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