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BACKGROUND: Transmetatarsal amputation (TMA) has a reputation for failure, centred around wound breakdown. No study has looked at the direct association between the patency of individual crural arteries and the healing of TMA. TMA relies on a posterior skin flap which derives its blood supply from the posterior tibial (PT) artery. We investigated the association between PT patency and achievement of successful TMA. METHODS: A retrospective review of all patients undergoing TMA for complications of peripheral arterial occlusive disease in a regional vascular tertiary referral centre over a 9 year period (2006-2015). TMA was considered successful by the absence of a higher-level amputation. Follow-up was for a minimum of 12 months. RESULTS: 24 patients (21 male; mean age 64 years) were studied. TMA was successful in 16 (67%). On statistical analysis, successful TMA was not significantly associated with vessel patency in either superficial femoral artery (SFA), or any single or combination of named crural artery. CONCLUSION: TMA healing can be achieved in the absence of a patent posterior tibial artery. We support the role of TMA in selected patients, given its benefits compared to transtibial amputation.

Ehlers–Danlos syndrome (EDS) is a hereditary disorder of the connective tissue. Ten different types of EDS have been described, most of which are associated with skin hyperflexibility and joint hypermobility. The type most frequently encountered by surgeons is the arterial ecchymotic type, or type IV. The phenotypical variance that characterizes EDS can make recognition difficult. The diagnosis is often made after vascular or gastrointestinal complications have occurred. We are describing a young pregnant patient with EDS type IV who developed a carotico-cavernous fistula, a crural artery pseudoaneurysm and died due to spontaneous intestinal rupture.

OBJECTIVE: to evaluate the efficacy of percutaneous transluminal angioplasty (PTA) of the crural arteries. PATIENTS AND METHODS: a retrospective review of patients treated with PTA of at least one crural artery during an 8-year period (1990--1997). RESULTS: one hundred and fifty-five legs in 140 consecutive patients (mean age 74 years, range 38--91 years) were treated. In 76% a more proximal lesion was also treated. After 1 year, results were significantly better in non-diabetics (improvement rate of 66% vs 32%p

Objective. To evaluate the long-term outcome of greater saphenous vein (GSV) infrapopliteal revascularisation in a single centre over a 10 year period. Material and methods. Fourty-one variables relating to a consecutive series of 90 crural artery GSV(76% in situ) bypasses in 81 patients (1990–2000) were analysed. The mean age of the 47 men and 34 women was 70 years. Limb-threatening ischaemia was present in 96% of cases, claudication in four patients. In 18 patients, surgery was ‘redo’. Results. The perioperative mortality was 3% (n=3). Patient survival was 54% at 4 years. Independent risk factors affecting survival were chronic renal insufficiency (p=0.04), hypertension (p=0.02), and ischaemic heart disease (p=0.01). Four bypasses thrombosed within 30 days. Three of them could be successfully reopened. Mean follow-up was 39 months. The primary patency rate at 4 years was 80%. Chronic renal insufficiency revealed to be the single independent risk factor for graft thrombosis (p=0.03, RR=12.4). The 4-year limb salvage rate was 88%. No independent risk factor affecting the limb salvage could be identified. Conclusion. Crural artery revascularisation is a valuable option for the management of limb threatening infrapopliteal arterial occlusive disease.

The most common peripheral aneurysm involves the popliteal artery. Crural artery aneurysms (aneurysms of one of the infrapopliteal arteries) are rare and almost always caused by a traumatic event. 1 This case report shows the rarely encountered phenomenon of the presence of a true aneurysm of the tibioperoneal trunk in a woman who attended our hospital because of ischemia of the toes of her right foot.

The subject of blood pressure in diabetes mellitus has aroused considerable controversy during recent years, and yet there is no unanimity of opinion on the matter at the present time. With the discrepancies in the literature in mind, a statistical study of the problem has been undertaken. Obviously, in order to make such a study, some standard must be used for comparison. In the analysis of the data presented in this paper the blood pressures of the diabetic persons are compared with those of three control series: (1) a group of dispensary patients; (2) a group of hospital patients, and (3) a so-called normal group. A necropsy series of diabetic cases is also studied. LITERATURE In 1733, Stephen Hales 1 performed his memorable experiment on the blood pressure of the horse, in which, after the insertion of a brass pipe into the crural artery, the "blood rose in the tube eight

We present two patients who presented with pain and swelling 3 weeks after a stab injury to the lower leg. Duplex scanning and arteriography revealed a pseudoaneurysm of a crural artery. Early diagnosis is important for a successful surgical reconstruction and delay in presentation may increase the risk of compartmental syndrome and subsequent soft tissue injury.