Relationship between the angle of popliteal artery trifurcation branches and atherosclerosis burden in chronic peripheral arterial disease

Year 2024, Volume: 7 Issue: 3, 200 - 204, 30.09.2024

Ahmet Tanyeri , Ali Alkaşı

https://doi.org/10.36516/jocass.1526855

Abstract

Aim: The aim of this study was to investigate the relationship between the angles of the popliteal artery trifurcation branches and atherosclerosis burden in patients with peripheral arterial disease (PAD).
Material-Methods: Digital subtraction angiography (DSA) images of patients who underwent angioplasty for lower extremity PAD between April 2021 and 2023 were retrospectively analysed. The study excluded non-type 1a popliteal artery branching variations, critical stenosis or occlusion cases, and those with motion artifacts or previous femoropopliteal bypass operations. Angles of the anterior tibial artery (ATA), posterior tibial artery (PTA), and fibular artery (FA) were measured. Atherosclerosis burden was scored from 0 to 18 based on luminal narrowing and occlusion in each artery. Spearman correlation analysis was used to examine the relationship between trifurcation angles and atherosclerosis burden.
Results: A total of 68 patients were included, with a mean age of 65 years. Angioplasty was performed on the right side in 56% of patients and on the left side in 44%. The ATA angle showed a weak positive correlation with atherosclerosis burden (rs = 0.144, p = 0.29). In contrast, PTA and FA angles exhibited moderate (rs = 0.398, p = 0.001) and strong (rs = 0.599, p < 0.001) positive correlations, respectively.
Conclusion: This study highlights the significant association between the angulation of popliteal artery trifurcations and atherosclerosis burden, suggesting that vessel geometry should be considered in the management of PAD.

Keywords

atherosclerosis, peripheral arterial disease, angioplasty, trifurcation artery, digital subtraction angiography

References

• 1.Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(12): 726-79. https://doi.org/10.1161/CIR.0000000000000502
• 2.Criqui MH, Matsushita K, Aboyans V, et al. Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement from the American Heart Association. Circulation. 2021;144(9): 171-91. https://doi.org/10.1161/CIR.0000000000001005
• 3.Farah BQ, Ritti-Dias RM, Montgomery PS, et al. Sedentary behavior is associated with impaired biomarkers in claudicants. J Vasc Surg. 2016;63(3):657-63. https://doi.org/10.1016/j.jvs.2015.09.018
• 4.Kim D, Orron DE, Skillman JJ. Surgical significance of popliteal arterial variants. A unified angiographic classification. Ann Surg. 1989;210(6):776-81. https://doi.org/10.1097/00000658-198912000-00014
• 5.Kil SW, Jung GS. Anatomical variations of the popliteal artery and its tibial branches: analysis in 1242 extremities. Cardiovasc Intervent Radiol. 2009;32(2):233-40. https://doi.org/10.1007/s00270-008-9460-z
• 6.Aragonés P, Rodríguez-Niedenführ M, Quinones S, et al. Popliteal artery: Anatomical study and review of the literature. Ann Anat. 2021; 234:151654. https://doi.org/10.1016/j.aanat.2020.151654
• 7.Davies PF. Hemodynamic shear stress and the endothelium in cardiovascular pathophysiology. Nat Clin Pract Cardiovasc Med. 2009;6(1):16-26. https://doi.org/10.1038/ncpcardio1397
• 8.Ziyrek M, Sertdemir AL, Duran M. Effect of Coronary Artery Bifurcation Angle on Atherosclerotic Lesion Localization Distance to the Bifurcation Site. J Saudi Heart Assoc. 2020;32(3):399-407. https://doi.org/10.37616/2212-5043.1071
• 9.Otero-Cacho A, Aymerich M, Flores-Arias MT, et al. Determination of hemodynamic risk for vascular disease in planar artery bifurcations. Sci Rep. 2018;8(1):2795. https://doi.org/10.1038/s41598-018-21126-1
• 10.Barakat AI. Blood flow and arterial endothelial dysfunction: mechanisms and implications. Comptes Rendus Phys 2013;14:479-96. https://doi.org/10.1016/j.crhy.2013.05.003
• 11.Cicha I, Beronov K, Ramirez EL, et al. Shear stress preconditioning modulates endothelial susceptibility to circulating TNF-alpha and monocytic cell recruitment in a simplified model of arterial bifurcations. Atherosclerosis. 2009;207(1):93-102. https://doi.org/10.1016/j.atherosclerosis.2009.04.034
• 12.Katakia YT, Kanduri S, Bhattacharyya R, et al. Angular difference in human coronary artery governs endothelial cell structure and function. Commun Biol. 2022;5(1):1044. https://doi.org/10.1038/s42003-022-04014-3
• 13.Dolan JM, Meng H, Singh S, et al. High fluid shear stress and spatial shear stress gradients affect endothelial proliferation, survival, and alignment. Ann Biomed Eng. 2011;39(6):1620-31. https://doi.org/10.1007/s10439-011-0267-8
• 14.Dolan JM, Kolega J, Meng H. High wall shear stress and spatial gradients in vascular pathology: a review. Ann Biomed Eng. 2013;41(7):1411-27. https://doi.org/10.1007/s10439-012-0695-0
• 15.Chaichana T, Sun Z, Jewkes J. Computation of hemodynamics in the left coronary artery with variable angulations. J Biomech. 2011;44(10):1869-78. https://doi.org/10.1016/j.jbiomech.2011.04.033
• 16.Krams R, Wentzel JJ, Oomen JA, et al. Evaluation of endothelial shear stress and 3D geometry as factors determining the development of atherosclerosis and remodeling in human coronary arteries in vivo. Combining 3D reconstruction from angiography and IVUS (ANGUS) with computational fluid dynamics. Arterioscler Thromb Vasc Biol. 1997;17(10):2061-5. https://doi.org/10.1161/01.ATV.17.10.2061