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INTRODUCTION: Oxidative response is a risk factor in the progression of arterial atherosclerosis. OBJECTIVE: This research study aimed to examine the effects of oxidative response on atherosclerotic susceptibility as well as the development of arteriosclerosis occlusions of the tibial artery through pro-inflammatory mediator genes in elderly patients with occlusion of coronary arteries. METHODS: We determined that oxidative stress biomarkers (Malondialdehyde-modified Low-density Lipoprotein (MDA-LDL), Oxidized Low-density Lipoprotein (Ox-LDL) as well as Heme Oxygenase- 1 (HO-1)] and the expressions of pro-inflammatory mediator genes [Toll-like Receptor 4 (TLR4), Nuclear Factor kappa-B (NF-κB), Myeloid Differentiating factor 88 (MyD88) and Growth Arrest-specific gene 6 (GAS6)] have an impact on the severity of arteriosclerosis occlusions of tibial artery in elderly patients suffering from occlusion of coronary arteries. RESULTS: Levels of MDA-LDL, Ox-LDL, HO-1, TLR4, NF-κB, MyD88, and GAS6 were increased in the occlusion of tibial arteries + two-vessel coronary occlusion group compared to the CON group and occlusion of tibial arteries + one-vessel coronary occlusion group, respectively (p < 0.001); they were also elevated in occlusion of tibial arteries + multiple-vessel coronary occlusion group compared to occlusion of tibial arteries + one-vessel coronary occlusion group and occlusion of tibial arteries + two-vessel coronary occlusion group, respectively (P < 0.001). This has indicated the key roles of oxidative stress and pro-inflammatory mediator genes in arteriosclerosis occlusions of tibial artery in elderly patients with occlusion of coronary arteries. CONCLUSION: Oxidative response may promote the expressions of inflammatory genes and enhance susceptibility to arteriosclerosis occlusions of the tibial artery in elderly patients with chronic total coronary occlusions.

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BACKGROUND: No research has been conducted to compare long-axis in-plane and short-axis out-of-plane techniques for ultrasound-guided posterior tibial artery cannulation in adults. This study compared these two procedures for cannulating the posterior tibial artery. METHODS: This prospective randomized trial included 236 adult patients undergoing general anesthesia who required arterial cannulation. The posterior tibial artery was cannulated using either the long-axis in-plane technique (group LAIP) or the short-axis out-of-plane method (group SAOP) with an ultrasound machine. First-attempt cannulation success, the number of cannulation attempts required to achieve successful cannulation, ultrasound localization time, cannulation time, and perioperative complications in these two groups were analyzed. RESULTS: The LAIP group demonstrated a significantly higher first-attempt success rate (40.7% vs 18.6%, p < 0.001), shorter ultrasound localization time (36.5 [30, 60] s vs 50 [35, 80] s, p < 0.001), and faster cannulation time (80 [55, 100] s vs 110 [70, 180] s, p < 0.001). LAIP group showed a significantly higher overall success rate (92.4% vs 81.4%, p = 0.012). The median number of cannulation attempts in the LAIP and SAOP groups were 2 [1, 2] and 2 [2, 3], respectively (p < 0.001). Complications were comparable between groups (p = 0.248). CONCLUSIONS: The LAIP group demonstrated higher first-attempt and overall success rates compared to the SAOP group for ultrasound-guided posterior tibial artery (PTA) cannulation in adult patients.

