Role of single peroneal versus single non-peroneal tibial angioplasty in limb salvage

The peroneal artery is known to give branches to the anterior and posterior tibial arteries. Scattered reports in the literature over the last decade failed to provide solid evidence as to the optimum strategy for below-knee targeted revascularization in limited-option patients with critical limb-treating ischemia (CLTI). We sought to determine the benefit of performing single peroneal tibial artery angioplasty revascularization compared with single non-peroneal angiosome-targeted tibial artery angioplasty revascularization for patients presented with CLTI.

We performed a two-center, retrospective cohort study of patients presented with CLTI treated with below-the-knee endovascular intervention from January 2020 to January 2022. Group 1 included patients who were treated with single peroneal tibial artery angioplasty revascularization. Group 2 included patients who were treated with single non-peroneal tibial artery angioplasty revascularization. Patients had no proximal lesions or previous intervention to tibial arteries. The primary endpoint is limb salvage. The secondary endpoints include wound healing and all-cause mortality.

This study included 45 patients presented with critical limb ischemia, they were treated with single angiosome-targeted tibial angioplasty revascularization, they were divided into 13 patients (28.9%) with single peroneal revascularization (group 1) and 32 patients (71.1%) with single non-peroneal revascularization (group 2), 20 patients (44.4%) had target anterior tibial artery, while 12 patients (26.7%) had target posterior tibial artery. The follow-up duration was 6 months. No difference was found in limb salvage between the two groups (92.3% vs. 87.1%; P=1). No differences were found in wound healing rates between the two groups (76.9% vs. 81.3%; P=0.281). The overall 30-day survival rate was 100% in both study groups.

Single peroneal tibial revascularization mostly is non-inferior to single non-peroneal angiosome targeted tibial artery revascularization regarding limb salvage and wound healing for patients with critical limb ischemia.