**5. Contemporary landmarks in ischemic wounds revascularization**

Expanding clinical evidence in the last three decades supports both bypass and the endovascular techniques as useful strategies in CLI revascularization [1–3, 29–31]. Providing low invasiveness, high reproducibility, and comparable limb salvage rate to open surgery [21–73], transcatheter strategies continue to evolve with new low-profile and high-performance devices in arterial reconstruction [21, 29, 74]. For most "high-risk" CLI patients [1, 2, 31, 34], new endovascular approaches and techniques were designed. In succinct overview, the "drilling," the "subintimal," or the "parallel wire" techniques via the ante- or retrograde accesses, the pedal-plantar "loop," and the femoral-femoral or transtibial collaterals angioplasties were recently described [29, 74, 75].

Not with standing with these spectacular transcatheter performances, the "classical" bypass for distal leg reperfusion is still imposed as a fundamental technique for CLI diabetic foot revascularization, tissue healing, and limb preservation [1, 3, 72, 76]. High-skill distal vein bypasses to the tibial [72], to the pedal [77], and up to the plantar or tarsal foot arteries [78] equally by targeting remote branches of pedal arteries in some particular cases [1, 76] were successfully documented. We now know that both surgical and endovascular techniques are more likely complementary than competitive techniques since each of them holds major advantages and inherent drawbacks [1, 29, 30, 79]. Endovascular techniques essentially provide minimal invasiveness, great accessibility, and reproducibility for one or multiple below-the-knee CTO recanalizations [1, 29, 73–75]. Alternatively, bypass offers a higher pressure on targeted arteries and more physiological and pulsatile flow inside collaterals around the wound zone [35, 53, 77–79]. This particularity heightens arterial-arterial collateral shear stress and enhances rising arteriogenesis [58–60] toward further tissue cicatrization [1, 29, 35, 60, 72].

Although still heterogeneously structured [1, 73, 79], increasing contemporary clinical observation documents equivalent limb salvage, clinical success, and survival outcomes for bypass versus endoluminal interventions in selected groups of CLI patients [1–3, 27, 29–31, 79, 80]. Notwithstanding with initial historical considerations [79], these two strategies appear nowadays more intricate than ever inside the conceptualized "team approach" as CLI treatment [29, 35].

Parallel advances concerning the DFS revascularization and ischemic wound healing were equally testified in the last two decades [1, 2, 75]. Beyond striking surgical arterial reconstructions [76–79], new tapered nitinol [81], drug-eluting stents (DES) [82], and original drugeluting balloon, (DEB) [83] were imagined. Novel or redesigned directional or rotational atherectomy devices [84], together with latest "bioresorbable scaffolds" technologies [85], represent few additional of numerous achievements that challenge today ancient technical barriers [1, 29, 75, 81–86].
