Critical Anatomic Variants in Peripheral Artery Disease Interventions

Abstract

Variant anatomy is relatively common in the lower extremity arteries and can play a role both in the incidence of peripheral arterial disease and the interventions performed to treat such disorders. Recognition of such anatomic variants prior to performing interventions on these patients is vital to be able to appropriately plan arterial approaches and in determining what intervention may be most appropriate for such patients. Interventional radiologists who perform lower extremity arterial interventions should be familiar with the most common anomalies affecting these vessels; this article discusses common lower extremity arterial anomalies and how these anomalies can affect interventional procedures in these vascular distributions.

Keywords

peripheral arterial disease - anatomy - interventional radiology - lower extremity - variant

Publication History

Article published online:
22 April 2025

• References

• 1 DeRoo E, Harris D, Olson S. et al. Conformability of the GORE EXCLUDER iliac branch endoprosthesis is associated with freedom from adverse iliac events. J Vasc Surg 2021; 74 (05) 1558-1564.e1
• 2 Wolf YG, Tillich M, Lee WA, Rubin GD, Fogarty TJ, Zarins CK. Impact of aortoiliac tortuosity on endovascular repair of abdominal aortic aneurysms: evaluation of 3D computer-based assessment. J Vasc Surg 2001; 34 (04) 594-599
• 3 Yufa A, Mikael A, Lara G, Nurick H, Andacheh I. Accessory renal arteries involved in atherosclerotic occlusive disease at the aortic bifurcation. J Vasc Surg Cases Innov Tech 2020; 6 (03) 425-429
• 4 Greenberg JI, Dorsey C, Dalman RL. et al. Long-term results after accessory renal artery coverage during endovascular aortic aneurysm repair. J Vasc Surg 2012; 56 (02) 291-296 , discussion 296–297
• 5 Malgor RD, Oderich GS, Vrtiska TJ. et al. A case-control study of intentional occlusion of accessory renal arteries during endovascular aortic aneurysm repair. J Vasc Surg 2013; 58 (06) 1467-1475
• 6 Granite G, Meshida K, Wind G. Frequency and clinical review of the aberrant obturator artery: a cadaveric study. Diagnostics (Basel) 2020; 10 (08) 546
• 7 Mengal MN, Ashraf T, Hassan Rizvi SN, Badini A, Karim M. Assessment of femoral artery bifurcation level with conventional angiography. Cureus 2018; 10 (10) e3479
• 8 Gupta V, Feng K, Cheruvu P. et al. High femoral artery bifurcation predicts contralateral high bifurcation: implications for complex percutaneous cardiovascular procedures requiring large caliber and/or dual access. J Invasive Cardiol 2014; 26 (09) 409-412
• 9 Uno T, Misaki K, Nakajima R. et al. Factors related to high bifurcation level of common femoral artery. J Stroke Cerebrovasc Dis 2023; 32 (03) 106976
• 10 Rajadurai VA, Sieunarine K. Superficial femoral artery duplication. J Vasc Interv Radiol 2015; 26 (09) 1323
• 11 van Hooft IM, Zeebregts CJ, van Sterkenburg SMM, de Vries WR, Reijnen MM. The persistent sciatic artery. Eur J Vasc Endovasc Surg 2009; 37 (05) 585-591
• 12 Bilhim T, Pereira JA, Fernandes L, Rio Tinto H, Pisco JM. Angiographic anatomy of the male pelvic arteries. AJR Am J Roentgenol 2014; 203 (04) W373-82
• 13 Qazi E, Wilting J, Patel NR. et al. Arteries of the lower limb-embryology, variations, and clinical significance. Can Assoc Radiol J 2022; 73 (01) 259-270
• 14 Rajasekaran S, Finnoff JT. Exertional leg pain. Phys Med Rehabil Clin N Am 2016; 27 (01) 91-119
• 15 Kim D, Orron DE, Skillman JJ. Surgical significance of popliteal arterial variants. A unified angiographic classification. Ann Surg 1989; 210 (06) 776-781
• 16 Tomaszewski KA, Popieluszko P, Graves MJ. et al. The evidence-based surgical anatomy of the popliteal artery and the variations in its branching patterns. J Vasc Surg 2017; 65 (02) 521-529.e6
• 17 Delgadillo D, Liang T, Hegazi M, Sharma N, Kabutey NK. In the loop: endovascular pedal arch revascularization. Ann Vasc Surg 2024; 107: 84-92
• 18 Troisi N, Turini F, Chisci E. et al. Impact of pedal arch patency on tissue loss and time to healing in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization. Korean J Radiol 2018; 19 (01) 47-53
• 19 Troisi N, Turini F, Chisci E. et al. Pedal arch patency and not direct-angiosome revascularization predicts outcomes of endovascular interventions in diabetic patients with critical limb ischemia. Int Angiol 2017; 36 (05) 438-444
• 20 Rashid H, Slim H, Zayed H. et al. The impact of arterial pedal arch quality and angiosome revascularization on foot tissue loss healing and infrapopliteal bypass outcome. J Vasc Surg 2013; 57 (05) 1219-1226
• 21 Ismail OA, Ahmed AA. Impact of pedal arch revascularization on clinical outcomes of diabetic patients with critical limb ischemia. Egypt J Surg 2020; 39: 344-351