The anterior tibial artery is the smaller terminal branch of the popliteal artery, passing anteriorly through a gap in the interosseous membrane to supply the anterior compartment of the leg. It descends on the interosseous membrane between the tibialis anterior and extensor hallucis longus, becoming the dorsalis pedis artery at the ankle.
The anterior tibial artery is the vessel most commonly absent or hypoplastic in peripheral artery disease of the leg, where the peroneal artery often provides collateral flow. Doppler assessment of the dorsalis pedis at the dorsal foot measures anterior tibial territory perfusion. The anterior tibial artery is the vessel used for anastomosis in fibular free flap reconstruction, where the peroneal artery flap is anastomosed to the recipient anterior tibial vessels in the leg. It may be damaged in anterior compartment syndrome from swelling within the tight anterior fascial compartment.
Raised pressure within the anterior compartment compromises the anterior tibial artery and deep peroneal nerve — a surgical emergency requiring urgent fasciotomy.
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