From the Guidelines
If the posterior tibial artery is lacerated by bone without severing the skin, immediate medical attention is required to prevent severe complications such as compartment syndrome and infection. The recommended course of action is:
- Seek emergency medical care immediately.
- Apply firm, direct pressure to the area to control bleeding.
- Keep the affected limb elevated above heart level.
- Do not attempt to remove any visible bone fragments. Upon arrival at a medical facility, treatment will likely involve:
- Diagnostic imaging (CT angiography or arteriography) to assess the extent of damage, as recommended by the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1.
- Surgical exploration and repair of the artery, with the goal of establishing in-line blood flow to the foot, as suggested by the 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease 1.
- Possible fasciotomy to prevent compartment syndrome.
- Antibiotic prophylaxis (e.g., cefazolin 1-2g IV every 8 hours for 24-48 hours) to prevent infection, as recommended by the ACC/AHA guidelines 1.
- Pain management as needed. Post-treatment, the patient will require:
- Close monitoring for signs of compartment syndrome or infection.
- Follow-up vascular studies to ensure proper healing.
- Physical therapy for rehabilitation. This situation is serious because the posterior tibial artery is a major blood supply to the lower leg and foot, and its laceration can lead to significant blood loss and potentially severe complications, as highlighted by the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1.
From the Research
Injury to the Posterior Tibial Artery
- The posterior tibial artery is a vital blood vessel that supplies blood to the lower leg and foot 2.
- If the posterior tibial artery is lacerated by a bone without penetrating the skin, it can lead to a pseudoaneurysm or aneurysm formation 3, 4.
- A pseudoaneurysm is a rare but potentially devastating injury that requires prompt diagnosis and treatment to prevent ischemic damage to distal tissues 2, 4.
Treatment Options
- Endovascular coil embolization is a safe and non-invasive treatment option for pseudoaneurysms of the posterior tibial artery, particularly in young patients with distal collateral circulation 4.
- Surgical repair of the posterior tibial artery may also be necessary, and techniques such as primary end-to-end anastomosis or resection of the aneurysm may be used 3.
- In cases where the wound is open and exposed, a cross-leg flap or retrograde sartorius myocutaneous flap may be used to cover the wound and promote healing 5, 6.