No estoy segura.

Acute arterial thromboembolism can cause acute arterial occlusion and in such situations is considered a vascular surgery emergency. The longer the dependent limb or area is without blood supply the higher risk of permanent loss of function. Best case scenario, to the OR emergently with vascular surgery with removal of fresh clot and restoration of blood flow to the dependent area. No harm done. Unfortunately an acute arterial occlusion can present with sudden neurological deficit. For example, sudden loss of sensation and movement of a leg or arm. Followed by frequent misdiagnosis and delayed trip to the OR.

This unfortunately happens too often. Just recently, the Reverend came in and was diagnosed with a stroke, was actually treated for a stroke. It was over 12 hours later, when the pain in his leg continued to persist that a different diagnosis was considered, vascular surgery was called and he was taken emergently to the OR.

The following day, one leg saved, attention turned to the Reverend's other leg. Also compromised, it was in need of emergent intervention. Yet one by one, to my increasing frustration, my Attendings were convinced it was okay.
The Reverend: "It always looks like that." "It turns blue like that when I get out of the shower." "No it doesn't hurt at all."
I'd hate to say that a Reverend would lie... but none of that was true!! The only thing I ultimately could not argue with was... "I don't want anything more done. I don't want surgery."

By the time the Reverend finally did admit that he was having severe pain from the other leg, it was already hurting his heart as well. Which was then hurting his kidneys, and so on and so forth. My Attendings, finally acknowledging the patient needed surgery for the other leg, and... it was too high risk to do anything. Too late.

Did we miss that small window of time immediately after the first surgery, when we could have saved the other leg? With this leg now hurting the heart, at this point should we just take the leg? Life over limb? Or had the initial lost 12 hours doomed us either way?

Ultimately, the only thing that remained in control was the Reverend himself, "I don't want anything more done."
Which can stop the rest of us from action, but can't stop the What if's and why's. I wish I knew those answers.

Much Love.