Bypass gives Louisville woman legs to stand on
There was no pain, nor was there any pulse in her feet.
Except for feeling as if each of her legs weighed 200 pounds, Cathy Robinson felt just fine. But the lack of pulses in her ankles told her doctor something was wrong.
“I have gone to the same primary doctor for almost 20 years, and she knows my whole family history,” said Robinson, whose mother died at 62 of heart disease. “She said, ‘Cathy, I’m not getting a good pulse in your ankles. We need to get this checked out.’”
Testing revealed that Robinson had severe aortoiliac occlusive disease, or more simply, plaque blockage of her lower aorta and proximal leg arteries. With peripheral artery disease (or PAD), the plaque builds up in the arteries, causing them to harden and narrow and restricting the flow of oxygen-rich blood from the heart to the legs. If that blockage is severe enough it can lead to limb threat if not treated.
“I could’ve lost my legs!” said the 63-year-old Louisville woman. “I don’t have very long legs and I wanted to keep ’em so I had the surgery.”
Robinson underwent an operation called an aortobifemoral bypass. The surgery was performed by vascular surgeon Dr. Richard Young at Fort Sanders Regional Medical Center this past January. Since surgery Robinson is once again enjoying shopping and playing with her grandson.
“Yesterday was my first trip to the grocery story on Senior Day,” she said, seven weeks out from the surgery. “I used to have to stop in an aisle and rest a minute. I didn’t get short of breath but I had to let my legs settle down before I could do the rest of my grocery shopping. But yesterday, I was just going through the store and I thought, ‘Oh, I’m not hurting.’ This is great!’”
Prior to the surgery, however, Robinson said, “It’s strange – it’s not pain. They don’t hurt. They don’t ache. They just feel like each of my legs weighed 200 pounds if I walked any distance.”
That was particularly true of Robinsons’ driveway, which is pitched at a 45-degree incline. “I was fine going down to the mail-box for the newspaper. Coming up? I had to stop halfway up. I didn’t really think much about it. I just thought, ‘Well, you’re an old woman and you’re out of shape.’ But then you realize it wasn’t the kind of feeling where you’ve exercised and your muscles get all sore.’ For me, it was just a heaviness.”
That “heaviness” or claudication, is one of the symptoms of PAD. Other symptoms might include weak or undetectable pulse in the leg, muscle atrophy, discolored or smooth shiny skin that is cool to the touch, non-healing ulcers or sores in the legs or feet, and cold or numb toes. As much as 40 percent of patients have no leg pain.
“PAD is very common,” said Dr. Young, noting it is believed that anywhere from 8 to 12 million people in the United States currently have it. “The majority of cases can be treated with angioplasty and stents, but Mrs. Robinson had an extensive amount of advanced disease that was better treated with a bypass. Her aorta and common iliac arteries were nearly occluded, reducing blood flow to her lower extremities.”
“Dr. Young told me that it wasn’t an ‘emergency situation by any stretch,’” said Robinson. “But when I got to the point where I couldn’t play baseball with my grandson, I couldn’t run with him, and that’s just heartbreaking … I said, ‘Let’s just get it done. If I’m going to have to have it, I don’t want to wait until I’m 73 instead of 63.’”
Aortobifemoral bypass has been around for at least four decades and is the preferred therapy for severe blockages of the aorta. With this bypass, a polyester tube (graft) is used to go around the blocked arteries connecting the aorta to the femoral arteries.
The aorta is the body’s major artery out of the heart. Near the belly button level, the aorta branches to form the two iliac arteries. At groin level, the iliac arteries become the femoral arteries.
Despite the extensiveness of the surgery, it took only about 90 minutes before Robinson was wheeled back into intensive care. She was back home five days later.
“I don’t think I had an idea in mind about what it would be like. I knew it was serious surgery, but I didn’t realize truly how serious it was and what all he would have to do. But you get through it, you get over it. There was a time, I will admit, when I was all drugged up that I would cry and tell me husband I really wish I hadn’t had this done, but I don’t feel that way now.
“The Fort Sanders hospital was very good to me, they were all really good,” she added. “Dr. Young was a blessing because he was so good and explains things in a way that a non-medical person can understand. He’s very positive with you even though it’s bad news.
“You don’t want to go in and hear that you’re going to have to have a bypass! Who wants to hear that? But he’s still very positive when he’s talking about it, even though he tells you everything that could go wrong. He’s still very positive about it, and I really did like that. I can’t say enough good things about him. I would recommend him to anybody. Anybody.”