I

Analgesia

Amputation

Angioplasty L Bypass or endarterectomy

Non-healing j Healing

Algorithm for treatment of critical limb ischaemia

Iliac stenosis

Iliac occlusion

Iliac stenosis

Iliac occlusion

Axillobifemoral Bypass

Iliac angioplasty and crossover graft

Aortobifemoral bypass graft

Axillobifemoral bypass graft

Iliac angioplasty and crossover graft

Aortobifemoral bypass graft

Axillobifemoral bypass graft

Surgical treatment options for aortoiliac disease

Methods of pain relief for critical limb ischaemia

• Slow release opiate analgesia—for example, morphine sulphate

• Prostacyclin analogues*—for example, Iloprost or prostaglandin Ej (alprostadil)

• Chemical or surgical lumbar sympathectomy

• Dorsal column spinal stimulation *Not licensed in United Kingdom

Further reading

• Scottish Intercollegiate Guidelines Network. Drug therapy for peripheral vascular disease. SIGN 1998;27.

• Joint British recommendations on the prevention of coronary heart disease in clinical practice. Heart 1998;80(suppl):S1-29.

• Leng GC, Fowler B, Ernst F. Exercise for intermittent claudication. In: Cochrane Library. Issue 4. Oxford: Update Software, 1999.

• Davies AH, Beard JD, Wyatt MG. Essential vascular surgery. London; W B Saunders, 1999.

The ABC of arterial and venous disease is edited by Richard Donnelly, professor of vascular medicine, University of Nottingham and Southern Derbyshire Acute Hospitals NHS Trust ([email protected] nottingham.ac.uk) and Nick J M London, professor of surgery, University of Leicester, Leicester ([email protected]). It will be published as a book later this year.

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