Editing Tibioperoneal arterial occlusion


== Anatomy ==

* ATA supplies anterior ankle and dorsum of foot
* PTA supplies plantar foot
* Peroneal artery supplies lateral ankle

== Examination ==

* Ability to walk
* Evidence of flexion contractures
* Local infection/soft tissue oedema/venous disease
* Arterial perfusion
** All pulses - check for inflow occlusion at femoral pulse - if evidence of inflow reduction, needs a CTA
* ABI (<0.9 = significant stenosis)

== Evaluation ==

* CTA is not as useful given the high burden of calcifications often seen
* Gold standard is digital subtraction angiography with an intra-arterial catheter

== Selecting patients for intervention ==

* Claudication only: non-op management (<5% progress to CLI)
** Smoking cessation
** Weight loss
** Antiplatelets
** Treat:
*** HTN
*** Hyperlipidaemia
*** Diabetes
** Exercise programs - 3x weekly, 30-45 mins
** Phosphodiesterase inhibitors may improve claudication pain
* Rest pain/tissue loss: intervention
** Endovascular interventions are preferred for class A/B and single-level C lesions
** Surgical bypass for multilevel C and D lesions
** Bypass is best with significant tissue loss (ulcer >1cm or gangrene involving the foot)
** Bypass with autogenous vein is best treatment for patients expected to survive >2 years


== Periop ==

* Antiplatelets

== Operation ==

* Most commonly CFA for inflow

[[Category:Vascular]]