ABC of vascular diseases. Critical leg ischaemia: amputation or reconstruction.

Reconstruction of aortoiliac segment and femoroperoneal graft. Such an extensive operation is now sometimes indicated. The number ofmajor amputations done each year for vascular insufficiency is not precisely known but is probably about 10 000. This suggests that between 20% and 40% of all critically ischaemic legs are amputated eventually. Society's attitudes to amputation have changed little since mediaeval times, and patients' responses to loss of a limb remain nearly as dramatic as to the announcement of terminal illness. Recent advances in vascular surgery have led us to reappraise the optimal management of critical leg ischaemia and in this article we consider the roles of amputation and revascularisation.