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Ex Vivo Evaluation of the Cranial Tibial Artery and Its Compression through Fragment Rotation during Tibia Plateau Levelling Osteotomy: An Angiographic Three-Dimensional ReconstructionFunding None.
Objective To illustrate the arterial vascularity of the proximal tibia three-dimensionally and to evaluate the impact of fragment rotation on the cranial tibial artery by tibia plateau levelling osteotomy (TPLO).
Methods Radiographic angiography and computed tomography (CT) were performed on 12 pelvic limbs from six large-breed canine cadavers before and after TPLO. Three-dimensional (3D) models of the stifle, including osseous and vascular structures, were obtained, and the integrity of the cranial tibial artery was assessed. Post-TPLO CT images were used to analyze compression of the cranial tibial artery by the rotated fragment.
Results The uncompressed cranial tibial artery caliber, measured proximally and distally to the osteotomy, was 9.52 mm2 (6.07–18.90 mm2). In all adequately rotated fragments, the mean caliber of the artery on the level of the osteotomy was 1.57 mm2 (0.89–2.93 mm2) after TPLO. This represented a significant decrease of approximately 81%. Only slight cross-sectional area decrease (8.8%) was seen in one limb, which was revealed to have insufficient fragment rotation (2.83 mm). Another limb only showed signs of stretching of the artery (31.51%), which was under-rotated and medially displaced. Pre-TPLO 3D reconstructions were mainly consistent with previous anatomic studies except for the distance between tibial cortex and cranial tibial artery, which appeared closer.
Conclusion Sufficient fragment rotation leads to compression of the cranial tibial artery. Intraoperative hemorrhage can be caused by laceration of the main cranial tibial artery or by multiple small branches reaching craniolaterally.
Keywordscranial cruciate ligament - cranial tibial artery - angiography - 3D reconstruction - tibial plateau levelling osteotomy
The conception of study and study design were done by L-.C.C., M.F., H.S., and O.H. All preoperative dissectional steps were performed by L-.C.C. under supervision of O.H. All surgical steps were performed by O.H. and assisted by L-.C.C. Model construction and data collection were done by L-.C.C. The analysis was performed by L-.C.C. with the assistance of H.S. and F.F. O.H. and M.F. supervised model construction, analysis, and manuscript editing. All authors read and approved the final manuscript.
The dogs were euthanized because of severe medical conditions (no orthopaedic problems) and remained in the hospital for disposal. None of the owners declared a ban on dissection.
Data Availability Statement
The collected and analyzed datasets for this study are available from the corresponding author on reasonable request.
Received: 24 March 2021
Accepted: 20 February 2022
Article published online:
17 May 2022
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