Next stage plan: save the leg

It continues to be a long and complicated road, made more complex by the ‘uniqueness’ of my problem (great – on this occasion I do NOT want to be unique!). But, here is what the plan is for the next stage in the ‘Save the Leg’ process.

What has been done so far

  • surgery to unblock the femoral artery (7 hours)
  • full arterial bypass hip to ankle (10 hours)
  • 2 further surgeries within 48 hours of the previous to unblock it again.

What’s happening at the moment

There is another blockage at the bottom of the graft in the posterior tibial artery. This blockage is causing reduced blood flow to my foot, and it’s also causing an artery to flow in the wrong direction (up instead of down my leg).

Symptoms of this are that my foot nerve pain has returned and the hypoxia in my calf is worse, meaning my walking distance has severely reduced again.

So, what now?

Angiogram – Tuesday 22 September. This has been rescheduled three times already so I hope it does in fact go ahead this time. This surgery is local anaesthetic. I will be awake throughout.

They are going to enter the leg just below the knee, they hope rather than the hip (due to the fact that the graft is so long – 1.5metres long in fact) and try to unblock the problem area. If they can’t do that they will enter at the ankle (a less preferable option – both for them and for me, that ankle has had way too much surgery already!). Plan is to use a balloon rather than a stent, because I’m told a stent has a lot more likelihood of reblocking. The hole I will have punched in me next will be around the size of a large needle. So I am hoping that means I will be waterproof and back swimming WAAAAAY sooner next time.. because I seriously do not want to wait another 2.5 months!

Here is an illustration of a stent and a balloon. Usually this is done of people with high cholesterol (which causes plaque to build up in the arteries). That is not the case for me, my arteries to not have any plaque. But this was the only image I could find to illustrate them both.

Angioplasty and stenting – CIRSE
Ignore the plaque in this image, I do not have that issue.

When will I know if it worked?

If the surgery is successful, I should know almost straight away, by the fact that the nerve pain should be almost immediately eliminated.

If it was more tricky than they hoped, the options following that are:

  • Try the Iloprost infusion (which means staying in or returning to hospital). This drug dilates the blood vessels. Research on whether it will work is a bit hit and miss. from what I have found, it’s really very much 50:50 whether it will or won’t. The surgeon’s take on it is it can’t hurt to try.
  • Wait 4 – 6 weeks to see what the symptoms are like and if there is any improvement in the resting pain.

Why is it still happening?

In all reality – they say that they have run out of things to test me for. From all the extensive testing they have done over the past few months, absolutely everything has come back clear, so we are no closer to finding out what is causing this problem.

A key question I still have not had answered..

My next question to them is this. I doubt I will get a straight answer, because it would implicate that someone (or several people) are at fault and there is a case for gross medical negligence against the district health board.

But, I simply cannot help but continue to wonder – if the 12-18 months delay while the messed me about and gave me all the wrong diagnoses has caused so much damage to the arteries and veins in the lower leg, that they simply can no longer continue to function properly.

I have asked that question directly already more than once. I have never yet been given an answer.

Will I get to keep the leg?

This still remains to be seen. But, suffice to say, I do not have very many surgical intervention options left (if any) to save the left leg if this problem continues to recur.