Endovascular management of complex tibial lesions

The ability of vascular surgeons and endovascular specialists to treat complex tibial lesions has expanded greatly in recent years with the dissemination of contemporary techniques and the development of new endovascular devices. The number of patients with peripheral artery disease with tibial lesions will only increase going forward, especially with the increasing prevalence of diabetes and renal disease in the aging US population. Although open surgical bypass remains a robust option for treating complex tibial lesions, endovascular approaches are being employed increasingly in the tibial segment, often with promising results. In this review, we will lay out general principles for endovascular treatment of complex tibial lesions, outline the initial procedural approach, discuss options for crossing and treating complex tibial lesions, and review the evidence behind both established and emerging endovascular techniques in this challenging anatomic segment.