Still standing on two feet
Cardiovascular experts at UC Irvine Medical Center save Tom Tiffany's foot from amputation
September 10, 2010
Tom Tiffany was stunned into silence. The scuba diving instructor and motorcycle enthusiast had gone to the doctor for a pain in his left leg. Suddenly he was lying on a bed in a community hospital emergency room and being told that his foot and possibly his limb might have to be amputated.
“I couldn’t say anything,” the 41-year-old auto technician recalls. “I was freaking out.”
Fortunately, the community doctors decided to transfer Tiffany by ambulance to UC Irvine Medical Center in Orange, where expert vascular and endovascular specialists treat complex conditions with state-of-the-art techniques. UC Irvine vascular and endovascular surgeon Dr. Roy Fujitani soon assured him that everything possible would be done to prevent an amputation.
“Dr. Fujitani is my hero,” Tiffany says.
Tiffany’s medical troubles began in June 2010. The Laguna Niguel resident had paid little attention to pain behind his knee for several days – until the big toe of his left foot turned blue and the other toes went numb. By the time he sought care, it “looked like a cadaver’s foot. There was no blood in it.”
At the community hospital, Tiffany learned that his heart rate and blood pressure were alarmingly high. The diagnosis: atrial fibrillation, also called A-fib – an arrhythmia found in about 2.2 million Americans that can cause blood to pool in the heart and form dangerous clots. If the heart “throws” a clot into an artery, it can travel to the brain, kidney, liver, intestine or any other organ, blocking blood flow and creating life-threatening consequences. In Tiffany’s case, clots had traveled to his left leg causing advanced ischemia, or lack of oxygen-rich blood.
When Tiffany arrived at UC Irvine, his heart was still in A-fib. Fujitani immediately ordered a thorough cardiac evaluation to make sure that the patient’s heart was not producing more clots and he began planning how to restore blood flow to Tiffany’s limb. Fujitani remembers well Tiffany’s fear that he would lose his leg.
“He told me he was a scuba diver, that he was engaged to be married and that he had a baby with a congenital heart problem. He had all these big things in his life, and he needed to be physically capable,” Fujitani recalls. “I thought to myself, ‘We need to take care of this patient so he can return to his life.’”
Inside UC Irvine Douglas Hospital’s advanced catheterization lab, Fujitani’s team started rheolytic therapy—a combination of drugs and then endovascular surgical procedures, all performed through small incisions with very thin catheters, to try to dissolve and remove the clots.
Fujitani had some success, but Tiffany had “a tremendous clot burden.” The blockages were in all of his leg arteries, and the older clots were the consistency of hardened rubber cement, making them more difficult to remove and unresponsive to clot-busting medications. After a second trip to the catheterization lab, Fujitani determined that the next step was an operation combining open surgery and endovascular techniques. “We had to revascularize every artery in his leg,” he recalls of the more than four-hour operation.
Five days later, Tiffany returned home and began a recovery regimen that included increasingly longer stretches of walking and treatment for his heart arrhythmia. He was making good progress until pain developed a few months later in his upper right leg. Fujitani found that another clot had lodged in the iliac artery descending from the abdomen to the groin. Because there was chronic scarring inside the blood vessel, he performed a bypass operation to reroute blood flow around the blockage.
Tiffany’s troubles were not over. Another clot soon lodged in the iliac artery near the bypass. Just days before Thanksgiving, Fujitani brought Tiffany on a third trip to the operating room, where the surgeon removed the clot and performed an angioplasty upstream from the bypass. After each operation, Tiffany began his recovery regimen anew, starting on shaky legs and walking longer and longer distances to increase the delivery of oxygen in the blood to his leg muscles. He will be closely monitored by Fujitani and heart doctors for the rest of his life.
Tiffany finally returned to work in January and looks forward to happier days. He and his fiancée, Dezzierea, plan to marry in June. He relishes family life with his daughter and two stepdaughters, and he's eager to ride motorcycles again and possibly return to scuba diving.
“For Tom, there was potential for him to have a very different life if he had not received state-of-the-art, combined therapies to revascularize his leg,” Fujitani says. “Surgery alone with a bypass wouldn’t have been enough. Endovascular treatment wouldn’t have been enough. Drug treatment wouldn’t have been enough. It was the combination of all these treatment regimens together that got him through.”
The year 2010 was tough, but Tiffany considers himself fortunate. He jokes about having “smart blood clots” that traveled to his legs instead of lodging in other vital organs.
“I am lucky to have my foot. I am lucky to have my leg,” Tiffany says. “I am lucky to be alive.”