Current Options in the Diagnosis and Management of Acute Limb Ischemia

Karthikeshwar Kasirajan, MD, Kenneth Ouriel, MD

Disclosures

Prog Cardiovasc Nurs. 2002;17(1) 

In This Article

Arteriography and Noninvasive Studies

Recently, a trend toward employing preoperative and intraoperative angiographic assessment of the patient with ALI has altered traditional teaching. Many vascular practitioners have realized that the time required to perform preoperative angiographic evaluation is well worth the information obtained; this information is essential to the operative plan. In addition, there has been a change toward a more aggressive attitude regarding the placement of a new bypass graft, as opposed to thrombectomy and repair of an old graft. For instance, a thrombosed prosthetic femoropopliteal bypass graft that was routinely treated by an immediate trip to the operating room for thrombectomy and distal patch angioplasty might now be more often managed with preoperative angiographic assessment and placement of a new autogenous vein bypass graft around the blocked arterial segment.[4]

In most cases, initial diagnostic arteriography should be performed to localize the site of occlusion and to visualize the distal arterial tree. It may also be possible to distinguish an embolic occlusion from an in situ thrombosis.[1] In addition to acquisition of valuable diagnostic information, percutaneous endovascular options for revascularization can be concomitantly employed.

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