Complete wound healing of ischemic heel ulcers or gangrene may require up to 6 months, and short-term graft patency is of minimal benefit. Successful arterial reconstruction, especially a patent posterior tibial artery after bypass, is effective in treating most heel ulcers or gangrene. Patients with impaired renal function are at increased risk for failure of treatment, but their wounds may successfully heal and they should not be denied revascularization procedures.

PIER is technically possible in patients with femoropopliteal occlusion, and the procedure is associated with a low complication rate. Most procedures provide at least short-term clinical success and have enabled successful wound healing and pain relief in patients without other effective options. Further studies and longer follow-up are required to determine long-term success and the role of PIER in treatment of femoropopliteal occlusion.

For grafts originating distal to the common femoral artery, stenoses proximal to the graft do not affect bypass graft patency and do not require repair to prevent graft occlusion. Surveillance of these lesions may therefore be unnecessary, inasmuch as the repair of proximal lesions should not be undertaken to preserve graft function.

No abstract