The fibular (peroneal) perforating artery pierces the interosseous membrane in the distal third of the leg, passing anterior to the distal fibula to anastomose with the lateral tarsal and anterior tibial arteries on the dorsum of the foot. It provides a critical collateral pathway when the anterior tibial artery is occluded.
The fibular perforating artery becomes clinically dominant when the anterior tibial artery is occluded by atherosclerosis, providing the only blood supply to the dorsalis pedis territory. Its presence is identified on CTA or angiography before bypass surgery. Perforator flaps based on this vessel are used in lower leg reconstruction.
Atherosclerotic occlusion of the anterior tibial artery at the ankle with maintained dorsal foot perfusion via the fibular perforating artery, detectable as a dorsalis pedis pulse despite absent anterior tibial signal on Doppler.
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