Crural or pedal artery revascularisation for limb salvage: is it justified

With the ageing of population, the incidence of limb-threaten in ischemia increases. In chronic critical limb ischemia, peripheral arterial occlusive disease almost always involves infrainguinal and infragenicular vessels. Fortunately, recent advances in vascular surgery made arterial reconstruction of crural and pedal vessels possible. Should crural or pedal bypass surgery be offered to these frail, polyvascular patients, or is primary amputation a preferable treatment option in case of advanced limb-threatening ischemia? In order to answer this controversial question, the author analysed recent literature data on the feasibility and durability of infrapopliteal bypasses. The quality of life was also considered as an outcome measure. Finally, the cost-effectiveness of both treatment modalities (limb-saving distal bypass versus primary amputation) was assessed.