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PURPOSE: The aberrant anterior tibial artery (ATA) runs along the posterior surface of the tibial cortex making it, particularly, at risk during high tibial osteotomy (HTO). This study aimed to analyze the prevalence of the ATA according to global morphotype and its anatomical features in consideration of knee surgery. METHODS: This retrospective study included 1589 knees on magnetic resonance imaging (MRI) studies with long-leg radiographs. The anatomical characteristics of the ATA, its distance in surgical areas at risk and its lumen were defined on MRI. Its presence according to the patient's morphotype (varus, valgus or neutral) was assessed using a χ2 test. RESULTS: The ATA was present in 33 of 1589 knees, resulting in a prevalence of 2.1%. The anteroposterior distance of the ATA to the tibial head was 6.6 ± 2.5 mm at the height of the tibial plateau, 2.7 ± 1.6 mm at the footprint of the posterior cruciate ligament and 1.0 ± 0.6 mm under the top of the fibula (p < 0.01). For these three levels, the ratio between the distance from the ATA to the lateral tibial border and the total tibial width decreases progressively (p < 0.001). The mean lumen area of the ATA was 4.2 ± 2.5 mm2, and the lumen of the popliteal artery was 9.2 ± 3.6 mm2, representing a ratio of 49.4 ± 27.0%. The prevalence of ATA was similar between varus and valgus patients (n.s). CONCLUSION: The presence of an ATA is rare, found in one out of 50 cases, but can be easily identified on MRI in patients before knee surgery, especially before HTO. The patient's morphotype did not influence its presence, the lumen diameter is highly variable and its clinical impact has yet to be determined. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3.

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During tibial plateau leveling osteotomy (TPLO), the laceration of the cranial tibial artery (LCTA) may occur, and the ligation of the cranial tibial artery might lead to impaired blood supply to the osteotomy site. The present case-control study aimed to evaluate the effect of LCTA on TPLO healing and the occurrence of perioperative complications. The incidence and predisposing factors to LCTA were also investigated. Fourteen cases experiencing LCTA were retrospectively enrolled from medical records of two veterinary teaching hospitals (LCTA group), whereas 28 randomly selected TPLOs that did not experience LCTA were included in the control group. Signalment data, proximal tibial epiphysis conformation, osteotomy features, perioperative complications, and bone healing were compared between the two groups. Bone healing was evaluated using the modified radiographic union scale for tibial fracture and the visual analog scale. The mean incidence was 9.6%. Bodyweight was significantly higher in the LCTA group compared to the control group (P = 0.009). Dogs belonging to the LCTA groups were significantly younger (P = 0.01). Intraoperative hypotension was significantly overreported in the LCTA group (P = 0.0001). None of the other variables differed significantly between the two groups. Dogs' size seems to be a predisposing factor, with dogs weighing >15 kg having 22 times more chance of experiencing LCTA. Due to the well-developed collateral blood supply of the canine hindlimb, LCTA and the closure of the cranial tibial artery did not appear to delay the radiographic bone healing or affect the incidence of perioperative complications.

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OBJECTIVE: The aim of the present study was to investigate the possible relationship between the segmental burden of lower limb atherosclerosis and Major Adverse Cardiovascular Events (MACEs). METHODS: All the consecutive symptomatic peripheral artery disease (PAD) patients admitted for digital subtraction angiography (DSA) at Turku University Hospital department of Vascular Surgery between 1 January 2009 and 30 July 2011 were retrospectively analyzed. Angiography due to symptomatic PAD was used as the index date for the inclusion in the study. The segmental burden of atherosclerosis based on DSA was divided into three categories according to the highest disease burden of the defined artery segment: aorto-iliac, femoropopliteal, or tibial segments. The major association for the study was MACEs (defined as a cerebrovascular event, heart failure (HF) and myocardial infarction requiring hospital admission). Demographic data and MACEs were obtained from the hospital electronic medical records system. RESULTS: The lower limb atherosclerosis burden of tibial vessels was related to an increased probability for HF (OR 3.9; 95%CI 2.4-6.5) and for MACEs overall (OR 2.3; 95%CI 1.4-3.6). The probability of both HF and MACEs overall rose with the increasing severity of the atherosclerosis burden. Moreover, the more severe the tibial vessel atherosclerosis, the higher the risk of HF and MACEs. The most extensive tibial atherosclerosis patients had an OR 4.5; 95%CI 2.6-8.0 for HF and an OR 3.1; and 95%CI 1.7-5.6 for MACEs overall. The femoropopliteal disease burden was also associated with an increased risk of HF (OR 2.3; 95%CI 1.6-3.2) and MACE (OR 1.9; 95%CI 1.3-2.7). However, the increasing extent of atherosclerosis of the femoropopliteal segment solely increased the risk of MACEs. CONCLUSIONS: PAD patients with severe tibial atherosclerosis are likely to present with MACEs. The risk is further enhanced as the extent of tibial vessel atherosclerosis is increased. An association between MACE and severe atherosclerosis on the aortoiliac segment was not detected. However, when the femoropopliteal segment was the most affected artery segment, the risk of MACEs was increased.

