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Tue Aug 8 14:24:27 BST 2006

There has been no report of neuromotor compromise to the limb which would contraindicate attempts at vascular reconstruction, nor is this an critically unstable patient who must be surgically abbreviated in damage control mode to preserve life.

  To go to amputation simply because you are limited to anatomic approaches due to unfamiliarity or discomfort with extra-anatomic approaches would be an clearcut breach of standard of care. A bit like taking out someone's colon because you weren't comfortable with appendectomy.

  We seem to be making a mountain out of a molehill here.

Ronald Gross <Rgross at harthosp.org> wrote:
  Sorry to say this Ken, but I think it is time to cut your loses (no pun
intended), and look to amputation. The expression "life over limb"
comes to mind, and I have thought all along, from what you described,
that the limb in question was going to be lost, I just wasn't sure
when.
Ron
>>> 8/7/2006 11:18 AM >>>
On the cases I presented last week, one developed an arterial sentinel 

bleeding episode during dressing change, which became torential the
next day. 
Arteriogram revealed a site at the proximal suture line, STENTED with

endovascular stent which stopped the bleeding. TWO days later the
same thing happened 
to the distal suture line and again a stent stopped the bleeding. NO

further bleeding, but groin is still a mess and not ready for an extra
anatomic 
bypass. 

What can we expect???
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