A Case of Diminished Blood Flow

Minimally invasive procedure restores circulation in veteran’s foot.

Edward Yoches made the military a career. He reached the rank of master sergeant in the Air Force, serving as an aircraft mechanic. Early on, Edward was stationed at a US airbase in Germany. He later returned to the States with his wife, Jean, and their two young children.

“We were lucky. We didn’t move around that much,” Jean reflects. “But Edward did go to Vietnam three times. For two of those tours, Edward was gone for a year. The third tour, he was gone for three months.

Dr. Mittleider can use minimally invasive procedures to treat many patients who were told surgery was their only option or that they have no option.

Dr. Mittleider can use minimally invasive procedures to treat many patients who were told surgery was their only option or that they have no option.

“That was difficult with two young kids. They were 8 and 9 when Edward was sent to Vietnam the first time and teenagers when he went the last time. I don’t think the kids even realized what was going on. They only knew their dad was away.”

After 21 years with the Air Force, Edward put in another 21 years with FedEx at its Memphis headquarters. After retirement, Edward took up fishing, but issues with the circulation in his feet disrupted his easygoing lifestyle.

“Edward had very little circulation from his legs to his feet, so his feet weren’t as good as they should be,” Jean shares. “It got really bad in one leg about a year and a half ago. It was like he had no circulation at all, and his left foot became numb. Sometimes, he was in pain, and at times it kept him awake at night.”

Jean says that, despite the pain in his feet, Edward was still able to complete most of his routine activities, such as going to the grocery store and church services.

“He had a little walker and could get around with that,” Jean describes. “The only thing he really couldn’t do was walk in the backyard to go fishing. We have a waterway behind our house where he fished. But his condition got so bad that he couldn’t walk on the grass in the yard to go down to the waterway.

“Our primary care doctor referred us to a foot and ankle surgeon, who treated one of Edward’s legs and started on the other but couldn’t finish. The doctor was going to do a vein transplant. We weren’t keen on that because Edward is 84 and would have to be under anesthesia for seven or eight hours. The doctor also told us there was no guarantee Edward would get circulation back and might lose his leg. That’s when Dr. Mittleider came in.”

Derek Mittleider, MD, FSIR, RPVI, is chief of vascular and interventional radiology at Vascular & Interventional Physicians. When he first met Edward, Dr. Mittleider noted right away that Edward had a wound on his left great toe. He soon learned that the wound had resisted healing despite multiple conservative treatments and that previous vascular procedures failed to restore circulation to the foot.

“Mr. Yoches was told that the only option left was an open surgical bypass, and that it had a very low chance of being successful, and he would likely end up with an amputation of his left foot,” Dr. Mittleider reports. “His foot and ankle surgeon was aware of our practice and referred him to me for a second opinion. 

“With our practice’s experience and skillset, we’re able to use minimally invasive procedures to treat the vast majority of patients who’ve been told their only option is major surgery. So there is hope.” 

Timely Techniques

Dr. Mittleider diagnosed Edward with chronic limb-threatening ischemia, or CLTI, a severe form of peripheral vascular disease.

“Peripheral vascular disease is a condition of diminished circulation in blood vessels outside of the heart,” Dr. Mittleider educates. “It affects at least 10 percent of the population and is much more common in smokers and diabetics.

“A portion of patients with peripheral vascular disease develop CLTI. With CLTI, circulation to the foot reaches such a critically low level that patients experience pain even at rest or develop wounds that won’t heal.”

Wounds that won’t heal often become infected and, ultimately, the bone becomes infected as well. Typically, this results in the amputation of a toe. But many times the rest of the foot is already compromised.

“The toe amputation begins a downward spiral that ends up not uncommonly in patients getting an amputation below the knee or in some cases above the knee if circulation cannot be restored,” Dr. Mittleider notes.

To restore circulation in Edward’s foot, Dr. Mittleider performed a minimally invasive technique called angioplasty. It involved inserting a small tube into the blocked artery in Edward’s leg and using tiny wires and balloons to open the blockage.

“There are two parts to this procedure,” Dr. Mittleider observes. “First, we must open up the blockage, which is usually achievable. But then we must keep the artery open. We use a special type of balloon with a drug on it that helps prevent the blood vessel from narrowing again.

“Sometimes, we place stents in the arteries to hold them open once we unblock them with the balloons. This is called angioplasty with stenting. Another technique we sometimes employ is atherectomy. That involves using a tiny drill-like device to burrow through the blockage and remodel the artery to improve circulation.” 

Successful Approach  

Thanks to Dr. Mittleider and Vascular & Interventional Physicians, Edward was able to avoid open bypass surgery and hours of general anesthesia. The retired Air Force sergeant is well on his way to an excellent outcome.  

“Dr. Mittleider used a different procedure on Edward, and it worked fine,” Jean reports. “Edward is still having some trouble with his feet, but I think that’s because he’s had very little circulation for so long. But he’s doing better.

“I like Dr. Mittleider a lot. He gave me a lot of confidence that he could take care of my husband. I’m really glad we went to Dr. Mittleider. I’m glad our podiatrist referred us to him.”

© FHCN article by Patti DiPanfilo. FHCN file photo. mkb
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