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Lisa Johnson didn’t know anything was seriously wrong with her right foot until her son noticed something she hadn’t.
The bottom of one of her toes was black.
“I was horrified,” said Johnson, 64, who lives in northwest Phoenix. “I went to the doctor thinking they could do something for it and got told, ‘What we do for it is cut it off.’”
It was the beginning of a medical ordeal that would eventually cost Johnson all five toes on her right foot and portions of two fingers. But an unusual diagnosis and a relatively new procedure would ultimately help her avoid losing her right leg.
Johnson has Type 2 diabetes and initially thought that might explain the circulation problems in her foot. An angioplasty was performed to improve blood flow, and her first affected toe was amputated.
For a while, things seemed to be getting better.
Then another toe began showing signs of trouble. Small red spots appeared on her fingers before turning black as tissue began to die.
“It came out of nowhere and just turned horrible really fast,” Johnson said.
When blood flow to her foot deteriorated again, another vascular surgeon told Johnson there was nothing more he could do with a traditional angioplasty. He referred her to Dr. Hasan Aldailami, vascular surgeon and network director of vascular surgery at HonorHealth.
Dr. Aldailami quickly noticed something unusual.
“She didn’t fit the bill for your typical patient with peripheral arterial disease,” he said. “Most of her disease was in the smaller blood vessels below the ankle.”
He suspected vasculitis, a group of autoimmune diseases in which the body attacks its own blood vessels. Working with rheumatologists and other specialists, the team confirmed the diagnosis and began treating the underlying disease.
But Johnson’s right foot was already in danger.
The disease had severely damaged the small arteries carrying blood to her foot. With no conventional route available to restore enough circulation, Dr. Aldailami turned to an advanced procedure known as deep vein arterialization.
Normally, arteries carry oxygen-rich blood down the leg and into the foot, while veins carry blood back toward the heart. Deep vein arterialization essentially creates a detour around badly damaged arteries. The procedure redirects oxygen-rich blood into veins in the foot, allowing it to reach tissue that otherwise isn’t getting enough blood to survive and heal.
“We convert the veins in the foot into arteries,” he said.
Dr. Aldailami was the first vascular surgeon in Arizona to perform deep vein arterialization using the LimFlow system. He also believes Johnson’s case may be the first in which the procedure has been used to treat peripheral arterial disease caused by vasculitis.
Johnson ultimately lost the remaining toes on her right foot, but the procedure restored enough circulation for the large wound left behind to heal.
Without it, Dr. Aldailami said the outcome would have been much different.
“She would have lost her leg,” he explained.
Today, Johnson can still use her right foot.
“I didn’t have to lose my foot, have a prosthetic and go through the whole complete nightmare of what that would be,” Johnson said. “The fact he did that procedure and it completely saved it is amazing to me.”
While the surgery played a critical role in saving her foot, it was just one part of a coordinated treatment plan. HonorHealth’s Limb Preservation Program brings together vascular surgery, rheumatology, podiatry, infectious disease, plastic surgery and wound care for patients whose limbs are threatened by complex disease or wounds.
For Johnson, the result is something much simpler.
“I can wear a shoe. I can walk,” she said. “It’s functional.”
After everything she’s been through, those ordinary things no longer feel quite so ordinary.
