Chronic lower limb ischemia.

Peripheral vascular disease commonly affects the arteries supplying the leg and is mostly caused by atherosclerosis. Restriction of blood flow due to arterial stenosis or occlusion often leads patients to complain of muscle pain on walking (intermittent claudication). Any further reduction in blood flow causes ischemic pain at rest, which affects the foot. Ulceration and gangrene may then supervene and can result in loss of the limb if not treated. TheFontaine score is useful when classifying the severity of ischemia (see box). Although many patients with claudication remain stable, about 150 to 200per million of the population progress to critical limb ischemia (Fontaine IIIor IV) each year. Many patients with critical limb ischemia can undergorevascularization, which has a reasonable chance of saving the limb. A recent audit by the Vascular Surgical Society found a success rate of over 70% for these patients. Many patients, however, still require major amputation.Rehabilitation of elderly patients after amputation can prove difficult and costly.