The Journal of Bone and Joint Surgery, Vol 72, Issue 3 409-414, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Magnetic resonance imaging of vascular anatomy before vascularized fibular grafting
BJ Manaster, DA Coleman and DA Bell
Department of Radiology, University of Utah, Salt Lake City.
Magnetic resonance images of the leg were made preoperatively to show the
vascular anatomy in twenty-nine patients (thirty-five legs) who were
between the ages of fourteen and forty-one years and in whom we planned to
use the fibula as a vascular graft. The fibula was harvested as a graft in
thirty-two legs, and this allowed us to compare the images with the
anatomical findings at operation. In these thirty-two legs, the branching
pattern, the measured distance to the bifurcation of the peroneal artery,
and all vascular anomalies in the area were accurately detected. No graft
was taken from the other three legs. We recommend that imaging of the
vascular anatomy of the leg be done before using the fibula as a vascular
graft in order to detect the precise point of origin of the peroneal artery
from the posterior tibial artery, to estimate the length of the vascular
pedicle, and to evaluate the role of the three major vessels in supplying
blood to the leg. All these aims can be accomplished with the aid of
angiography, but we have found that gradient-recalled acquisition in the
steady state (GRASS) magnetic-resonance imaging is more cost-effective and
is associated with less morbidity. It is not adequate for older patients
who have arterial stenosis or atherosclerosis or for patients who have some
other underlying vascular disease. Metallic hardware may cause artefacts
that obscure the vascular anatomy.
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