How to manage this "multi-system, multi-organ failure in 58 yr/Male patient, admitted Twice in our 150 bedded Multi-speciality institute for - Uncontrolled Diabetic causing Nephropathy and CRF (Sr.Creatinine=3.70, Urea above 80 and gross Anaemic. Underwent CABG "Cardiac bypass grafting" for Tripple vessel coronaries in 2009. P oor Left ventricular ejection fraction-20%, Severe breathlessness. G ross Congestive hepatomegaly due to Rt.cardiac failure. N ow developed "Gross Cellulitis" of both lower limbs, wet gangrene of fingers and Septicaemia shock.
How to save his both legs from Amputation? Not fit for General or Spinal anaesthesia. I'm planning- Endovascular "Long segment mechanical Atherectomy" with Turbohawk directional and Jetstream Orbital rotational Atherectomy under local anaesthesia to salvage limbs. CRF requires Renal dialysis & failing Heart needs ionotopic support. Can…
