Ep. 674 Treatment Strategies for Acute and Chronic Limb Ischemia with Dr. Anahita Dua and Dr. Ripal Gandhi

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. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Stryker Peripheral Vascular https://www.stryker.com/us/en/peripheral-vascular.html --- 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 --- 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. --- Resources Rutherford classification of acute and chronic limb ischemia. https://doi.org/10.1016/S0741-5214(97)70045-4 Global vascular guidelines on the management of chronic limb-threatening ischemia. Conte, Bradbury, Kolh et al., Journal of Vascular Surgery, 2019. https://doi.org/10.1016/j.jvs.2019.02.016 PROMISE II. Transcatheter Arterialization of Deep Veins in Chronic Limb-Threatening Ischemia. Shishehbor et al., New England Journal of Medicine, 2023. https://doi.org/10.1056/NEJMoa2212754 BackTable VI Episode 618, How to Manage Advanced DVA Cases: Techniques and Tips, with Dr. Kumar Madassery and Dr. Sabeen Dhand. https://www.backtable.com/shows/vi/podcasts/618/how-to-manage-advanced-dva-cases-techniques-tips --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app