Prior endovascular intervention of femoro-tibial vessels does not have a negative impact on the outcome of subsequent tibial or peroneal bypass surgery in patients with critical limb ischemia.

Bypasses to the below knee popliteal artery show good results in patients with CLI unsuitable for endovascular therapy. Vein is still the first line graft material.

The results of our study show that autologous vein grafts are still first choice for tibial and peroneal bypasses in patients with critical limb ischemia. If no adequate vein is available, heparin-bonded expanded polytetrafluoroethylene bypasses are an acceptable alternative to an otherwise impending major amputation.

Crural endovascular intervention does not seem to have a negative impact on the outcome of subsequent pedal bypass surgery. Requirements are avoiding a destruction of the target vessel and opting for timely bypass surgery whenever endovascular treatment does not achieve a sufficient perfusion for wounds to heal. Early graft occlusions are associated with a higher risk for major amputation.

Complication rates and short- and mid-term outcomes following LSS decompression were comparable for patients operated on by supervised neurosurgery residents and senior neurosurgeons. Our data thus indicate that a structured neurosurgical hands-on training including LSS decompression is safe for patients.