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INTRODUCTION: Neurovascular compromise following primary or revision total knee arthroplasty is a rare but severe complication. To the best of our knowledge, there have been reports of pseudoaneurysm of the popliteal artery following primary and revision; however, an anterior tibial artery pseudoaneurysm with articulating spacer has not been described yet. CASE PRESENTATION: We introduce a rare case of anterior tibial artery pseudoaneurysm and concomitant foot drop caused by an articulating spacer in a two-stage revision for infected knee replacement. Displacement of the articular spacer was observed on knee x-rays. Hematoma and pseudoaneurysm were detected. The patient was operated on urgently, and a pseudoaneurysm originating from the anterior tibial artery was intraoperatively observed. DISCUSSION: Vascular complications following TKA are rare but could be limb-threatening and even life-threatening. If postoperative displacement of the articulating spacer is observed with neurovascular symptoms, orthopedic surgeons should be alerted to the possibility of a pseudoaneurysm. CONCLUSION: Although rare, anterior tibial artery pseudoaneurysm should be considered among vascular injuries in revision knee arthroplasty cases.

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OBJECTIVE: This randomized clinical trial aimed to investigate the clinical efficacy of combining a medial superior malleolar perforator flap from the posterior tibial artery (PTAPF) with a vacuum-assisted closure (VAC) dressing for skin and soft tissue defects in the Achilles tendon area. METHODS: Twenty-eight patients were randomly divided into two equally sized groups: the control group received treatment with a medial superior malleolar perforator flap, while the experimental group was treated with a perforator flap from the posterior tibial artery in combination with a VAC dressing. Perioperative data, including average operative time, intraoperative blood loss, intraoperative complications, time to ambulation, and hospital stay after surgery, were recorded. Clinical outcomes were assessed based on the time to first weight-bearing walking, time to full weight-bearing activity, Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society hindfoot and ankle score, and the range of motion for ankle plantar flexion. RESULTS: The patients were monitored for 3-12 months (average, 8.5), and it was observed that the flaps remained stable without enlargement, and their texture and color were similar to the surrounding tissue. Significantly enhanced postoperative indices were noted in the experimental group compared to the control group (P<0.05). CONCLUSION: The medial superior malleolar perforator flap from the posterior tibial artery, especially when combined with a VAC dressing, proves to be an effective method for repairing medium-sized skin defects in the Achilles tendon area. This approach offers several benefits, including a reliable blood supply, simplicity of the procedure, decreased damage to the donor site, improved aesthetic outcomes, and fewer postoperative complications.

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PURPOSE: To investigate the clinical effect of posterior perforator tibial artery flaps on repairing soft tissue defects of limbs. METHODS: From June 2012 to June 2021, 14 cases of soft tissue defects of limbs were repaired with pedicled or free flaps of posterior perforator tibial artery. Among them, there were 9 cases of pedicled flaps and 5 cases of free flaps. The donor sites were closed directly or covered with skin grafting. The defects area varied from 3 × 5 cm to 7 × 16 cm. All cases were followed up for 1 year to 2 years. RESULTS: All flaps survived completely except 3 cases with distal end necrosis and the 3 cases healed after dressing change. There were not any other complications at both donor and recipient sites. Appearance of the recipient sites was close to the surrounding skin. All patients were satisfied with the results. CONCLUSION: Posterior perforator tibial artery flaps have the advantages of relatively simple technique, few damage, few complications and satisfying appearance. It is a good choice for soft tissue defects of limbs.

