What a great disappointment to find that the graft you put yesterday to treat a patient with lower limb ischemia has been blocked!!! Did you spend 2, 3 even 4 hours for nothing? You need to re-explore the patient, especially if he/she develops acute limb ischemia. Should you take him/her straight to the theater ? Or what else should you do in this unpleasant situation?

A graft is occluded straight after its insertion for technical issue(s):

  1. Problematic inflow
  2. Problematic outflow
  3. Bad anastomosis
  4. Graft of poor quality
  5. Hypercoagulopathy (???)

So what do you need to do carry on? Definitely, before taking the patient to the theatre, take a deep breath and ask for a CT angiogram. It will give you an idea of what went wrong the first time and what you can try to get it better this time

(To be continued…)