Summary
Objective: To investigate arterial vascularity at the level of the proximal tibia as a potential source of the severe intra-operative haemorrhage, which has been previously reported as a complication during tibial plateau levelling osteotomy (TPLO) and triple tibial osteotomy (TTO) surgeries in dogs. To devise a surgical approach for the management of this complication.
Method: Eight pelvic limbs from five canine cadavers were dissected and the vascular structures at the level of the proximal tibia were identified and photographed. An arterial phase angiogram was performed on a sixth cadaver to further describe the vasculature in situ. Additional dissection was performed on four pelvic limbs to devise a medial surgical approach to the popliteal artery and the cranial tibial artery proximal to the stifle.
Results: The cranial tibial artery was identified as the most likely source of profuse haemorrhaging if damaged during proximal tibial osteotomy. Its course and branching are described. A simple medial approach to the popliteal artery at the level of its bifurcation into the cranial and caudal tibial arteries was developed.
Clinical relevance: Understanding of the vascular anatomy at the level of the proximal tibia may prevent iatrogenic damage and resulting haemorrhage during TPLO and TTO surgeries. Temporary occlusion of the cranial tibial artery can be achieved through a simple medial approach, proximal to the stifle, in the event of severe haemorrhage associated with TPLO or TTO.
Keywords
Cranial tibial artery - triple tibial osteotomy - tibial plateau levelling - haemorrhage - canine
