[The present status of conservative therapy in critical lower limb ischemia]

1. Conservative therapy of critical limb ischaemia either supports the effect of revascularisation procedures (thrombolysis, PTA, surgical reconstruction) or is employed in cases where instrumental intervention is no more possible. As a longterm control programme, the conservative approach reduces the number of local and general vascular complications. 2. The main physiological principles of conservative treatment are as follows: improvement of driving pressure (limb dependency, slow walking, mild temporary hypertension induced by isometric contraction of forearm muscles), decrease of vascular resistance (exercise, reflex dilatation by body heating, pharmacological vasodilators, prostanoids), microcirculatory improvement (oxygen inhalation, full recommended doses of drugs), prevention of oedema (calcium blocking agents not to be administered) and prevention of tissue destruction (anabolic hormones). It is of utmost importance to start vigorous therapy without delay when symptoms or signs of incipient critical ischaemia are detected; this should be followed by a life-long control and treatment programme. 3. Early beginning of therapy makes it usually possible to control incipient critical ischaemia effectively. The long term control and treatment programme contributes to a significant drop of relapses and mortality.