Acute Limb ischemia is elderly

[Nick Macartney]

Everything=
1) embolectomy
2) Redo fem-distal
3) fem-fem crossover
4) ax-fem
5) BK amp
AK amp
Death

In that order.
Or, as K says, do nothing.

Nick Macartney - the anaesthetist/intensivist view. 

> -----Original Message-----
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of kmattox at aol.com
> Sent: 02 December 2007 10:42
> To: Trauma & Critical Care mailing list
> Subject: Re: Acute Limb ischemia is elderly
> 
> Options include:
> 
> 1.  NOTHING
> 2.  Sympathectomy
> 3.  Redo the fem far away bypass
> 4.  Amputation sometime in the future.  
> 
> As described I would favor less rather than more.  
> 
> K
> 
> 
> Sent via BlackBerry by AT&T
> 
> -----Original Message-----
> From: saad shebrain <shebrain1 at yahoo.com>
> 
> Date: Sat, 1 Dec 2007 21:46:06
> To:trauma-list at trauma.org
> Subject: Acute Limb ischemia is elderly
> 
> 
> 92 year-old female with multiple co-morbidities including DM, 
> CHF, HTN, PVD, A-fib, AAA 5.5 cm, underwent Femoral-peroneal 
> bypass (using Propatent graft) 1 year ago for acute left foot 
> ischemia. she stopped taking her coumadin, and other meds in 
> the last 4 months.
>   Now presented to ER with 1 day history of increasing pain 
> in the left foot, still has sensory and motor function, no 
> pulses or even doppler signals. the LLE is cold from midthigh-toes.
>   pt is slightly demeted, but wants evrything to be done.
>    
>   vitals: A-fib, HR 80-110, BP 160s-210s/90s-110s.
>   of options:
>   1. angio with tPA provided that BP is well controlled ( but 
> what about AAA, by the way a non contrast CT showed no change 
> in size of aneurysm).
>   2. Heparin drip and accept the fact if the whole graft is 
> gone, the likelihood of limb salvage is poor.
>   3.Thrombectomy of the the graft under local anesthesia and 
> accept the fact it has notorious results when used for 
> occluded grafts with high chance of unsuccess.
>    
>   What is the best option for this patient?
>    
>    
>   Thanx
>    
>   SS
>    
> 
> 
> 
> 
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