94%) and medial (6%) superior genicular arteries. Seventy-one percent (35 of 49) of collaterals ran within the short head of the biceps femoris. In crural artery occlusion, 17 collaterals were found. Donor arteries included the peroneal (29%), posterior tibial (24%), and combinations thereof. Recipient arteries were the anterior tibial (53%), plantar (29%), and dorsalis pedis (18%). All collaterals coursed through the soleus muscle, with 35% traversing the posterior tibial muscle.

CONCLUSION: Collateral vessels in chronic lower-extremity arterial occlusive disease exhibit preferential development within specific muscles. In SFA occlusion, collaterals develop predominantly within the short head of the biceps femoris, while in crural artery occlusion, collaterals develop within the soleus muscle. These findings suggest that targeted intramuscular injections, guided by anatomical knowledge of collateral pathways, may enhance angiogenesis therapy efficacy.