based on the given information, the patient is slightly improved on conservative measures. I will recommend continue conservative measures with anticoagulation to prevent thrombus propagation and scheduled angioplasty for the iliac occlusion with covered stent (ESVS recommendation 57 level IIb B)
After full history and examination with cardiac assessment and anesthiae consult.
Pt. Now cludicant on 10 meter after attack of acute ischemia..
I prefer to prepare hybrid OT
Rt open femoral exposure wire traversal test and selective angiography and deal accordingly..
1. Throbectomy with or withou CDT and angioplasty
2. Angioplasty
3. Fem fem
4.aorto bifem if pt fit and previous choises failled
Asmaa Saleh
6 months ago
I would start with detailed history (comorbidities? cardiac history? prev MI? previous antico-agulant? last taken? previous LL complaints? bleeding risk?)
then general and vascular physical examination (irregular HR? BP? bilateral LL Pulse assessment? ABPI bilaterally?)
then investigations, including s.creat and other full lab bloods, Echo, ECG.
Given the CTA; and after assuming there is no AAA, and excluding cardiac embolic source, the culprit lesion is likely to be an underlying Rt iliac stenosis.
Regarding CTA .. what about the other Lt limb vascularity? Lt aorto-iliac segment? distal RT ipsilateral limb vascularity? bilateral CFA disease?
Then after assessment of patient’s risk status, availability of hybrid suite, distal ipsilateral and contralateral limb vascularity, I think my options are..
1- Rt groin incision and trial of proximal embolectomy, if good-flow then balloon angio and stenting of diseased iliac artery..
or
2- Fem-Fem bypass with/out distal angioplasty if Pt is high risk, and given that the other limb is non-ischemic.
In all options I would do proximal and distal angio, and manage accordingly.
Catheter directed thrombolysis may be an option but I believe its benefits after 2 weeks are minimal.
56 years old gentlaman presented to your clinic with 2 weeks history of weakness and bluish discolouration of his right foot, he recover slightly but patient is not a claudicant at 10 meters.
CTA shows acute on top of chronic occlusion of right CIA and EIA , what are the options of management ?
I will recommend continue conservative measures with anticoagulation to prevent thrombus propagation and scheduled angioplasty for the iliac occlusion
based on the given information, the patient is slightly improved on conservative measures. I will recommend continue conservative measures with anticoagulation to prevent thrombus propagation and scheduled angioplasty for the iliac occlusion with covered stent (ESVS recommendation 57 level IIb B)
scheduled after 6 weeks
After full history and examination with cardiac assessment and anesthiae consult.
Pt. Now cludicant on 10 meter after attack of acute ischemia..
I prefer to prepare hybrid OT
Rt open femoral exposure wire traversal test and selective angiography and deal accordingly..
1. Throbectomy with or withou CDT and angioplasty
2. Angioplasty
3. Fem fem
4.aorto bifem if pt fit and previous choises failled
I would start with detailed history (comorbidities? cardiac history? prev MI? previous antico-agulant? last taken? previous LL complaints? bleeding risk?)
then general and vascular physical examination (irregular HR? BP? bilateral LL Pulse assessment? ABPI bilaterally?)
then investigations, including s.creat and other full lab bloods, Echo, ECG.
Given the CTA; and after assuming there is no AAA, and excluding cardiac embolic source, the culprit lesion is likely to be an underlying Rt iliac stenosis.
Regarding CTA .. what about the other Lt limb vascularity? Lt aorto-iliac segment? distal RT ipsilateral limb vascularity? bilateral CFA disease?
Then after assessment of patient’s risk status, availability of hybrid suite, distal ipsilateral and contralateral limb vascularity, I think my options are..
1- Rt groin incision and trial of proximal embolectomy, if good-flow then balloon angio and stenting of diseased iliac artery..
or
2- Fem-Fem bypass with/out distal angioplasty if Pt is high risk, and given that the other limb is non-ischemic.
In all options I would do proximal and distal angio, and manage accordingly.
Catheter directed thrombolysis may be an option but I believe its benefits after 2 weeks are minimal.
56 years old gentlaman presented to your clinic with 2 weeks history of weakness and bluish discolouration of his right foot, he recover slightly but patient is not a claudicant at 10 meters.
CTA shows acute on top of chronic occlusion of right CIA and EIA , what are the options of management ?
This patient has grade 2b acute ischemia
, after exclusion of an embolic cause, the options i have are:
Endovascular cdt
Open bypass