[HSF] New case- CAD + Leriche

[Tea Acuff]

I don't see much advantage to delay with an SEMI. I would do beating heart with or without CPB and not expect to need IABP unless there were technical problems. It might be wise to know the lower leg anatomy before you set sail in the off chance that some unexpected storm comes up, especially since you are staring at one. 
tea



----- Original Message ----
From: "tdmartin2000 at aol.com" <tdmartin2000 at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, May 16, 2008 6:51:32 AM
Subject: Re: [HSF] New case- CAD + Leriche

Gentlemen
Thanks for the input so soon. To answer some of the questions posed so far- he does pass the eyeball test and in fact works at the info desk at our hospital, he does smoke but "down to 5 a day", his mitral and aortic valves are OK and I think the low if may be secondary to his MI, his legs are fairly ischemic and currently I do not know the status of his vessels below the inguinal lig. I have thought about all of these approaches and am considering either ax-fem (which I am not?a real fan of) or combined ABF/CAB which I have done on several occasions.
I worry about not having a good and safe way to use a IABP and the possibility of severe lower extem ischemia if we have any problem with low output. 
No one has addressed the issue of timing yet in the face of a nonQ infarct?

Tom


-----Original Message-----
From: Hgrmd at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Fri, 16 May 2008 7:05 am
Subject: Re: [HSF] New case- CAD + Leriche



John,
  Agree with your comments except for the ascending aortic graft to  the 
iliac.  Guaranteed much simpler is a conventional axillary (either  right or 
left) 
bifemoral bypass.  Ax-fems have been used for years with  good results.  For 
the first 8 years of my practice, at least half of my  time was spent doing 
peripheral vascular surgery (I still do a few  carotids).  I don't currently 
read much about vascular surgery, but I know  that this is a simple, relatively 
atraumatic procedure.  BTW, do you know  of any studies comparing the 2 
techniques?

Hal



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