Atherosclerosis is a chronic inflammatory process that is responsible for reduced blood flow to some parts of the body, including the lower limbs. People who do not receive adequate treatment can lose their lower limbs. Bypassing arterial vascular obstruction in the legs is a surgical procedure that improves blood flow to reduce leg pain and sometimes to improve function. The mortality rate can be 10.5% after acute occlusion of an arterial blood vessel. The surgical procedure can improve outcomes when performed up to 12 hours after symptoms are first noted. Usually the procedure is performed with the patient unconscious and under general anaesthesia or awake but with legs numbed by neuraxial anaesthesia. Neuraxial anaesthesia may be administered as an injection of local anaesthetic around the spinal cord either in the back (spinal anaesthetic) or in the area where the nerves from the legs come together (epidural anaesthesia). A combination of general and neuraxial anaesthesia can be used. Other types of anaesthesia are used less often. At present, no single guideline shows why one anaesthetic technique is better than another. This systematic review is important because review authors assessed the risk of important outcomes after lower-limb revascularization with the participant under neuraxial or general anaesthesia. They performed this systematic review to answer a single research question: What are the rates of death and major complications with spinal and epidural anaesthesia as compared with other types of anaesthesia for lower-limb revascularization? In this second update of the Cochrane review, we searched the databases until April 2013 but found no new studies. The total number of participants in the four included studies was 696, of whom 417 received neuraxial anaesthesia and 279 received general anaesthesia. No evidence revealed differences in postoperative risk of death, myocardial infarction or leg amputation between the two types of anaesthetic. The risk of pneumonia was 9% after neuraxial anaesthesia and 20% after general anaesthesia. Evidence was insufficient to show the effects of neuraxial anaesthesia compared with other types of anaesthesia on cerebral stroke, duration of hospital stay, postoperative cognitive dysfunction, complications in the anaesthetic recovery room and transfusion requirements. No data described nerve dysfunction, postoperative wound infection, patient satisfaction, postoperative pain score, claudication distance and pain at rest. One study recruited more than 50% of all reported cases.This systematic review shows that neuraxial anaesthesia may reduce the risk of pneumonia after lower-limb revascularization, but evidence is insufficient to support other benefits or harms.