Atherosclerosis commonly affects the superficial femoral and posterior tibial arteries but often spares the profunda femoris and peroneal arteries. The authors hypothesized that the descending branch of the lateral circumflex femoral artery (DBLCFA) is usually spared in the atherosclerotic process and thereby flaps based on this system can be useful for reconstructive surgery in patients with peripheral vascular disease (PVD) and diabetes mellitus (DM).
They retrospectively reviewed angiograms performed on patients with suspected vascular disease over a 1-year period. They measured the degree of stenosis present in the superficial femoral (SFA), profunda femoris (PFA), popliteal, tibioperoneal trunk, anterior tibial (AT), peroneal, and posterior tibial arteries, as well as the DBLCFA. Patient demographics were determined from computerized records and included age, sex, presence of coronary artery disease (CAD), DM, PVD, hypertension, hypercholesterolemia, end-stage renal disease, tobacco use, and aneurismal disease. Mean stenosis was calculated for each vessel, and using ANOVA, the patency of the DBLCFA and superficial femoral artery was compared in diabetics and non-diabetics. A chi-square test was used to determine any correlation between vessel stenosis and DM.
Forty-nine patients were identified who underwent LE angiograms and had adequate demographic data available. This included 29 males and 20 females with a mean age of 68 years (range: 38–88 years). Twenty-nine patients (59%) with DM, 43 (86%) with PVD, 14 (29%) with CAD, 39 (80%) with hypertension, 19 (39%) with hypercholesterolemia, 6 (12%) with end-stage renal disease, 18 (37%) who smoked, and 3 (6%) with aneurismal disease were included. Seventy-two limbs were studied angiographically (33 left and 39 right). The DBLCFA showed no atherosclerotic changes in 87%, mild changes in 4.5%, moderate changes in 1.5%, and severe disease in 7%. This was compared to the SFA where 19%, 23.5%, 13%, and 44% were seen, respectively. Mean stenosis of the DBLCFA was 10%. All other vessels demonstrated mean stenoses greater than 50% except for the PFA (12.5%). There was no correlation between the presence of DM and DBLCFA or SFA stenosis using the ANOVA test. No comorbidities or patterns of occlusive disease were identified which could predict DBLCFA stenosis.
The DBLCFA appears to be relatively spared from atherosclerosis, providing the reconstructive surgeon with multiple flap choices based on the versatility of this system.
