[Pedal bypass versus PTA (percutaneous transluminal angioplasty) of the crural arteries]

Diabetic foot syndrome in patients with atherosclerotic angiopathy of the crural arteries frequently develops in critical ischaemia and gangrene. Revascularization then may be the only approach to limb salvage. In the ongoing decade, pedal bypass grafting has become the method of choice for treatment of the most severe forms of chronic critical leg ischaemia caused by obliteration of the crural arteries. However, in patients in whom angiographic findings are favourable (short stenosis of the crural artery and the presence of suitable distal outflow arteries), percutaneous transluminal angioplasty (PTA), with stent placement, if indicated, is preferred. In multisegmental or diffuse disease or when PTA is associated with complications (occlusion or dissection) with subsequent limb ischaemia, bypass surgery is the method of treatment. In this study, the group of 30 patients undergoing bypass grafting showed 90% patency of the pedal bypasses at 12-month follow-up; in 18 patients treated by PTA, the patency of crural arteries at 6 months after angioplasty was 78%. Since either method has its advantage and disadvantages, an individual approach to each patient is recommended. In decision-making on the basis of angiographic findings, PTA is not confronted with pedal bypass grafting but the two methods are regarded as complementary in treatment of patients with crural artery disease.