[Strategies in treatment of critical leg ischemia. An approach to the solution with decision trees]

In critical leg ischemia the main treatment options are reconstructive vascular surgery and primary amputation but in some cases conservative treatment can be considered. The choice between the alternatives is difficult as a large number of factors must be considered. Among these are significant complication rates, reoperation rates and perioperative mortality as well as medical risk-factors. This paper demonstrates how formal decision analysis using special computer software can contribute by structuring of the decision situation and by quantification of risks and gains. Important is also the possibility of sensitivity analysis, i.e. to examine the effect of varying values of pertinent variables. The explicit structure and the quantification makes a formal decision analysis open for critique, discussion and improvement. This is a distinct advantage over the usual spontaneous clinical decision making.