Abstract
Among peripheral arterial disease (PAD) patients the proportion of the critical limb ischemia with below-the-knee (BK) lesions is markedly increasing in consequence of the growing number of diabetic patients. Although the indication of endovascular therapy for occlusive disease in iliac and superficial femoral arterial lesions has been established, such treatment for BK lesions still shows a poor long-term outcome in spite of its early benefits for limb salvage. Although endovascular therapy has surpassed surgical bypass in the iliac and even in the femoral area, the indication of distal bypass surgery in the BK area for critical ischemia has been established. For complex PAD cases involving multiple lesions from iliac to BK we are performing “hybrid surgery” in that vascular surgeons perform both EVT and bypass surgery simultaneously in the operating room and are achieving good results. The number of critical limb ischemia cases is likely to keep increasing in future, and thus we need to be engaged in multidisciplinary treatment therapies to improve outcomes.
