Conservative treatment, amputation or revascularisation for critical limb ischaemia.
Patients with critical chronic limb ischaemia may be addressed by different approaches: conservatively with control of risk factors and in some cases also medical treatment, or by amputation, primarily or secondarily, following attempt to revascularise, or treatment may be surgical, either with endovascular or open vascular surgery. The different options are shortly described, with indications and likely results which may be obtained in each case. The paper concludes that no matter what treatment is considered, control of risk factors is of benefit. Patients who, judged by the vascular surgeon, are operable, and who are physically active and without serious medical risk factors, are best treated with open surgical revascularisation. In high risk cases or when inoperable, medical therapy may be an option. Endovascular treatment may be considered in patients with high surgical risk. Primary amputation should be considered in cases where outcome of surgical treatment may be seriously affected by medical risk factors, in cases with progressive ischaemia, in cases where the chances of successful surgery are small or when the patient is in a situation where the benefit of surgery is negligible.
Department of Vascular Surgery B, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. Sillesen@inet.uni-c.dk
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D000671:Amputation, Surgical; D000800:Angioplasty, Balloon; D001158:Arteries / Q000601:surgery; D002908:Chronic Disease; D003661:Decision Support Techniques; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D012307:Risk Factors; D014656:Vascular Surgical Procedures