There is not enough evidence to favour bypass surgery over angioplasty to treat chronic limb ischaemia (inadequate blood flow to the legs).
The most common symptom of arterial disease of the leg is claudication, a cramping pain caused by an inadequate supply of blood to the affected muscle. It often affects the calf muscle and is typically triggered by exercise and relieved by rest. More severe restriction of the blood supply may produce pain at rest, leg ulcers or gangrene. These conditions, and severe claudication, may require bypass surgery or angioplasty (repair by minor surgery) to improve blood flow to the leg. The review of trials found no evidence to favour bypass surgery over angioplasty in terms of the effect on walking distance, complications and disease progression, amputation rate or death. There was evidence in patients with critical lower limb ischaemia that surgery was associated with increased surgical complications and longer hospital stays than for those that received angioplasty. There was also no clear evidence to favour bypass surgery compared with other treatments. Further research is needed.