- The treatment of below knee arterial disease has undergone a gradual shift over the last few years to incorporate a greater proportion of endovascular treatments. Not only does this include patients who now have endovascular therapy rather than surgery, but also patients who in the past would have been offered supportive treatment only, due to factors such as being medically unfit for surgery, lacking sufficient donor vein for bypass grafting, or swelling. Diabetes mellitus is becoming increasingly common, potentially causing numerous comorbidities in patients. It tends to have a more distal pattern of peripheral vascular disease, presenting later and with generally high complication and failure rates following therapy (surgical or endovascular) and higher amputation rates. Given these comorbidities, the reduced morbidity and mortality of endovascular treatments may be beneficial in treating below-knee arterial disease. The success and complication rates of endovascular therapy vary between treatment for claudication and critical limb ischaemia, though success rates are improving and in some cases are comparable to the current gold standard of surgical bypass.