Introduction: Critical limb ischemia (CLI) is a clinical syndrome characterized by chronic ischemic at-rest pain, ulcers, or gangrene in one or both legs attributable to objectively proven arterial occlusive disease (1). Patients with CLI have a one-year risk of amputation greater than 25%. Endovascular treatment is preferred as the first option of revascularization treatment because of lower morbidity and mortality compared to open surgery (2). The main goal of the treatment is to establish flow through at least one vessel to the foot. CLI is often associated with multilevel disease usually requires outflow (tibial) revascularization as well as treating inflow disease. It remains unclear whether revascularization of both inflow and outflow vessels yields better outcomes than treating only inflow vessels in patients with critical limb ischemia (3).

Case report: We present the case of 75-year-old male patient with CLI presented with non-healing ulcer of right foot. Risk factors for peripheral artery disease were diabetes, hypertension, and previous stroke. WIfI (Wound, Ischemia, foot Infection) index was 2-2-0 which addressed high risk of amputation. MSCT scan showed superficial femoral artery (SFA) occlusion in inflow region, while in outflow region both tibial arteries were occluded, and a peroneal artery was patent. We performed an SFA intervention with a good result in inflow region. In 3 months, follow-up the ulcer healed completely.

Conclusion: Concomitant inflow and outflow revascularization in CLI did not offer an advantage over just inflow revascularization in reducing the rate of amputation, total death, target lesion revascularization, if there is at least one patent artery in tibial region.