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It is the use of electric energy in the vicinity of the spinal cord. The leads are placed in the epidural space to stimulate the spinal cord.

The management of the acutely ischaemic limb remains a challenge for even experienced vascular surgeons. This chapter aims to give rural or remote surgeons a straightforward algorithm for the management of the acutely critical ischaemic limb, and some guidance in the operative techniques utilised in the management of these patients. Clearly many of these issues are best dealt with in a more appropriate centre; however, we recognise that this is not always feasible and this chapter aims to assist in the local management of these problems.

It has always been difficult to be certain of the results of surgical treatment for critical ischaemia, mainly because of the lack of a definition which would allow patients to be categorised appropriately [1]. Although Fontaine described his grading of limb ischaemia some years ago, there are patients, particularly in the Fontaine III Group who can improve spontaneously and may not fit the modern definition of critical ischaemia. Attempts have been made recently to define the problem more clearly [2] and suggest that Fontaine III can be sub-divided into further Subgroups as explained earlier in this book. It should now be possible to carry out comparative studies to examine either surgical or other methods of treatment which will hopefully provide the data we need to decide which is the best method of treating the different causes of critical ischaemia. Precisely because of the lack of a definition most studies have, and continue to, contain a variety of patients who are said to be in danger of losing their limb or alternatively the reason for undertaking the procedure is not mentioned at all. The result is that many such patients have been suffering from claudication or are a group who would be expected to do well. Critical ischaemia therefore refers only to those patients who will, as far as we can tell, lose their leg if nothing is done to improve the circulation. Bearing this in mind the place of surgical reconstruction in critical ischaemia has to be examined objectively.