Avoiding major amputation: the crucial role of the vascular specialist

When Professor alberto oliaro asked me to organize a monography for Italian Journal of Vascular and Endovascular Surgery “on an issue of contemporary interest and debate,” my thoughts and feelings have been malperfusion to the lower extremities. These are the most symptomatic patients in the vascular scenario, so limited in their daily activity, suffering from incoercible pain, discomfort, and restless nights. still, their poor condition seems to be faced by most vascular specialists with a sense of resigned disenchantment, likely because of the complex treatment these patients should undergo, and their poor prognosis. furthermore, there seems to be a diffuse, but wrong opinion that limb loss is not correlated with death. therefore, critical limbthreatening ischemia ( still looks like a secondclass disease, as well as limb salvage, at least compared to other vascular operations and procedures, surely more exciting in the short term.