Techniques and importance of pedal and peripheral crural bypass surgery

The autologous venous bypass has been an effective and proven treatment option for limb preservation in critical limb ischemia for decades. Modern endovascular treatment methods have pushed pedal and peripheral crural bypass surgery to a certain extent into the background. Nevertheless, even today there are clear indications for the use of pedal and peripheral crural bypass surgery. Preoperative diagnostics include appropriate arterial imaging, the choice of bypass material and an evaluation of the surgical risk. The bypass system should aim for the shortest possible bypass length. For the distal connecting vessel, the quality of the vessel (run-off) has priority. The preferred bypass material is an autologous vein. The recommendations for medication-based treatment are oriented towards those for infragenual bypasses. Regular follow-up examinations of peripheral venous bypasses have a positive effect on bypass patency and amputation-free survival.