[Vascular reconstruction and/or amputation in severely handicapped patients]

In the course of demographic ageing with a growing number of handicapped and people in need of care the vascular surgeon will be confronted more and more with the question whether to perform a leg-saving vascular reconstruction or a primary amputation, when treating such patients. This question is discussed by analyzing the parameters benefit, risk and costs. On balance the conclusion is made, that considering nursing, medical and psychological aspects also the seriously handicapped will benefit from the leg-saving procedure. Also the risk of a vascular reconstruction is justifiable, when the procedure has a real chance of success. Concerning the costs the question is still unanswered, if in consideration of the dictated economical commulsions it is allowed to perform an expensive reconstructive procedure, when the primary amputation is the substantially "cheaper" solution.