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Objectives:The purpose of this study is to compare the results of revascularization in a critically ischaemic limb due to infragenicular arterial diseases, using either the conventional bypass operations or endovascular revascularization.Methods: Over a period from December 2010 and May 2012, forty patients suffering from limb-threatening ischaemia were included in this study; all of the patients had peripheral arterial disease falling into Fontaine III & IV categories. All patients had extensive infrapopliteal disease (TASC type C&D). All patients had a good run off at the posterior tibial, anterior tibial or dorsalis pedis. The patients were divided into group A treated by PD bypass surgery and group B treated by endovascular management.Results: The primary patency rate of group A at 6 months and one year was 77% and 65% respectively, with limb salvage rate 80% after one year follow up. In group B the primary patency rate at 6 months and one year was 65% and 60% respectively, with limb salvage rate 75% after one year follow up.Conclusions: PD bypass has primary success rate and limb salvage rates higher than infragenicular PTA that might be due to our still growing experience in PTA.

To evaluate short term results of both modified Chopart's amputation & below knee amputation in the management of unsalvageable forefoot in diabetic patients.Settings and design: Prospective non-randomized study.Patients and methods: This study was conducted at the vascular surgery unit, Zagazig university hospital between December 2011 and December 2014. The patients were divided into two groups. The 1 st group included 19 patients who underwent below knee amputation (BKA). The 2 nd group included 15 patients who underwent modified Chopart's amputation. Two cases in the first group were excluded because they were missed during follow-up period; the remaining 17 cases included 13 cases of infection and 4 cases of ischemia in the first group while there were 12 cases of infection and 3 cases of ischemia in the second group. The Arabic version of the RAND-36 Survey from the RAND Medical Outcomes Study was used at 12 months postoperatively.Results: In the 1 st group who underwent BKA, 2 patients were excluded from the study because they were missed during follow-up, the remaining 17 patients completed the study; they were 10 males and 7 females with a mean age of 51.2 ±10.5 years. The 2nd group included 15 patients who underwent modified Chopart's amputation; they were 9 males and 6 females with a mean age of 47.9 ±11.05 years. The demographic data were not statistically significant between the two groups. The mean follow up of the patients in both groups was for 17.3 ±1.9 months. Six month walking distance and rehabilitation time were significant between the two groups. The RAND 36 questionnaires in this study showed significant difference between the modified Chopart's and BKA group in the physical function, emotional role limitation and social function, but the two groups were comparable in the other items.Conclusion: Modified Chopart's amputation showed better physical function, emotional role limitation and social function according to the RAND 36 questionnaires in the management of unsalvageable forefoot in selected patients but it isn't a replacement for higher amputations like BKA. Future long term follow up studies with larger sample sizes is needed to further evaluate this technique.