In the case of acute limb ischaemia with poor inflow, what is the next step of management?

In the management of acute limb ischaemia with poor inflow, performing an iliac trawl is crucial because it addresses the underlying issue of inadequate blood supply. Poor inflow often indicates that there are significant vascular problems, typically at the level of the iliac arteries or proximal to that segment.

An iliac trawl involves accessing and potentially manipulating the iliac vessels to improve blood flow to the affected limb. This intervention can involve catheter-based techniques to remove clots or dilate narrowed segments, which is vital for restoring perfusion.

Embolectomy, while a common procedure for acute limb ischaemia, is most effective when there is a clear distal occlusion. Obtaining CT imaging, although helpful in defining vascular anatomy and pathology, would delay necessary intervention and is not the immediate management step in such an urgent scenario. Immediate amputation is rarely the first step; it would only be considered if there were no options left to salvage the limb. Therefore, iliac trawl is the appropriate choice to enhance inflow and promote limb viability.