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There is accumulating evidence that thrombosis contributes to peripheral arterial disease, and that antithrombotic therapy should be considered at all symptomatic stages. In claudication, antiplatelet therapy is indicated in addition to lifestyle advice and sometimes surgery or angioplasty; the place of thrombolysis is unproven. In chronic critical limb ischaemia, prophylaxis of venous thromboembolism by low-dose heparin is indicated during hospitalisation, as is long-term antiplatelet therapy; local thrombolysis or systemic prostanoid infusions are increasingly used. In acute critical limb ischaemia, full dose heparinisation is followed by thromboembolectomy, local thrombolysis, angioplasty and surgery as appropriate. Antiplatelet therapy and/or anticoagulation are employed following such procedures, according to risk factors in the individual patient. Collaboration between vascular surgeons, radiologists and physicians is important in comprehensive patient care.

Cutaneous blood flow in the foot was assessed by 125I iodoantipyrine clearance in patients with peripheral vascular disease. Three groups were studied: group (a) consisted of 10 controls, Group (b) of 10 patients who had arterial reconstruction, and Group (c) of 10 patients having lumbar sympathectomy. Skin blood flow remained constant in the control patients. In Group (b) arterial reconstruction increased skin blood flow from mean 4.3 ml/100g/min to a mean of 14.9 ml/100g/min (p less than 0.001). In group (c) skin blood flow did not significantly change from a mean preoperative value of 7.6 ml/100g/min to a mean postoperative value of 8.1 (ml/100g/min). These results suggest that lumbar sympathectomy does not affect nutritional blood flow.