Lower limb amputation: indication is the key

This epidemiological study, ¹ which is of great national interest, captured our attention. We agree that demographic differences may not fully explain the discrepancy between the North and South of England with respect to infra-inguinal revascularisation and amputation rates. They are, however, underestimated in the data, as acknowledged by the authors. There is a known significantly higher prevalence of smoking in the North compared to the South, ² the extent to which may be masked by this under-reporting. Of more interest to us, however, is the initial indication for revascularisation. Regional differences in the rates of revascularisation for intermittent claudication, acute limb ischaemia or critical limb ischaemia may be a possible explanation for the higher rates of revascularisation in the North of England. We hope the authors are willing to share this information if available?