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Tibial artery pseudoaneurysms often result from penetrating or blunt trauma to the lower extremities, or after orthopedic and endovascular interventions. Clinically, these lesions manifest as an expanding pulsatile mass of the affected area accompanied with pain and erythema. Despite the rare occurrence, traumatic tibial pseudoaneurysms can be associated with significant morbidity including local discomfort, rupture, and lower limb ischemia. Duplex ultrasound is considered the gold standard for diagnosis. Treatment options include surgical repair, ultrasound-guided compression or thrombin injection, and endovascular repair. In this report, we describe a 42-year-old male who presented to our center with pulsatile swelling over the mid-lateral aspect of the left leg. The diagnosis of a large anterior tibial artery pseudoaneurysm was made on clinical basis and was confirmed with computed tomography angiography. The lesion was treated endovascularly with a covered stent graft. In conclusion, this case highlights the role of endovascular therapy as a surgery-sparing and minimally invasive approach in managing traumatic peripheral arterial pseudoaneurysms with excellent clinical outcomes.

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INTRODUCTION AND IMPORTANCE: Hydroxyurea is a cytotoxic drug commonly used to treat various myeloproliferative disorders. However, prolonged oral administration of this drug may trigger skin side effects and ulcers. There are few clinical reports on treating leg ulcers caused by hydroxyurea and even fewer clinical reports on managing recurrent ulcers after treatment. CASE PRESENTATION: An 87-year-old woman with essential thrombocythemia presented with a painful skin ulcer on her left calf. After failed outpatient treatment, she opted for hospitalisation for free skin grafting. Four months later, ulcers reappeared at the transplant site, leading to her readmission to the hospital. The diagnosis revealed that the leg ulcers were caused by hydroxyurea. Despite this, she persisted with hydroxyurea treatment and subsequently underwent posterior tibial artery perforator flap surgery. During the two-year follow-up, a new ulcer developed on the medial condyle of her other calf. However, no new ulcers or local pain were observed in the area where perforator flap grafting was performed. CLINICAL DISCUSSION: Leg ulcers caused by hydroxyurea are rare clinically and can easily be misdiagnosed. There is currently minimal research on ulcer recurrence after treatment. Posterior tibial perforator flaps may more effectively promote the healing of recurrent ulcers. CONCLUSION: Compared to conservative treatment and skin grafting surgery, the posterior tibial artery perforator flap offers a dependable blood supply and enhances the likelihood of wound healing. It can be considered an option, particularly for recurrent and refractory ulcers, even without discontinuing medication.

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In this study, we present a case of 59-year-old man with a posterior tibial artery (PTA) aneurysm. Mostly, PTA aneurysm is caused by trauma, infection, and iatrogenic injury. The patient had a history of ankle trauma that occurred 2 years ago. Computed tomography and ultrasonography showed a 7×14 mm PTA aneurysm. The aneurysm was resected and primary end-to-end anastomosis was performed. So far, there are only few reported cases of PTA aneurysm. Herein, we describe the surgical strategy and provide detailed intraoperative images.

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The study aims to evaluate the clinical application of posterior tibial artery or peroneal artery perforator flap in the treatment of plate exposure after ankle fracture fixation. A posterior tibial artery or peroneal artery perforator flap was used on 16 patients with plate exposure after ankle fracture fixation in our hospital between July 2018 and July 2021. The time required to harvest the flap, the amount of intraoperative blood loss, the duration of postoperative drainage tube placement, the outcome of the flap and the healing observed at the donor site are reported. The sizes of the flaps were 2.5-7.0 cm × 5.0-18.0 cm and averaged 4.0 cm × 12.0 cm. The time required to harvest the posterior tibial artery or peroneal artery perforator flap ranged from 35 to 55 min and averaged 45 min. The amount of intraoperative blood loss ranged from 20 to 50 mL and averaged 35 mL. The duration of postoperative drainage tube placement ranged from 3 to 5 days and averaged 4 days. A total of 15 flaps survived and one flap had partial necrosis and survived after conservative treatment. All donor area defects were directly sewed and stitched without complications. There are multiple advantages of the posterior tibial artery or peroneal artery perforator flap, including simple preparation technique, reliable repair of the defects and without the need for performing microvascular anastomosis. It can be safely used in curing plate exposure after ankle fracture fixation and worth popularizing in grassroots hospitals.

