From the Guidelines
Tibial occlusion should be treated with a multidisciplinary approach, focusing on risk factor modification, medical therapy, and revascularization as needed, to improve outcomes and reduce the risk of morbidity, mortality, and poor quality of life.
Diagnosis and Treatment
Tibial occlusion refers to a blockage in the tibial artery, typically caused by peripheral artery disease (PAD) [ 1 ]. The diagnosis and treatment of tibial occlusion depend on the severity of the disease, which can be classified using the Rutherford classification system [ 1 ].
Medical Therapy
Medical therapy for tibial occlusion includes antiplatelet therapy with aspirin (75-100mg daily) or clopidogrel (75mg daily), along with risk factor modification [ 1 ]. Statins, such as atorvastatin (40-80mg daily), are also recommended to reduce cardiovascular risk and slow disease progression [ 1 ]. For symptomatic patients, cilostazol (100mg twice daily) may help improve walking distance [ 1 ].
Revascularization
Severe cases of tibial occlusion require revascularization through endovascular procedures or bypass surgery [ 1 ]. Endovascular revascularization, including percutaneous transluminal angioplasty, drug-coated balloon angioplasty, stenting, and atherectomy, can be effective in restoring blood flow to the affected limb [ 1 ]. Surgical revascularization, such as bypass surgery, may also be necessary in some cases [ 1 ].
Lifestyle Modifications
Regular exercise, particularly supervised walking programs (30-45 minutes, 3-5 times weekly), is essential for improving symptoms and collateral circulation [ 1 ]. Smoking cessation is critical as tobacco use accelerates disease progression [ 1 ]. Diabetic patients require tight glucose control to prevent worsening of vascular disease [ 1 ].
Follow-up
Regular follow-up with vascular specialists is necessary to monitor disease progression and adjust treatment [ 1 ]. Early intervention is important as untreated tibial occlusion can lead to critical limb ischemia, tissue loss, and potentially amputation [ 1 ]. A multispecialty care team, including professionals skilled in endovascular revascularization, surgical revascularization, wound-healing therapies, and medical evaluation and care, is recommended for the management of patients with chronic limb-threatening ischemia (CLTI) [ 1 ].
From the Research
Diagnosis of Tibial Occlusion
- The diagnosis of tibial occlusion can be challenging, and a high index of suspicion is required, especially in cases of trauma or acute limb ischemia 2, 3.
- Imaging studies such as angiography, CT scans, and plain films can be used to diagnose tibial occlusion 2, 3, 4.
- The ankle-brachial index (ABI) can be used to assess the severity of ischemia, but a normal ABI does not rule out tibial occlusion 2.
Treatment of Tibial Occlusion
- Percutaneous treatment, including thromboaspiration, thrombolysis, and correction of the underlying lesion by percutaneous transluminal angioplasty (PTA), can be effective in treating tibial occlusion 3.
- Retrograde tibial recanalization technique can be used to treat complex infrainguinal arterial occlusions, especially when antegrade revascularization fails 5.
- Surgical treatment, including embolectomy, bypass, and amputation, may be necessary in some cases, especially when percutaneous treatment fails or is not feasible 6, 3.
- In cases of tibial plateau fracture, surgical approach via an anterolateral and/or posteromedial double incision, with adequate grafting to support the bone defect, can be used to prevent complications such as popliteal artery occlusion 4.
Complications of Tibial Occlusion
- Complications of tibial occlusion can be severe and include limb loss, compartment syndrome, and nerve injury 6, 2, 3, 4.
- Hemorrhage and thromboembolic events are also potential complications of treatment, especially when using thrombolytic therapy 6.
- Early detection and treatment of tibial occlusion are crucial to prevent complications and improve outcomes 2, 3.