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Acute Lower Limb Ischaemia for the Generalist

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Acute Lower Limb Ischaemia for the Generalist

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    1. Acute Lower Limb Ischaemia for the Generalist John Thompson Exeter j.f.thompson@exeter.ac.uk

    2. Causes of acute LLI Acute on chronic ischaemia (Aneurysm) Embolus Bypass failure Trauma Microvascular

    3. Microvascular Failure Pressors Bacterial Toxic Immune complex DXRT CRF Diabetes

    4. Assessment Analgesia and oxygen Hydration Cardiac (troponin) Respiratory Hypothermia

    5. Urgency Pallor on dependency Cold Paraesthesia Sensory blunting (warm hand) Muscle tenderness (fasciotomy)

    6. Urgency 2 Paralysis Fixed staining Plasticine texture ? Agonal Ischemie Depasse Revascularisation can be fatal

    7. Doppler Dependent Compression test Elevation h/13 = mmHg x 10 Buergers test

    8. Investigations Duplex- impractical Doppler best DSA

    9. Pick out losers Delay Previous grafts No vein No run-off Tissue loss Socially deprived Dementia Previous mobility

    10. Selection for EVAR: Exeter Vascular Service Protocol

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