disease in the legs only 25% (25 in 100) of the arteries were still open at 12 months and results were poorer when segments of artery greater than 10cms long were treated ( Smith BM et al, 2005 ). The patency rates (whether the artery is open or not) of angioplasty are important, but what matters to the patient is whether their quality of life is improved.  For instance a patent artery after angioplasty may improve walking distance by 100 metres, but the patient may feel almost as much disability as they did before their angioplasty.  If the angioplasty does not improve quality of life and decrease the disability suffered by the patient it is worthless, even if the artery is open and the patient can walk a little further on a treadmill.  There is some evidence that angioplasty makes minimal difference to quality of life particularly over the longer term ( Spronk et al 2008 ). A recent study ( BASIL, 2005 ) has compared angioplasty with bypass surgery in patients with severe limb ischaemia (see bypass surgery ).  In patients who are suitable for both angioplasty and bypass surgery, an angioplasty first strategy had broadly similar outcomes to surgery, although a more recent analysis indicates surgery is a more durable policy in patients with a life expectancy of more than 2 years.  Unfortunately, the majority of patients presenting with severe disease (approximately 80%) are not suitable for both strategies and are more likely to require surgery.  In general