Wednesday, June 17, 2015

Leg artery bypass

Spent 13.00 to 17.00 in haematology outpatients to review status following Tuesday and Wednesday totally zonked. They couldn't see a direct cause, but it became clear later.

After that, a discussion with vascular consultant, who said the scan I had on June 10 showed left femoral artery is blocked down as far as the knee, and he recommends replacement by a venous graft. The only alternative would be to do nothing, which would mean that the artery blockage would extend still further, so that the leg would have to be amputated. He wants three further scans, which can probably be fitted in next week,so that my operation might even overlap with Lindsay's, next Thursday. I could be in hospital for up to a week, followed by several weeks' recuperation.

Mr M says that King's perform dozens of these operations, many of them on patients in a worse condition than mine. Although there are obviously some risks, the quality of life improvements make it a no-brainer, and Lindsay agrees.

Blood results last 8 months below. Platelets continuing to fall, so hydroxy-
carbamide reduced to three days a week pending further consultation next
Wednesday. White blood cell count also continues to fall.

Hb has gone up a bit, as a result of the transfusions I had last
Thursday and Friday.   
17.06 9.06 27.05 25.03 2.03 21.02 24.12 26.11 Normal
Hb 107 93 96 98 98    101 104 109 130-180
WBC 2.25 2.55 2.91 3.15 3.36 3.52 4.00 3.02  4.5-10.0
Neutrophils 1.17 1.14 1.3 1.57 1.78    1.6 1.8 1.16 2.0-7.5
Plt 232 296 342 369 449    494 551 391 150-450

Letter from consultant to GP of June 17:

I reviewed Lord Avebury in clinic today. His left leg perivascular disease symptms hae progessed further. For he last few weeks he has bee having constant pain in his foot for which he is required to take Tramadol. Even then he is still waking up from the pain. His claudication symptom.. is now at very short distance.......More worryingly over the last few days he stated developing skin lesions which I examined today and they looked a ischaemic part of the skin.

He saw today the haematology team ... to see whether it has anything in relation with his haematology disorder and I will.... contact Professor M to have further feedback directly from him. However his left foot does look quite ischaemic today..... On the left hand side, he had progression of his short SFA occlusion which was picked up on the scan two years ago [it was October 2011 to be precise] now he has full SFA occlusion shortly after its origin and extends all the way to the poplitea. Beyond that the popliteal artery is damped with  very low flow of only 0.2 m's  and the ATA occludes at the origin, however his PTA and peroneal are patent all the way down to the foot with severe damped flow.

I explained the finding and I am concerned that now he has got critical ischaemic symptoms, this would need revascularisation based on his scan, therefore we will put his scan on our next MDM meeting to discuss this further. However, I have warned him that this might require also a bypass surgery rather than endovascular treatment, with complication of surgery including risk of bleeding, infection, pain, failure of bpass which might lead to limb loss or even death as a result of surgery.

To start with we can book a CT angiogram to look at the arterial tree fr target vessels as well as echocardiogram to assess his fitness and vein mapping. We will see him next week in the clinic to discuss the results and we will take it from there,

ATA = anterior tibial artery
SFA = superficial femoral artery

It seems to me that the vascular team are not keen on leg angioplasty, possibly because the occlusion tends to return. For patients with a short expectation of remaining life this may not be an important consideration

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