The purpose of this document is to provide the clinician with easy-to-use guidelines when faced with a patient with severe ischaemia in the limbs requiring interventional treatment; the CoCaLis document does not focus on the management of the lower limb ischaemia, but rather on the best possible approach to the associated coronary and/or carotid artery disease. The first part of the text deals with the epidemiological aspects of this condition followed by a description of, and proposals for, the management of risk factors. The next part deals with the approach to the coronary circulation and the carotid territory. In each part attention is mainly given to the practical aspects in terms of both diagnosis and treatment; for each of these steps the costs involved are considered and attention given to balancing the clinical decisions against the costs. The recommendations given are 'evidence based' when such evidence exists and, if not, the proposals are based on the consensus of the members of the group. In many instances it was apparent that the necessary information is not available in the literature. The authors hope that the CoCaLis document may not only improve the management of the vascular patient but also stimulate further research in this difficult clinical condition which carries a significantly increased risk for the patient.