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Multiple stenotic lesions may restrict the access sites for endovascular therapy in the lower extremity arteries. Because guide sheaths used for endovascular therapy have recently become easier to insert, they are directly inserted into the posterior tibial or dorsalis pedis artery to perform the transtibial approach. We herein describe an 81-year-old man who was admitted to our hospital because of claudication of the left lower extremity. He had a history of left iliofemoral and femorofemoral bypass surgery. The patient's symptom was due to a stenotic lesion extending from the left common femoral artery to the distal part of the left superficial femoral artery. In an angiographic procedure using the antegrade approach via the right radial artery, a multipurpose catheter became stuck in the middle of the left iliofemoral bypass. The antegrade ipsilateral approach was too close to the stenotic lesion for the insertion of the guide sheath. Therefore, a retrograde approach using a 5-French guide sheath inserted via the dorsalis pedis artery was successfully performed.

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PURPOSE: The tarsal tunnel (TT) is a fibro-osseous anatomical space coursing from the medial ankle to the medial midfoot. This tunnel acts as a passage for both tendinous and neurovascular structures, including the neurovascular bundle containing the posterior tibial artery (PTA), posterior tibial veins (PTVs) and tibial nerve (TN). Tarsal tunnel syndrome (TTS) is the entrapment neuropathy that describes the compression and irritation of the TN within this space. Iatrogenic injury to the PTA plays a significant role in both the onset and exacerbation of TTS symptoms. The current study aims to produce a method to allow clinicians and surgeons to easily and accurately predict the bifurcation of the PTA, to avoid iatrogenic injury during treatment of TTS. METHODS: Fifteen embalmed cadaveric lower limbs were dissected at the medial ankle region to expose the TT. Various measurements regarding the location of the PTA within the TT were recorded and multiple linear regression analysis performed using RStudio. RESULTS: Analysis provided a clear correlation (p < 0.05) between the length of the foot (MH), length of hind-foot (MC) and location of bifurcation of the PTA (MB). Using these measurements, this study developed an equation (MB = 0.3*MH + 0.37*MC - 28.24 mm) to predict the location of bifurcation of the PTA within a 23° arc inferior to the medial malleolus. CONCLUSIONS: This study successfully developed a method whereby clinicians and surgeons can easily and accurately predict the bifurcation of the PTA, to avoid iatrogenic injury that would previously lead to an exacerbation of TTS symptoms.

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In idiopathic tarsal tunnel syndrome (TTS), walking seems to make symptoms worse. The findings imply that an ankle movement dynamic component may have an impact on the etiology of idiopathic TTS. We describe how the ankle movement affects the nerve compression caused by the surround tissue, particularly the posterior tibial artery. We enrolled 8 cases (15 sides) that had TTS surgery after tarsal tunnel (TT) MRI preoperatively. Dorsiflexion and plantar flexion were the two separate ankle positions used for the T2* fat suppression 3D and MR Angiography of TT. Based on these findings, we looked at how the two different ankle positions affected the posterior tibial artery's ability to compress the nerve. Additionally, we assessed the posterior tibial artery's distorted angle. We divided the region around the TT into four sections: proximal and distal to the TT and proximal half and distal half to the TT. Major compression cause was posterior tibial artery. Most severe compression point was proximal half in the TT in all cases without one case. In each scenario, the nerve compression worsens by the plantar flexion. The angle of the twisted angle of the posterior tibial artery was significantly worsened by the plantar flexion. In idiopathic TTS, deformation of posterior tibial artery was the primary compression component. Nerve compression was exacerbated by the plantar flexion, and it was attributable with the change of the distorted angle of the posterior tibial artery. This could be a contributing factor of the deteriorating etiology by walking in idiopathic TTS.

