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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