Objective: Pedal acceleration time (PAT) is a novel sonographic method for assessing foot perfusion in peripheral arterial disease (PAD), which has been shown to correlate with wound healing and amputation-free survival. This study aimed to assess the response of PAT to open compared to endovascular revascularisation approaches. Secondary outcomes were major limb amputation (MLA) and death. Methods: This was a retrospective study that included patients who underwent a revascularisation procedure for PAD of any severity from 2021-2024 at a single tertiary-centre. PAT were obtained by trained sonographers prior to and after the revascularisation procedure. Data was collected on disease severity, renal function, diabetes, MLA, and mortality. Data was analysed using t tests and reported as % or mean +/- SD. Results: There were a total of 1,111 revascularisation procedures over the study period, of whom 463 patients had pre- and post-PAT measurements and were included. Average age was 71.4 +/- 10.3yr, 66.3% diabetic, creatinine 162.9 +/- 203.1 umol/L and median Rutherford class 5. PAT improved with revascularisation in all groups, open (n=79) pre 241.6 +/- 62.0 vs post 120.0 +/- 42.3, endovascular (n=356) pre 192.3 +/- 65.0 vs post 138.5 +/- 48.1, hybrid (n=28) pre 235.2 +/- 51.3 vs post 146.4 +/- 45.6, all P <0.0001. Open revascularisation was associated with a greater change in PAT compared to endovascular revascularisation, change in PAT with open 109.0±66.9 vs endovascular 53.1 +/- 66.9, P <0.0001. Open revascularisation was associated with lower rates of MLA and 1yr mortality, 8.9% vs 14.0% and 5.0% vs 20.8%, respectively. Conclusion:​​ This study showed that open revascularisation resulted in the greatest improvement in PAT. Future studies should seek to validate these findings in larger cohorts and assess the impact of disease severity on PAT.