How to Select for Angioplasty or Surgical Bypass in People With Diabetes and Peripheral Arterial Disease

Diabetes-related foot disease represents a growing burden on healthcare services. Peripheral arterial disease (PAD) is a contributing factor in over half of the cases, with treatment of severe PAD through revascularisation being crucial for limb salvage. The Society for Vascular Surgery Wound, Ischaemia, foot Infection (WIfI) classification system enhances diagnosis by providing a framework for identifying high-risk individuals needing intervention. Decision-making regarding which strategy of revascularisation (angioplasty or surgical bypass) is most suitable in these patients is complex, with decisions being primarily guided by the anatomical pattern of the disease, patient fitness, and availability of autologous vein. This review aims to provide a summary of the assessment and management of patients with diabetes-related foot disease and PAD, discussing the factors that influence patient selection for revascularisation. In general, short-segment disease is best treated by an endovascular-first approach, while long-segment occlusions are better managed with open surgery. Ultimately, individuals should be assessed and managed in conjunction with a multi-disciplinary team as part of a holistic management strategy.