1155_Carroccio.pdf

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1、ALI ManagementALI ManagementCase Based Discussion Case Based Discussion CDT Overnight vs OnCDT Overnight vs On-Table CDT vs Table CDT vs Device Embolic vs ThromboticDevice Embolic vs ThromboticAlfio Carroccio M.D.Chief,Division of Vascular Surgery Lenox Hill HospitalProfessor of Surgery,Hofstra Scho

2、ol of MedicineConflict of InterestDISCLOSURESNoneAcute Limb Ischemia Identifying Acute Limb Ischemia Guidelines Current Results AlgorithmAcute Limb IschemiaClinical QuestionsHow much time do we have?Is it salvageable?Location?Native Anatomy vs Previous Stent vs Previous BypassEmbolic vs ThromboticAg

3、e of ThrombusEtiologyApproach QuestionsCD Lysis Overnight vs On-Table CD Thrombectomy vs BothOptimal deviceAcute Limb Ischemia-what is itSudden decrease in perfusion that threatens the viability of the limb without“timely”treatment-Viable Threatened Irreversibly damaged-Dictated by preexisting arter

4、ial pathology and location of thrombus/embolusStages of Acute Limb IschemiaAcute Limb IschemiaOutcomes OverallLimb salvage 50-85%Mortality 10-20%SurgicalMore expeditiousGreater morbidityCatheter Directed Less expeditious?Less morbidity SurgicalBypassEmbolectomyCatheter BasedPharmacologicMechanicalAw

5、aiting new stride subgroup analysis on Native vs In stent vs Bypass graftAcute Limb Ischemia TreatmentRecs-Date of onset age of thrombus-Native circulation,Graft,stent,embolus or thrombus-Dont declare unsalvageable unless your sure-Confirm lysis is an option-How quickly can you get the circulation r

6、estored-Know what your embolizing-Filter an option-Any identifiable runoffIntravenous HeparinStage III*Irreversible DamageStage IIBImmediately ThreatenedStage IIAThreatenedStage IViable Not threatenedImaging*AmputationAssessment of Stage and Allowed Time*Endo Surgical or BothAlgo