Anatomy of the Peroneal Artery and its Role in Foot and Ankle Surgery

Abstract

The fibular artery (FA), according to the classic description, terminally divides into the posterior fibular artery (PFA) and the anterior perforating branch (APB). The objective of this study is to detail the terminal distribution of the peroneal artery. Anatomic dissection of 54 specimens was performed. The following variables were measured, taking the fibular malleolus as reference: distance to the most distal APB (terminal division), distance to other APB, presence of anastomotic branches (AB) between the FA and PTA, horizontal distances from the FA to the fibula at 5, 10 and 15 cm. Six types on the terminal distribution of the fibular artery were identified: type 1 or classical bifurcation (40.7%); type 2 (14.8%), accesory anterior perforating branch proximal to the terminal bifurcation; type 3A (18.5%), terminal trifurcation into anastomosis, anterior perforating branch and posterior peroneal artery; type 3B (5.6%), terminal trifurcation where the anastomotic branch bows to join both posterior peroneal and posterior tibial arteries; type 3C (13%), accesory anterior perforating branch proximal to the terminal trifurcation; type 3D (3.7%), accerosy anterior perforating and anastomotic branches proximal to the terminal trifurcation. Two specimens (3.7%) were nonclassifiable. Three dominant peroneal arteries were found (5.56%). Horizontal distances from the fibula to the FA were, at 5 cm, 0.83 ±1.21mm; at 10 cm 1.24 ±1.16mm; at 15 cm 1.63 ±1.34mm. No differences were found for side or gender.

Understanding the anatomy of the FA, its branches and anatomical variations, may help to avoid iatrogenic injury to the fibular vascular bundle during the varied and increasing foot and ankle surgical procedures performed, such as posterior open reduction internal fixation of ankle fractures, ankle arthrodesis or arthroscopy.