Clinical features of vascular insufficiency in the limbs.

Drugs (nicotine, beta blockers) can exacerbate symptoms of vascular insufficiency. Vasodilators and anticoagulants have no place in the treatment of chronic insufficiency. Analgesics rarely, if ever, relieve ischaemic pain at rest. Ischaemic pain at rest and gangrene are absolute indications for surgical restoration of the circulation. Spasm is never the determining factor in acute insufficiency associated with trauma. Surgical restoration of circulation is essential in most cases of acute insufficiency. The knee joint should be preserved if possible in lower limb amputation, even if proximal vascular reconstruction is necessary. Surgery should not be denied on the basis of age or infirmity. Restoration of normal circulation in the limb is the best treatment for vascular insufficiency. Acute or chronic vascular insufficiency is eminently correctable in most cases. Advances in diagnosis, patient selection, anaesthesia, operative surgery and rehabilitation have rendered reconstructive procedures safe and successful. Early diagnosis and referral to a vascular unit with modern facilities offers a greater chance of salvage of life and limb than that possible in earlier decades. Many patients return to an independent life free of pain and requiring minimal ongoing care.