Innovative Revascularization Procedure Saves Canadian Man's Legs
He could have lost both of his legs.
Vladimir Paller, 56, a former construction designer from Belarus in the Soviet Union, received his first scare, involving his left leg, in 1992, after he and his wife had emigrated to Ontario, Canada. "I was in terrible pain; I couldn't walk," he recalls.
Vladmir went to a hospital in Toronto, where he was told his leg would need to be amputated. Fortunately, he consulted with his family doctor, who referred him to Beth Israel Deaconess Medical Center.
At the time, Vladimir had never heard of his condition-severe "peripheral artery disease" (PAD). This occurs when arteries in your legs become blocked by plaque (also known as atherosclerosis) and your legs don't receive enough blood or oxygen. The prescribed treatment for Vladimir was lower extremity revascularization to open the blocked section of his leg arteries by means of a bypass, or a detour around the arteries.
For his first procedure, Vladimir had open bypass surgery at BIMDC performed by Frank W. Logerfo, MD. Dr. Logerfo bypassed the femoral and popliteal arteries (in the thigh and knee) using the saphenous vein, harvested from the inner thigh and calf area. Following a successful outcome, Vladimir was able to resume normal activities in Canada.
Vladimir's second scare came in 2006, when he experienced similar discomfort and immobility in his right leg. He went to a local specialist and was told, once again, that he had PAD and his leg couldn't be saved. This time, Vladimir knew he should contact BIDMC.
Dr. Logerfo, it turned out, was preparing to retire, so Vladimir was referred to his colleague Marc Schermerhorn, MD, now Chief of the Division of Vascular and Endovascular Surgery at the CardioVascular Institute at BIDMC.
Vladimir was put at ease by Dr. Schermerhorn and his multidisciplinary team, including a nurse who is fluent in Russian. But he was concerned after learning that his condition was highly unusual.
"In most cases, patients with lower extremity revascularization have diabetes, and the required bypasses are in the calf vicinity," says Dr. Schermerhorn. "Vladimir wasn't diabetic, but he still had developed gangrene on the tips of his toes, and the required procedure was very intricate because we had to get all the way down to his forefoot."
As was the case with Vladimir's other leg, Dr. Schermerhorn needed to perform open surgery. Also similar to the first procedure, he used the saphenous vein as a new path for the blood to flow. But this time, it was necessary to start in the calf (the anterior tibial artery) and end in the forefoot (the first plantar metatarsal artery).
The need to reach the lowest extremity is what made this procedure so complicated and unique. In fact, until then, such a procedure had not been performed before anywhere in the world.
The operation was a success, Vladimir's toes healed, and he returned to Canada to start a rehabilitation program. Before long, he was walking up to seven kilometers, and he resumed camping and fishing trips with his wife.
Since his surgery on Vladimir, Dr. Schermerhorn has performed hundreds of lower extremity revascularization bypass procedures. But to this date, Vladimir is believed to be one of only a few patients worldwide who have received this specific treatment.
"Other minimally invasive procedures such as angioplasty and stents are options that we may offer to patients for similar conditions," says Dr. Schermerhorn. "Of course, treatment must be customized, and bypasses are often the procedure of choice. However, to be successful, the right expertise and the right system must be in place."
"I received wonderful care," says Vladimir. "Very personalized, very professional. I almost lost my ability to walk. Now, I can even dance again!"