56 y/o M  with critical left leg ischemia. Possible procedure would be a very long, very complex, multi-faceted reconstruction. Conservative management would eventually result in AKA which may be complicated by poor wound healing due to ongoing vascular compromise.

Background

• CLL- WCC 38
• Smoker – cigarettes currently 5/d (recently ceased marijuana)
• Exercise Tolerance- DASI 3.94 METs – Limited by acute limb pain 

Issues:

• Cardiovascular – Reduced exercise tolerance, ? prior non-transmural infarct in RCA territory on sestamibi (but nil reversible ischaemia). TTE pending.
• Ongoing smoking – multiple strategies discussed in clinic and NRT provided

Discussion:

• Optimisation opportunities preoperatively – smoking only
• Conservative management is a poor option 

Plan:

• Await TTE Report
• Smoking Cessation 
• Likely proceed to surgery given poor conservative mx option