Assessment of limb salvage in single peroneal runoff versus single tibial runoff in patients with critical limb ischemia having complex lesions

Ghoneim, Baker; Elwan, Hussein; Elmahdy, Hossam; Taha, Ahmed; Gad, Amr

doi:10.4103/ejs.ejs_135_17

Assessment of limb salvage in single peroneal runoff versus single tibial runoff in patients with critical limb ischemia having complex lesions

Authors

Abstract

Introduction
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.
Aim
The aim was to assess the adequacy of single peroneal vessel runoff in endovascular revascularization of patients with TASC C-D lesion and critical limb ischemia (CLI) as infrapopliteal disease.
Patients and methods
This is a prospective study involving patients with TASC C-D lesions presenting with CLI along 1 year. Patients were stratified into two groups according to their runoff states. Group P includes patients with single peroneal vessel runoff, whereas group T includes patients with single tibial runoff other than peroneal. Patients with two or three vessel runoff were excluded from the study.
Results
The study included 180 patients, with age ranging from 42 to 86 years; 55% were male patients. Of the 180 patients, 60 patients had single peroneal vessel runoff (group P) whereas 120 patients had a single tibial runoff (group T). The mortality rate along 2 years was 10 and 5% in groups P and T, respectively. Limb salvage rate along 2 years was 68.8% in group P and 79.8% in group T (<0.036). The primary and secondary patency rates over 2 years in group P were 31.3 and 54.2%, respectively, and in group T were 47.7 and 62.4%, respectively.
Conclusion
In patients having CLI with TASC C-D lesion, although single peroneal runoff showed slightly lower limb salvage rate compared with single tibial runoff, it is valuable in patients with no other alternative for revascularization. We think that further studies are required to examine the importance of presence of direct pedal communication and its effect on the clinical success (limb salvage and disappearance of rest pain) of peroneal artery angioplasty.

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