What surgical intervention is typically indicated for a failed iliac trawl in acute limb ischaemia?

In the context of acute limb ischaemia, a failed iliac trawl, which often refers to a failed attempt at endovascular revascularization, usually indicates the need for a more robust surgical intervention to restore perfusion to the affected limb. An axillo-femoral crossover graph is a bypass procedure that connects the axillary artery to the femoral artery, effectively bypassing any obstructed segments in the iliac vessels.

This procedure is particularly indicated when previous attempts at revascularization, such as an iliac trawl (which could include techniques like stenting or angioplasty), have not successfully restored blood flow. The goal of the axillo-femoral crossover is to establish adequate arterial flow to prevent limb loss and preserve function, making it an appropriate intervention in this scenario.

Immediate amputation and below-knee amputation are typically reserved for cases where there is a significant risk of tissue loss or when limb viability is compromised to the point that salvage is no longer possible. Nerve decompression is not relevant in the context of vascular obstruction but rather pertains to cases of nerve impingement or compression syndromes. Thus, the bypass procedure stands out as the most appropriate surgical intervention in the case of a failed iliac trawl