What question did this study set out to answer?

To evaluate the clinical efficacy and safety of tibial transverse bone transport (TTT) in managing thromboangiitis obliterans (TAO).

June 13, 2026Open Access

Efficacy of the Tibial Transverse Bone Transport Technique in the Management of Thromboangiitis Obliterans: A Systematic Review

Key Points

To evaluate the clinical efficacy and safety of tibial transverse bone transport (TTT) in managing thromboangiitis obliterans (TAO).
Systematic review conducted per PRISMA guidelines.
Search performed on multiple databases until December 2025, including clinical investigations of TTT for TAO.
Descriptive analysis of patient characteristics, surgical techniques, outcomes, and complications due to heterogeneity.
TTT was associated with significant clinical improvements, including pain relief and ulcer healing, typically observed within weeks.
Limb salvage rates were high, with major amputation rates ranging from 3.3% to 13.3%.
Common complications included pin-site infection up to 30%, with fewer cases of fractures and osteomyelitis.

Abstract

Background: Thromboangiitis obliterans (TAO) is a nonatherosclerotic inflammatory vascular disorder affecting small- and medium-sized vessels, often leading to critical limb ischemia and a high risk of amputation. Conventional medical and surgical treatments remain limited, particularly for advanced diseases. Tibial transverse bone transport (TTT), based on the principles of distraction osteogenesis, has emerged as a novel technique to promote angiogenesis and improve microcirculation. This systematic review evaluated the clinical efficacy and safety of TTT in the management of TAO. Methods: A systematic review was conducted according to the PRISMA guidelines. A comprehensive search of PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar was performed until December 2025. Eligible studies included clinical investigations that evaluated TTT in patients with TAO. Data on patient characteristics, surgical techniques, clinical outcomes, and complications were extracted and analyzed descriptively because of the heterogeneity in study design and reporting. Results: Ten studies involving 368 patients were included in this review. TTT was consistently associated with significant clinical improvement, including pain relief, increased claudication distance, and ulcer healing, which were typically observed within weeks after the procedure. Limb salvage rates were high, with major amputation rates generally ranging from 3.3% to 13.3%. Objective improvements in perfusion parameters have also been reported in several studies. The most common complication was pin-site infection (up to 30%), while fractures, delayed consolidation, and osteomyelitis were less frequent complications. Conclusions: Current evidence suggests that TTT is a promising limb-salvage strategy for TAO and is associated with favorable clinical and functional outcomes, with an acceptable complication profile. However, the available evidence remains limited, partly because of the rarity of TAO and the specialized nature of the TTT procedure. Most available studies are observational, and further high-quality prospective and randomized trials are required to validate the long-term efficacy of this technique.

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