Today, on Valentine’s day, Rachana underwent vascular surgery to clear clots that were blocking optimal blood flow to her legs.
Back in November the doctors had concluded that she had complete occlusion of her right iliac, left common femoral and left posterior tibial arteries. The main artery out of the heart is the Aorta, which divides around the abdomen area into two Iliac arteries that go into each of the legs, which again divides up around the thighs into the Femoral arteries, which again divides up around the calf into the Tibial arteries. So, Rachana was in a bad place when her right iliac, left femoral and left tibial arteries were fully blocked. At that time the situation was critical with a very active infection in her lungs and the heart, and since her platelets were low they could not plan any intervention. There were some secondary arteries that were still carrying blood to her legs and that really was the only reason why her legs survived, and the damage was limited to half of her both feet. When she started getting a little better, subsequent scans showed clots reducing in size and no longer completely blocking the vessels. In fact the clot in the tibial artery was gone and absorbed by the body.
The surgeon’s plan was to do a Endarterectomy on the left femoral artery i.e. make an incision to reach, cut open the femoral artery, scrap and remove the clot. For the right iliac artery she was planning to use a catheter to pull out the clot and then use a stent to prop and keep the iliac artery open. Leading up to the surgeries the surgeon ordered a bunch of tests to confirm her general health to handle a surgery like this. Her general health and blood test looked quite normal, but the surgeon was worried about the lungs. The x-rays and CT showed significant cavities in and around the lungs and the surgeons were worried of a lung collapse during the surgery. For the vascular surgery they planned to put her under general anesthesia, which basically means putting the patient on the ventilator to support the body as often the medication to make one go into this deep sleep makes them stop breathing. In Rachana’s case, the risk is that the forced air from the ventilator can ‘pop’ one or more of these cavities, causing a lung collapse, which can then put dangerous pressure on the heart. We had to consult a thoracic surgeon, who cleared her for the surgery basically saying that the risk is manageable as the situation is known and they can be prepared to put a chest tube if she has a lung collapse during the surgery. He explained that the situation with her lungs is as stable as it could be in her condition and that waiting any longer would not necessary change the risk level; this is a lifelong risk she will potentially always carry. Obviously we were nervous, but understood that even though there were risks, the doctors know the situation well and she’ll be in a controlled environment and they’ll be prepared to handle a lung collapse, i.e.put a chest tube if needed.
The last few days both Rachana and I were a little jittery but we were surprisingly calm and confident walking into the hospital. The surgeon walked through the what she’ll be doing as said it’s probably gonna take 2-3 hrs for the surgery. The surgery was done in about 2 hrs. The surgeon came out to update me while the rest of the team were finishing up the dressings. She explained that they started on the left side and were able to clean out the femoral artery which did have large clots. After clearing the clots, they used a camera to go through that open artery to the right side and were surprised to see that adequate blood was flowing around the clot on the right side and the clot itself was not large. They therefore decided to leave the right side untouched as they expect the body to absorb the clot over time and he blood flow was enough for her leg to heal after the amputations. She also said that the lungs were stable and there were no complications with the anesthesia/ventilator.
When I saw Rachana a little while later she was in pain but generally stable. The pain medications helped and within an hour she was as normal as one could be having gone through a couple of hours of invasive surgery. It was a relief to get this procedure behind us. Overall, things went better than what I had expected. The doctors expect 2-3 days of recovery and they’ll then work with the foot doctors to plan for a date for the amputations. Today’s surgery was done basically to restore blood supply which is required for the amputations to heal, when it’s done. Hopefully the next few days will go as planned, she’ll recover well from this surgery and planning will start for the big one.