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  • Peroneal Artery Angioplasty As a Single Runoff Vessel for Foot Revascularization in Patients with Critical Limb Ischemia

    Abdelrahman Mohammed, MD, Ahmed Kamal Gabr, MD, Sherif Essam Eldin Tawfik, MD
    Department of Vascular Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Introduction: Prevention of major amputation in critical limb ischemia is arguably the most important goal and is based on the capability for restoring and maintaining straight-line tibial arterial blood flow to the foot. The main objective of below-knee limb salvage angioplasty is to restore a direct straight-line flow to the foot through a native tibial artery and is usually attempted by selecting, whenever possible, the anterior tibial artery for ischemic forefoot lesions and the posterior tibial for calcaneal lesions. If neither the anterior nor the posterior tibial artery can be treated, the alternative treatment may consist of providing direct flow along the peroneal artery. The aim of this study is to assess the clinical and haemodynamic outcomes of peroneal artery angioplasty as a single runoff vessel for foot revascularization in patients with critical limb ischemia. Methods: Between September 2014 and January 2016, we enrolled 23 patients in our prospective clinical study with critical lower limb ischemia having the peroneal artery as a single runoff vessel to the foot. Our patients were treated by endovascular balloon dilatation of the peroneal artery. Our primary end points were primary, assisted primary, secondary patency, and limb salvage rate at 12 months, while secondary end points were procedure related complications, and major adverse cardiovascular events. Results: Data was obtained for 23 patients presenting with critical limb ischemia with 46.8% of patients presenting with rest pain (Rutherford category 4), and 56.5% of patients presenting with minor tissue loss (Rutherford category 5). Peroneal artery angioplasty as a single vessel was attempted in all patients with a mean duration of follow up of 1 year post intervention. Using the Kaplan-Meier survival curves, our primary patency rate was 63.2%, assisted primary patency rate was 81%, secondary patency rate 100%, Limb salvage rate was 91.3%. Conclusion: This study successfully demonstrates a durable 1 year primary, assisted primary, and secondary patency rates as well as limb salvage rate together with good clinical, and haemodynamic outcome. Therefore, in patients with critical limb ischemia, peroneal artery angioplasty as a single vessel runoff to the foot is essential and sufficient to improve their clinical outcomes and limb salvage rate. Keywords: Angioplasty; critical limb ischemia; peroneal; single runoff.