Acute Limb ischemia is elderly

[Karim Brohi]

Thrombolysis: definitely not (high complication rate with low short-term
success)
Heparin will be of no value

If the patient is adamant that you attempt limb salvage I would offer a
single try at graft thrombectomy with on-table angiogram and possible
angioplasty of the distal anastomosis.  I would be clear that the chance of
success is low and that a below-knee amputation is the likely result either
way.  If she will tolerate LA then fine.

Karim

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of saad shebrain
Sent: 02 December 2007 05:46
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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