A Matter Of Life and Limb

Procedures that restore blood flow save a leg, stop excruciating pain.

Randy celebrates his dramatically reduced pain with music.

Randy Smith was 13 years old when he was diagnosed with Type 1 diabetes, a condition that makes it difficult to manage blood sugar levels and can result in complications that include heart and blood vessel disease.

As Randy grew older, he experienced the latter in spades.

“I’ve had a lifelong problem with poor circulation, including blood clots in my veins,” the 51-year-old elaborates. “In recent years, I started having problems with the arteries in my legs, especially my right leg. And with a lack of blood flow, I developed ulcerations and faced losing my limbs. I also suffered two bad heart attacks.”

In addition to Type 1 diabetes, Randy lives with a condition called hypercoagulation, which causes his blood to clot easily. The clots can then block blood flow. To counter the condition, he was prescribed the blood-thinning medication warfarin as a teen. People taking blood thinners bleed easily and must be monitored carefully.

“You have to have blood tests every week when you’re taking them,” Randy asserts. “There are so many issues that go along with having vascular problems that you wish you didn’t have to deal with them.”

Possibly the worst issue associated with vascular problems, Randy suggests, is the pain.

“When there’s a lack of blood flow and oxygen to your legs, they are actually being strangled, and the pain that comes with that is a very bad, horrible pain,” Randy describes. “On a scale of one to 10, it’s 10 times 10. It’s not just any pain. It’s crying into your hands, life-changing pain. It affected me to the point that it altered my position in the universe.”

By 2018, the circulation in Randy’s right leg was so poor that it put him in danger of losing his foot.

“That situation was just awful,” Randy confirms. “I was having trouble walking and this open wound that I had on my right foot went all the way to the bone. The problem was that it wouldn’t heal, so I was in danger of possibly losing my right foot. I had recently suffered a heart attack and was seeing a cardiovascular doctor at the time, and he said I needed to see a specialist to look at my leg.”

He recommended Brian L. Dunfee, MD, a board-certified vascular and interventional radiologist at Interventional & Vascular Center. Dr. Dunfee and his partner, board-certified vascular and interventional radiologist Robert J. Kennedy, MD, use minimally invasive, image-guided techniques to treat conditions such as poor blood flow in the legs.

”Randy first came to us in June 2018,” Dr. Dunfee recalls. “His vasculature was significantly compromised by diabetes and hypercoagulation. He also suffered with coronary artery disease and had just undergone a cardiac catheterization before coming to us.

“At that time, Randy’s right leg was cramping, burning and turning a dark color. His foot, meanwhile, was very cold and blue. To get an idea of what was happening, we performed an ultrasound and angiogram. The pictures from the angiogram showed the blood vessels going down to Randy’s lower leg were almost shut down, so no blood was getting to his foot.”

Plaque Proliferation

The ultrasound and angiogram further revealed that the blood vessels in Randy’s right leg were filled with plaque, a combination of cholesterol, calcium and other substances that collects on the vessel walls and interferes with blood flow. Dr. Dunfee planned to eliminate the plaque with endovascular procedures.

“Endovascular techniques go through the blood vessels,” Dr. Dunfee explains. “First, we take pictures endovascularly, so we can view the blood vessels from the inside out and determine what’s causing the blockage and why the blood flow is slow down Randy’s right leg.”

Dr. Dunfee discovered almost 100 percent blockage in two of the three vessels running from Randy’s knee to his foot.

“I can walk without pain now.” – Randy

“We opted to perform two endovascular procedures to open up the blood vessels: atherectomy and angioplasty,” the doctor discloses. “We entered those blood vessels through his groin and foot. First, we performed the atherectomy, where we essentially Roto-Rooter® the plaque and remove it from the body.

“Once the atherectomy is completed, we perform the angioplasty, where we use a balloon to flatten the plaque and open up blood flow. In some cases, we place stents during the angioplasty to further strengthen the opening. We can also use drug-eluding balloons that place medication directly into the blood vessel.”

It sometimes takes more than one procedure to achieve the desired results. With Randy, Dr. Dunfee performed four over a two-year period.

“When the procedures were completed, Randy was able to walk again,” Dr. Dunfee says. “Most importantly, we were able to significantly improve the blood flow in Randy’s right leg and save his foot. He lost some tissue, but kept his leg. That was the saving grace for him because he didn’t want to have a prosthesis for the rest of his life. He is now going through wound care with a podiatrist, but his improved blood flow will help that be effective.”

An appreciative Randy says: “I did lose my big toe, but fortunately that’s all I lost.”

“I’m Still Alive”

Dr. Dunfee’s procedures also had a dramatic impact on Randy’s universe-altering pain.

“It’s not like it went away completely, but it’s not excruciating,” Randy admits. “My pain now is probably a one, which is manageable. I can live with it, but sometimes there are rough patches. I can walk without pain now. I’m sensibly functional, and that’s what I asked Dr. Dunfee to do for me.

“The fact that I’m still alive is pretty amazing. I get wounds that open and close, which is an ongoing issue I have to deal with. Thankfully, I no longer take warfarin and don’t need the weekly blood tests.
Randy is grateful for Dr. Dunfee, his staff and the success of his treatment.

“I love Dr. Dunfee,” he enthuses. “He’s very knowledgeable, more than anyone I’ve ever met in my life. The people at Interventional & Vascular Center do good work, but it’s about more than the work. It’s about having a caring relationship with my provider. Dr. Dunfee gives me good advice about life, and that’s difficult to find.”

©FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. js
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