Popliteal-to-distal (PD) bypass versus infragenicular percutaneous transfemoral angioplasty (PTA) to treat limb threatening ischemia

Objectives:  The purpose  of this study is to compare the results of revascularization  in a critically ischaemic limb due to infragenicular arterial diseases, using either the conventional bypass operations or endovascular revascularization. Methods: Over a period from December 2010 and May 2012,  forty patients suffering  from limb-threateningischaemia wereincluded in this study; all of the patientshad peripheral arterial disease  falling into  Fontaine  III  & IV categories.  All patients had  extensive infrapopliteal disease (TASC type C&D). All patients had a good run off at the posterior tibial, anterior tibial or dorsalis pedis. The patients  were divided into group A treated by PD bypass surgery and group B treated by endovascular management. Results:  The primary patency rate of group A at 6 months and one year was 77% and 65% respectively,  with limb  salvage rate 80% after one year  follow up. In group  B the primary patency rate at 6 months and one year was 65% and 60% respectively,  with limb salvage rate 75% after one year follow up. Conclusions: PD bypass has primary success rate and limb salvage rates higher than infragenicular PTA that might be due to our still growing experience in PTA.