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The optimal management of below the knee pathology remains one of the most challenging areas for revascularization in patients presenting with critical limb threatening ischemia. Patients commonly have multilevel lesions and have a high amputation rate and associated mortality. This review aimed to assess the outcomes of below the knee revascularization strategies. An online literature search of medical databases for original articles or review articles was conducted using mesh terms. Bypass surgery remains the gold standard for revasc