Limb salvage arterial surgery for gangrene.

IN THIS paper we are concerned with the management of the severely ischaemic state resulting from chronic occlusive arterial disease. For all practical purposes this means atherosclerotic obliteration of the arterial supply to the lower limb. In general, atherosclerosis of the peripheral arteries is a relatively benign disease, and the collateral circulation compensates well for the loss of the main vessel. In about 15% of patients the disease is more extensive and the degree of ischaemia such that major amputation becomes inevitable unless blood flow to the distal tissues can be improved. Some patients will reach this stage after a period with intermittent claudication alone and others will present de novo with abrupt severe ischaemia due to sudden and extensive thrombosis in their atherosclerotic but previously unobstructed arteries. The latter group may resemble closely the clinical picture of embolic occlusion, but the absence ofa central source for embolus, the age of the patient and clinical evidence of atherosclerotic disease in other areas, will usually point to the correct diagnosis.