Background: The importance of the angiosome concept in critical limb ischemia remains controversial. Aim of the study: to assess the outcomes of direct re-vascularization (angiosome-targeted tibial angioplasty alone) (DR) versus indirect re-vascularization (IR) non angiosome target, in isolated tibial lesions. Patients and Methods: thirty patients were included and presented to vascular surgery department of Al-Azhar University Hospitals with infra-popliteal arterial lesions, randomly distributed into two equal groups;15 patients was treated with (DR) while 15 patients treated with (IR). Results: fifteen patients reached the end point of adequate healing: (9 patients with ‘DR' technique and 6 patients with ‘ID' technique) and 9 patients underwent major amputations. The limb salvage after one year was 70%. Conclusion: direct re-vascularization (DR) of the tibial vessels appears to improve wound healing and limb salvage rates compared with IR, with no effect on patency, morbidity, mortality or re-intervention rates.