Images in cardiovascular medicine. Untreated gangrene in patients with peripheral artery disease.

The extent to which advanced stages of limb jeopardy are routinely tolerated in patients with peripheral artery disease is remarkable, given the emphasis on early diagnosis and therapy otherwise typical of cardiovascular medicine. This practice derives in part from a lack of patient education: patients fail frequently to seek medical consultation despite the development of black feet. In part, however, this practice is a function of physician attitudes: lower extremity ischemia is frequently permitted to progress to gangrene before definitive therapy is recommended. Unfortunately, "definitive therapy" often implies amputation. This was the case for patients whose limbs were photographed at the time of presentation and are illustrated in panels a through h (top two rows) of the accompanying composite figure.