Endovascular procedures for below the knee arteries in diabetics

Patients with below the knee (BTK) lesions may present either with intermittent claudication (IC) or with critical limb ischemia (CLI). Generally, these patients with a high incidence of diabetes have a high rate of myocardial infarction and mortality. So, even if, the surgery is potentially a very good technique with excellent results when the best conduit as a vein graft is used, the ratio benefice/risk seems too low for the IC patients. On another hand for the CLI patients a lot of reasons contraindicate or are unfair to the surgical option: lack of conduit, bad or unclear run-off or distal outflow site, bad local cutaneous conditions. Endovascular option by specialists with experience of coronary devices should be the treatment of choice. We review the different techniques and their recent upgrades in order to improve the percutaneous endovascular treatment of BTK lesions.