INTRODUCTION This chapter discusses open surgical options for critical lower limb ischemia, which may be defined as sufficiently poor arterial blood supply to pose a threat to the viability of the lower extremity. Manifestations of critical ischemia are rest pain, ulceration, and gangrene. These manifestations typically occur because of arteriosclerotic occlusive disease of large, medium-sized, and/or small arteries, although other etiologies may produce or contribute to these manifestations. For example, several nonvascular etiologies may cause rest pain, infection may cause or contribute to gangrene, and trauma and decreased sensation may produce ulceration. Although thromboembolism and other etiologies can produce acute critical limb ischemia, this chapter only deals with chronic lower extremity ischemia due to obliterative arteriosclerosis. Over the last three decades, it has become increasingly apparent that limbs that are threatened by this process almost always have multilevel occlusive disease, which often includes occlusions of arteries in the leg and foot (1).
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