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Introduction: Synthetic vascular grafts perform poorly in small-caliber (<6mm) anastomoses, due to intimal hyperplasia and thrombosis, whereas homografts are associated with limited availability and immunogenicity, and bioprostheses are prone to aneurysmal degeneration and calcification. Infection is another important limitation with vascular grafting. This study developed a dual-component graft for small-caliber reconstructions, comprising a decellularized tibial artery scaffold and an antibiotic-releasing, electrospun polycaprolactone (PCL)/polyethylene glycol (PEG) blend sleeve. Methods: The study investigated the effect of nucleases, as part of the decellularization technique, and two sterilization methods (peracetic acid and γ-irradiation), on the scaffold's biological and biomechanical integrity. It also investigated the effect of different PCL/PEG ratios on the antimicrobial, biological and biomechanical properties of the sleeves. Tibial arteries were decellularized using Triton X-100 and sodium-dodecyl-sulfate. Results: The scaffolds retained the general native histoarchitecture and biomechanics but were depleted of glycosaminoglycans. Sterilization with peracetic acid depleted collagen IV and produced ultrastructural changes in the collagen and elastic fibers. The two PCL/PEG ratios used (150:50 and 100:50) demonstrated differences in the structural, biomechanical and antimicrobial properties of the sleeves. Differences in the antimicrobial activity were also found between sleeves fabricated with antibiotics supplemented in the electrospinning solution, and sleeves soaked in antibiotics. Discussion: The study demonstrated the feasibility of fabricating a dual-component small-caliber graft, comprising a scaffold with sufficient biological and biomechanical functionality, and an electrospun PCL/PEG sleeve with tailored biomechanics and antibiotic release.

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Introduction Dorsalis pedis or posterior tibial artery is selected as an alternative to radial artery cannulation when there is no access or unsuccessful cannulation of a radial artery. This study aimed to compare the two major arteries of the foot (dorsalis pedis and posterior tibial) in terms of their ultrasound (USG)-guided cannulation characteristics in patients posted for elective neurosurgical procedures. Methods All consenting patients, 18-65 years of age, scheduled for elective neurosurgical procedures under general anesthesia requiring arterial cannulations were enrolled. The first-pass success rate, assessment time, cannulation time, total procedural time, and the number of cannulation attempts for both procedures were estimated. Results A total of 90 patients were included in the study. The assessment time, cannulation time, and total time for arterial cannulation were significantly greater in the dorsalis pedis artery group than in the posterior tibial artery group (p < 0.001). Successful arterial cannulation in the first attempt was 73.3% in the dorsalis pedis, whereas it was 80% in the posterior tibial group but comparable (p = 0.455). The successful cannulation outcome was slightly more in the posterior tibial artery group but comparable (p = 1.00). Conclusion First-pass successful cannulation rates in the posterior tibial and the dorsalis pedis artery are comparable. However, the assessment time, cannulation time, and total procedural time are higher and statistically significant for dorsalis pedis artery cannulation compared to the posterior tibial artery group.

