Purpose: To review the infrapopliteal bypass to the LEAD-CLI patients in our department.

Methods: From 2018 to 2023, we experienced 196 cases/232 limbs of infrapopliteal bypass to the LEAD-CLI patients. The mean age was 70 years-old, and 68% of the patients were male. Comorbidities were diabetes mellitus (83%), hypertension (59%), dyslipidemia (40%), previous ischemic heart disease (42%), hemodialysis (HD) (56%), and cerebrovascular disease (26%).

Results: The distal target arteries for bypasses were 40 cases in distal anterior tibial artery, 5 cases in peroneal artery, 23 cases in distal posterior tibial artery, 102 cases in dorsal pedis artery and 62 cases in planter artery.  The postoperative observation period ranged from 1-60 months, and surgical mortality was 3.5%. The 1- and 3-year primary patency rates were 72% and 69%, and 1- and 3-year secondary patency rates were 86% and 80%, The 1- and 3-year survival rates were 93% and 86%, respectively. The wound healing rates were 42% and 77% at 6 months and 1 year, respectively. 

Conclusions: The results of bypass with autologous vein in LEAD-CLI with infrapopliteal lesions were satisfactory and the bypass surgery is the good for the wound healing of foot gangrenes.