Episode # 674 • 11 Sept 2026
Treatment Strategies for Acute & Chronic Limb Ischemia
How do you choose between thrombolysis, mechanical thrombectomy, or open surgery for acute limb ischemia, and what options remain when there’s no vessel to open? On this episode of the BackTable Podcast, host Dr. Chris Beck is joined by vascular surgeon Dr. Anahita Dua (Massachusetts General Hospital) and interventional radiologist Dr. Ripal Gandhi (Miami Cardiac and Vascular Institute) to explore treatment strategies across the full spectrum of limb ischemia. They discuss presentation and referral patterns, the imaging and exam findings that start the clock, single-session mechanical thrombectomy, the evolving role of lysis, procedural endpoints, and deep vein arterialization for chronic limb-threatening ischemia.
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Timestamps
00:00 - Introduction
02:27 - Presentation, Referral Patterns, and Imaging
06:07 - Acute Limb Ischemia: Treatment Algorithm
12:16 - Thrombectomy Device Selection
16:09 - Thrombolysis and Applications Beyond Lower Extremity
18:46 - Procedural Endpoints, Closure, and Case Selection
24:43 - Deep Vein Arterialization: Patient Selection and Planning
31:25 - DVA Technique: Imaging, Anesthesia, and Access
34:58 - Step-by-Step DVA Approach
41:56 - Surveillance and Managing Expectations
45:59 - Wound Care and Amputation Decisions
49:40 - Future Directions in PAD
52:43 - Closing Remarks
Resources
- Rutherford classification of acute and chronic limb ischemia.
- Global vascular guidelines on the management of chronic limb-threatening ischemia. Conte, Bradbury, Kolh et al., Journal of Vascular Surgery, 2019.
- PROMISE II. Transcatheter Arterialization of Deep Veins in Chronic Limb-Threatening Ischemia. Shishehbor et al., New England Journal of Medicine, 2023.
- BackTable VI Episode 618, How to Manage Advanced DVA Cases: Techniques and Tips, with Dr. Kumar Madassery and Dr. Sabeen Dhand.
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More about this episode
The conversation moves from acute interventions for the cold leg, where mechanical thrombectomy has become first-line and lysis is held in reserve, to the stepwise management of no-option chronic cases, including pedal access, valve disruption, and inflow for deep vein arterialization. Drs. Dua and Gandhi share practical insights on device selection, preventing distal embolization, and when to consider open embolectomy or hybrid approaches. The episode closes with a discussion of post-procedure surveillance, wound care, and the need for better measures of perfusion to improve limb salvage and patient outcomes.
Drs. Anahita Dua and Ripal Gandhi are paid consultants of Stryker. Their opinions and experiences using these devices were formed independently of Stryker and may not necessarily be those of Stryker. Individual experiences may vary.
The material presented is intended for educational purposes only. A healthcare professional must always rely on their own professional clinical judgment when deciding whether to use a particular product when treating a particular patient Stryker does not dispense medical advice and recommends the healthcare professionals be trained in the use of any particular product before using the product. Stryker does not endorse or support the unapproved uses of its products.
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The Materials available on BackTable are provided for informational and educational purposes only and are not a substitute for the independent professional judgment of a qualified healthcare professional in diagnosing or treating patients. Any opinions, statements, or views expressed are those of the individual contributors and do not necessarily reflect those of the publisher, platform, or any affiliated organization.