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Objective: To investigate the accuracy and reliability of augmented reality (AR) technique in locating the perforating vessels of the posterior tibial artery during the repair of soft tissue defects of the lower limbs with the posterior tibial artery perforator flap. Methods: Between June 2019 and June 2022, the posterior tibial artery perforator flap was used to repair the skin and soft tissue defects around the ankle in 10 cases. There were 7 males and 3 females with an average age of 53.7 years (mean, 33-69 years). The injury was caused by traffic accident in 5 cases, bruising by heavy weight in 4 cases, and machine injury in 1 case. The size of wound ranged from 5 cm×3 cm to 14 cm×7 cm. The interval between injury and operation was 7-24 days (mean, 12.8 days). The CT angiography of lower limbs before operation was performed and the data was used to reconstruct the three-dimensional images of perforating vessels and bones with Mimics software. The above images were projected and superimposed on the surface of the affected limb using AR technology, and the skin flap was designed and resected with precise positioning. The size of the flap ranged from 6 cm×4 cm to 15 cm×8 cm. The donor site was sutured directly or repaired with skin graft. Results: The 1-4 perforator branches of posterior tibial artery (mean, 3.4 perforator branches) in 10 patients were located by AR technique before operation. The location of perforator vessels during operation was basically consistent with that of AR before operation. The distance between the two locations ranged from 0 to 16 mm, with an average of 12.2 mm. The flap was successfully harvested and repaired according to the preoperative design. Nine flaps survived without vascular crisis. The local infection of skin graft occurred in 2 cases and the necrosis of the distal edge of the flap in 1 case, which healed after dressing change. The other skin grafts survived, and the incisions healed by first intention. All patients were followed up 6-12 months, with an average of 10.3 months. The flap was soft without obvious scar hyperplasia and contracture. At last follow-up, according to the American Orthopedic Foot and Ankle Association (AOFAS) score, the ankle function was excellent in 8 cases, good in 1 case, and poor in 1 case. Conclusion: AR technique can be used to determine the location of perforator vessels in the preoperative planning of the posterior tibial artery perforator flap, which can reduce the risk of flap necrosis, and the operation is simple.

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INTRODUCTION: Assessment of amputation risk has been discussed more than once in the management of patients with diabetes. Systemic inflammatory symptoms can serve as signs of an infectious process. However, not all patients show exhibit these symptoms in a timely manner. At the same time, a decrease in pain, tactile and temperature sensitivity fails as a part of the main assessment of risk factors in diabetes mellitus. METHODS: Using examination methods and comparing with clinical experience and the results of other researchers, a pilot study was carried out to diagnose structural changes in the foot in patients with diabetes. Nested examinations were carried out in several stages, on the expert class medical ultrasonographic apparatus Siemens Acuson NX3. The methods of ultrasound diagnostics in the diabetic foot can be significantly helpful when using a scale of criteria and guidelines for the examination. CONCLUSION: The main diagnostic criterion for determining the risks of developing a diabetic foot condition, could be a gradual transition from the phase of compaction of hyaline cartilage to the phase of synovitis, and then to the phase of development of bone tissue necrosis related to a part of the Charcot's foot. It leads to disruption of the musculoskeletal system of the foot, and atherosclerotic plaques and stenosis of the dorsalis pedis artery and first toe, which form a deterioration in the nutrition of the soft tissues of the foot with their necrosis.

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BACKGROUND: The palpation method of posterior tibial artery cannulation has not yet been compared to ultrasound-guided posterior tibial artery cannulation in adults. This research examined whether using ultrasound to cannulate the posterior tibial artery enhances first-pass cannulation success and lowers total procedure time. METHODS: In this randomized controlled experiment, 76 adult patients were included who were undergoing surgery under general anesthesia and required artery cannulation. Cannulation of the posterior tibial artery was performed utilizing either an ultrasound-assisted method (group U) or a palpation method (group P). Data were analyzed for cannulation success on the first attempt, number of cannulation attempts, assessment time, cannulation time, and total procedure time. RESULTS: The P group had a considerably shorter mean assessment time than the U group [14.29 ± 2.79 s vs 20.89 ± 2.70 s; p < .001]. Moreover, cannulation time was substantially longer in the P (29.20 ± 12.60 s) than in the U group (15.90 ± 6.50 s) (p < .001). The total procedure time remained statistically more in the P group than in the U group (p = 0.007). The rate of successful posterior tibial artery cannulation on the first attempt was comparable between the two groups (63.2% in the U and 55.3% in the P group, respectively; p = .484)]. CONCLUSIONS: The posterior tibial artery may be a suitable alternative to arterial cannulation for individuals with multiple failed attempts or difficult access. The application of ultrasound during posterior tibial artery cannulation in adult patients is safe and feasible and accompanied by a reduction in cannulation and total procedure time. The rate of first-attempt successful posterior tibial artery cannulation was comparable between the two groups.