Relationship between the angle of popliteal artery trifurcation branches and atherosclerosis burden in chronic peripheral arterial disease

Aim: The aim of this study was to investigate the relationship between the angles of the popliteal artery trifurcation branches and atherosclerosis burden in patients with peripheral arterial disease (PAD). Material-Methods: Digital subtraction angiography (DSA) images of patients who underwent angioplasty for lower extremity PAD between April 2021 and 2023 were retrospectively analysed. The study excluded non-type 1a popliteal artery branching variations, critical stenosis or occlusion cases, and those with motion artifacts or previous femoropopliteal bypass operations. Angles of the anterior tibial artery (ATA), posterior tibial artery (PTA), and fibular artery (FA) were measured. Atherosclerosis burden was scored from 0 to 18 based on luminal narrowing and occlusion in each artery. Spearman correlation analysis was used to examine the relationship between trifurcation angles and atherosclerosis burden. Results: A total of 68 patients were included, with a mean age of 65 years. Angioplasty was performed on the right side in 56% of patients and on the left side in 44%. The ATA angle showed a weak positive correlation with atherosclerosis burden (rs = 0.144, p = 0.29). In contrast, PTA and FA angles exhibited moderate (rs = 0.398, p = 0.001) and strong (rs = 0.599, p < 0.001) positive correlations, respectively. Conclusion: This study highlights the significant association between the angulation of popliteal artery trifurcations and atherosclerosis burden, suggesting that vessel geometry should be considered in the management of PAD.