Outcome of limb salvage in single peroneal versus other tibial revascularization in infra-popliteal arterial disease

Abstract

Background The importance of the angiosome concept in critical limb ischemia remains controversial. The peroneal artery is relatively spared from the terminal stages of atherosclerosis and is often the last tibial vessel to become occluded in diabetes or end-stage vascular disease. The main prejudice, on the contrary, against its use in distal revascularizations is that the perfusion of the foot is indirect, via collaterals from its anterior and posterior branches, despite an extensive collateral arterial bed, so the target vessel may be inadequate for treating a septic or gangrenous foot. The value of peroneal artery revascularization has always been debatable, especially in patients with tissue loss. As one of the most important factors of wound healing is the establishment of in-line flow to the foot, the role of peroneal angioplasty has to be defined. The aim of this retrospective study was to assess the outcomes of single peroneal indirect revascularization (IR) (nonangiosome-targeted tibial angioplasty) versus other tibial direct revascularization (DR) (angiosome-targeted), in infra-popliteal arterial disease. Patients and methods Thirty patients were included and presented to the Vascular Surgery Department of Al-Azhar University Hospitals and El araby Specialized Hospital, Menoufia with infra-popliteal arterial lesions, distributed into two equal groups: 15 patients were treated with single peroneal IR, while 15 patients were treated with other tibial DR during the period from June 2019 to June 2019. Results Fifteen patients reached the endpoint of adequate healing (nine patients with ‘DR’ technique and six patients with ‘ID’ technique) and nine patients underwent major amputations. The limb salvage after 1 year was 70%. Conclusion DR of tibial vessels appears to improve wound healing and limb salvage rates compared with IR, with no effect on patency, morbidity, mortality, or reintervention rates.