Medical treatment of critical limb ischaemia: encouraging results if candidates selected early, therapy based on physiological principles and long-term control established.

: Medical therapy of CLI is only indicated in patients unsuitable for vascular reconstruction or angioplasty. The approach includes early detection of subjects at risk, observation of physiological principles of therapy and long-term control. The finding of ankle pressure < or = 50 mmHg is of particular value in early detection because of high specificity with respect to CLI. Limb dependency increases skin flow in CLI while in patients with moderate ischaemia vasoconstriction occurs. Positioning of the limb thus contributes to therapeutical effect. Vasodilator substances increase foot blood flow only when administered to patients covered with blankets; improper administration may cause vasoconstriction. When a long-term control programme is established, the number of episodes of CLI decreases as compared to spontaneous course of disease. Rational use of available methods in early diagnosis and therapy considerably improves the prognosis of CLI.