From critical ischaemia to incipient critical ischaemia: a new concept of good hope for salvage of endangered extremities.

: 1. Although critical limb ischaemia has been clearly defined, in everyday practice the patients are detected too late. This causes poor local and general prognosis despite intensive treatment. 2. A new concept of "incipient critical ischaemia' is advocated. The leading idea is to detect the risk much earlier and secure prompt adequate therapy. To this goal simple clinical tests of sufficient sensitivity and specificity were elaborated and checked for the use of general practitioners. Any single positivity substantiates the diagnosis of incipient critical ischaemia and transport to a vascular centre for therapy. 3. Evidence is presented showing that with the above approach prognosis is remarkably better and many unnecessary amputations can be prevented.