Tibial Interventions for Peripheral Arterial Disease

Abstract Endovascular treatment for tibial arterial disease has grown in popularity through technological advancement and improvement in techniques, allowing increased success in treating difficult lesions. With growing evidence for decreased morbidity and mortality, as well as equivalent limb salvage rates following endovascular therapy when compared with open bypass surgery, tibial percutaneous transluminal angioplasty (PTA) is now commonly used as first-line treatment for infrapopliteal atherosclerotic disease. The Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) guidelines provide recommendations agreed upon by multiple medical, surgical, and radiological societies in Europe and North America for the diagnosis and treatment of peripheral arterial disease. These guidelines are based on disease complexity and anatomic locality, offering treatment recommendations ranging from endovascular therapy for the least severe TASC A lesions to surgical revascularization for the most severe TASC D lesions. Initially, the TASC II classification systems only included aortoiliac and femoropopliteal segment treatment recommendations, but more recently, an updated infrapopliteal classification was created to include management of tibial lesions. However, in these updated classifications, groups such as the Society of Vascular Surgery were not represented. For many vascular specialists, endovascular treatment for TASC C or D lesions is considered because patients with chronic limb-threatening ischemia secondary to tibial disease tend to have multiple comorbidities and may benefit from a less morbid procedure rather than a tibial or pedal bypass. Proper prevention and management of complications will ensure technical success during endovascular treatment of tibial lesions when open bypass is not an option.