Management of the ischaemic leg. The modern approach

Atheroma leading to blockage of the leg arteries is on the increase, throughout the world. Its commonest manifestation is intermittent claudication, a symptom which usually improves without treatment, provided that the patient takes regular exercise and does not smoke. It follows, that claudication on its own does not usually need further investigation. If the patient deteriorates, or develops rest-pain, then some form of arterial reconstruction will be required, and at this point an arteriogram becomes necessary, in order to decide the best method. Available techniques include endarterectomy, balloon and laser angioplasty, and bypass surgery, and the respective roles of these are discussed. If surgery becomes necessary, the best bypass is the patient's own long saphenous vein. In the event of this not being available, a synthetic tube is used. There is nothing to suggest that the more expensive synthetics have any advantage over the cheaper ones.