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Abstract Abstract. Objective: To compare clinical outcomes and technical success when direct versus indirect revascularization achieved after endovascular technique for critical limb ischemia patients with isolated below the knee lesions. Patients and methods: 50 patients were included, 34 male and 16 female, their age from 49 to 77 years (mean 63+/- 16). All patients were subjected to infragenicular angioplasty and divided into direct 28 (31limbs) and indirect group 22 (24 limbs). Antegrade approach through ipsilateral CFA was used in 48 patients, while retrograde approach through tibiopedal access used in 2 patients. Diagnostic angiography was done for all cases and duplex ultrasound used for follow up. Results:137 lesions were encountered, 46 in ATA, 43 in PTA, 29 in peroneal artery and 19 in dorsalis pedis artery. Transluminal approach was done in 47 limbs while subintimal cross used in 8 limbs. After 1 year follow up, AFS was 75% in direct group and 67% in indirect group. Freedom from MALE was 65% in direct group and 55% in indirect group. Freedom from MA was 86% in direct group and 75% in indirect group. Conclusion: when there is a choice of target artery for revascularization, preference should be given to an artery directly feeding the wound’s Angiosome |