Management of the severely ischaemic leg

Ischaemic rest pain or tissue necrosis in the foot requires arterial reconstruction or lumbar sympathectomy if major amputation is to be avoided. Arterial reconstruction is preferred but if it is not possible, lumbar sympathectomy frequently is adequate. Conservative treatment is rarely successful. Arterial reconstruction is a relatively safe procedure, even in the elderly. The long-term survival rates are reasonably good, though appreciably less than for the general community. Many amputees have a short life expectancy and do not regain independence.