Presentation
Venous arterialisation for no option CLI: Limflow procedure
This case demonstrates the unique Limflow procedure for the so-called ‘no option’ CLI patients. This term is used for advanced disease with occlusion of the pedal arteries used for distal bypass or angioplasty targets. This ‘desert foot’ also represents an end-stage pathology that commonly leads to failure of all conventional revascularization attempts. In this video, you will learn the steps of the procedure, all devices needed and important technical tips and tricks for a successful outcome.
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Michael thank you for this excellent video. I have two questions about the postoperative course:
1. These patients develop severe pain after the revascularization, probably due to the hyperemia. Have you seen also the same problem in your patients? Do you have any specific recommendation?
2. What is the postoperative anticoagulation in those patients?
Two important questions.
Because of the massive venous filling after the procedure a significant edema in these patients is usually seen which causes pain. Leg elevation and bed rest for 2-3 days together with pain medication is recommended during this initial phase. Anticoagulation (Vit. K antagonist) plus at least one antplatelet medication (preferable Clopidogrel) is standard after the procedure.
What a case presented. Thank Dr. Michael Lichtenberg. As for the pain and edema after the venous arterialisation, in my opinion, it is due to the pathological cause of ischemia reperfusion injury with a mount of temporary release of inflammatory factors. The better with the revascularization, the worse with the edema. Thus, some anti-inflammatory drug might be a good option, such as glucocorticoid once or twice.