The arterial risk posed by the posterolateral approach to the ankle. An anatomical cadaveric observational study

N. Heeran, L. Roper, A. Gomaa, L. Mason, A. Bond

Introduction: The most commonly used approach for posterior malleolar access is the posterolateral approach. This approach gives good access to the fibula and lateral aspect of the posterior tibia, however; there is little known on the vascular risks with this approach.

Aim: The aim of this study was to assess and describe the anatomy of the peroneal artery and its branches at the ankle region.

Methods: Eleven cadaveric foot and ankle specimens were dissected in layers, preserving the peroneal artery, anterior tibial artery (ATA) and posterior tibial artery (PTA).

Results: The peroneal artery was consistently found between the peroneal compartment and deep muscular compartment of the posterior leg. A wide range of anatomical variation was found in the peroneal artery, in its location, muscular branches, anastomosis and anterior perforating branch. A variable anterior perforating branch of the peroneal artery (36.36%), a superficially located peroneal artery (27.27%), a variable anastomosis between the peroneal artery and PTA (27.27%), and a variable anastomosis between the ATA and peroneal artery (45.45%). The peroneal artery was the largest diameter artery in one specimen. The mean proximal distance between the medial malleolus and the posterior communicating branch of the peroneal artery was 37.93mm (range: 19.03- 85.43mm). The mean proximal distance from the medial malleolus to the anterior peroneal perforating artery was 44.23mm (range:35.44-62.32mm). Distal to the anterior perforating branch of the peroneal artery, the peroneal artery was immobile.

Conclusion: Understanding the common variations within the ankle’s arterial anatomy can help surgeons protect these vessels from damage during the surgical approach. The posterolateral surgical approach, specifically puts the peroneal artery at risk and knowledge of its anatomy and variability is important when undertaking this approach.