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BackTable / VI / Podcast / Episode #118
Treating Acute Limb Ischemia
with Dr. Donald Garbett
Interventional Radiologist Dr. Donald Garbett talks with Dr. Michael Barraza about how he approaches acute limb ischemia, including different endovascular techniques for removing acute arterial clot.
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BackTable, LLC (Producer). (2021, March 29). Ep. 118 – Treating Acute Limb Ischemia [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Dr. Donald Garbett
Dr. Donald Garbett is a practicing Vascular and Interventional Radiologist at Minimally Invasive Specialists in Eugene, Oregon.
Dr. Michael Barraza
Dr. Michael Barraza is a practicing interventional radiologist (and all around great guy) with Radiology Associates in Baton Rouge, LA.
Show Notes
In this episode, Dr. Donald Garbett joins Dr. Michael Barraza to discuss treating acute limb ischemia. We explain when to take a hospital patient to the OR instead of angio, and Dr. Garbett tells us why he prefers establishing severity of the limb ischemia using the Rutherford classification. We discuss the circumstances of needing to have an immediate procedure, and what challenges may occur in these patients.
We discuss the beginning of treating acute limb ischemia, including getting access, initial angions, and when to get an ACT. We review how to get femoral access, and we explain some cases where a different type of access is needed. We discuss which sheath size to use for diagnostics and when lysing overnight. Dr. Garbett tells us when he will lyse while treating acute limb ischemia and why he treats the underlying issue first.
We review the different kinds of grafts, and we discuss what guides the approach to re-vascularizing a graft. We talk through some challenging situations that can occur when working on a graft and the dangers of the lipstick effect. We discuss how to use balloons to treat an underlying stenosis and how to deal with an unexpected intraprocedural clot. We discuss follow-up care and working with vascular surgery to coordinate care.
Transcript Preview
[Dr. Michael Barraza]
In terms of putting it all together and establishing the severity, do you usually rely on Rutherford classification [for chronic limb ischemia] or just gestalt?
[Dr. Donald Garbett]
I love our Rutherford because it's just nice to put one word on them (Rutherford 4, Rutherford 5). Rutherford is good for the acute-on-chronic patient, which most of them are. I would say that half of the patients we see like this already have an ulcer. Most are going to be Rutherford 5’s, so they're acute, probably chronic, with an ulcer. It's not common to have a 6 with massive, sloughing tissue, but usually it’s a little bit earlier. Although, during early COVID, we saw a whole bunch of just black feet. People were just like, "It was fine. I was fine." It was pretty bad, but now it's sort of tapered off to mostly toe ulcers and profound ischemia. We'll see an arterial thrombosis and no pulses, then we'll get the Doppler and the tech will say, "Hey, there's DVT also."
[Dr. Michael Barraza]
Really?
[Dr. Donald Garbett]
Yeah. When I originally came here, I had very little arterial experience and I was a little bit scared. I needed to learn this. I just started grabbing the Journal of Vascular Surgery and grabbing textbooks from vascular surgery and just reading about how to assess the patient. I know that vascular surgery would see him, but I have to know it too.
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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