| Objective:To study the popliteal artery branching pattern using MDCT Angiography, to provide more information about the morphometric data of the popliteal artery so that we can contribute in the field of intervention radiology, vascular surgery and orthopedic surgery.Methods:The popliteal branching patterns were analyzed in the femoral CT angiograms of807cases (587male,220female) were evaluated retrospectively that is total of1614lower extremities, median age of patients included here is67years (age ranging from18-92years). All patients who had lower extremity angiogram in the Tianjin (Tianhe) hospital, Radiology department were included since2009.8till2013.4. CTA has been performed for the imaging process, and then images were reviewed in workstation using various post processing techniques like Maximum intensity projection and Volume Rendering. We used the classification of the Kim et al to verify the anatomical variation of the popliteal artery. For each artery three measurements were taken. We measured vertical length of the distance from medial tibial plateau to origin of the anterior tibial artery in millimeters and labelled it A and the distance from origin of AT to the PR and labelled it B. Distance B represent the vertical length of tibioperoneal trunk. And the3rd measurement was the angle formed by the popliteal artery and the AT. We took3values from each angle and calculated the average. For the statistical analysis of the data, firstly, we used normality test to check whether I can use parametric or non-parametric test. For non-parametric test I used chi square and for parametric test used t-test (for2groups), ANOVA (more than two groups) to compare mean. All these parameters were analyzed using SPSS version17.0. A value of P<0.05was regarded as statistically significant.Result:1)807cases were collected i.e. total1617lower extremities. After exclusion of121limbs,686cases were evaluated bilaterally and121cases unilaterally.624(90.96%) cases is showing the bilaterally symmetrical pattern which has Type I in611(89.07%) cases, Type II is4(0.58%) cases and TypeⅢis9(1.31%.).62(9.04%) bilateral cases are showing bilaterally unsymmetrical pattern which has Type I and II in39(5.96%) cases. Type Ⅰ and Ⅲin21(3.06%) cases and Type Ⅱ an Ⅲin2(0.29%) cases.2) Type I A,1344extremities (90.02%), the most common type of popliteal artery; Type I B,45extremities (3.01%), the most common type of variation; Type I C,8extremities (0.54%);Type ⅡA,32extremities(2.14%); Type ⅡB,21extremities (1.41%); Type ⅡC not seen; Type Ⅱ new,2extremities (0.13%); TypeⅢA,27extremities (1.18%); TypeⅢB,5extremities(0.33%); TypeⅢC9extremities (0.60%).3) We compared the frequency of both limbs in all three types relating with gender, result showed insignificant in all other types as P value is>0.05except in right extremities in both Type Ⅱ and Type Ⅱ which is significant. It shows that the female has higher incidence of Type Ⅱ and Ⅲas compared to male (Ⅱ:male1.26%, female2.91%,,χ2=4.69, P<0.05;Ⅲ:male0.81%, female2.12%, χ2=4.30,P<0.05).4) We compared difference in mean age and the angle in the total no. of extremities in Type I and it showed statistically significant difference (P=0.000,t=24.301). The mean angle in Type I in≤49years is (133.89±12.89)°,for50-59years is (129.24±18.81)°,for60-69years is (127.09±16.20)°,for70-79years is (126.17±17.07)°, and for≥80years is (122.96±14.82)°. We also compared the difference in mean angle between gender and age group. Result showed only significantly significance in two age group i.e.50-59and70-79years. The mean value for angle at age50-59years was (130.20±18.51)°n male and (123.20±16.69)°in female. At70-79years group is (128.47±16.59)°in male and (121.04±17.08)°in female.5) Association of side of the limbs with Angle, DIS1and DIS2in Type I without taking gender into consideration, shows statistically significant with the distance from origin of AT to the PR (DIS2).6) Association of gender with DIS1&2and Angle in Type I without taking side of the limbs into consideration, shows that gender has significant relationship with DIS1and Angle. However, it showed no relationship with DIS2with both gender.Conclusion:1) For this group of patients, the most common type of the popliteal artery is Type Ⅰ A; the most common Type of variation is Type Ⅰ B, Type ⅡC-rare. Type Ⅱ and TypeⅢ is more common in female than in male. Encountered one new pattern Type Ⅱnew.It provides not just anatomical data but also contribute in the field of interventional radiology and vascular surgery.2) When we compared limbs bilaterally for variation, it shows that as age increases the angle of the popliteal artery and the anterior tibial artery decreases in both male and female also decreases. Clinical data shows that the incidence of lower extremity vascular disease also increases with age. Such changes in anatomical factors may increase incidence in vascular disease.3) In Type Ⅰ, Side of limbs has influence on DIS2, Right side is longer than Left. In Type Ⅰ, Gender has influence on Angle and DIS1, Male’s Angle and the Distance is larger than Female. We made a reference distance of the popliteal artery branches:Male for the left and right limb, the mean distance from medial tibial plateau to the origin of the anterior tibial artery (DIS1) is (52.82±7.46) mm and (53.03±7.24) mm respectively, the mean distance from anterior tibial artery to PR (DIS2) is (26.20±12.11) mm and (28.42±11.38) mm respectively. Similarly for female on the left side and right side, the mean distance from medial tibial plateau to the anterior tibial artery origin is (47.46±6.67) mm and (47.93±5.71) mm respectively, from anterior tibial artery to PR (DIS2) is (24.94±10.87) mm and (28.28±10.06) mm respectively. These research results are based on Chinese people and reference values can be useful in the procedure like balloon catheter dilation of the blood vessels and the manufacture of stent. |
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