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Cardiovascular Report - Rarely Performed Arterial Bypass for Claudication Can Restore Quality of Life

Spring 2012

Rarely Performed Arterial Bypass for Claudication Can Restore Quality of Life

Date: April 23, 2012

Thomas Reifsnyder
When claudication doesn’t threaten the limb, Thomas Reifsnyder says, surgery requires careful consideration.
photo by Keith Weller

John Coll always enjoyed taking long walks for several miles every day, but in 2010, he developed a rare case of giant cell arteritis that inflamed the vessels behind his knees, restricting blood flow to his calves. “I couldn’t even walk around the block. The pain in my legs forced me to stop and rest frequently,” says Coll, 66, who lives in Pennsylvania. “I had lost my mobility and I was at my wit’s end.”

While steroids had put his arteritis in remission and his limbs were not in jeopardy, the severe, cramping claudication due to permanent damage from the inflammation was affecting Coll’s quality of life. Determined to find help, he consulted with his local physician, who referred him to Johns Hopkins.

“Whether or not to treat claudication depends on the condition and the wishes of the patient, and I believe you should treat it conservatively,” says Thomas Reifsnyder, head of vascular surgery at Johns Hopkins Bayview Medical Center, who evaluated Coll. He suggested that Coll first take part in a walking program to see if his symptoms would improve and advised him not to rush into an invasive treatment. However, Coll came back a few months later. “I was confident that he could help me,” Coll says.

Reifsnyder ruled out one treatment option, percutaneous transluminal angioplasty with stenting, because of the location and extent of Coll’s disease. The other option was a surgical femoral-tibial arterial bypass, rarely performed for claudication, which Coll decided to have in each leg, two months apart.

Reifsnyder used saphenous veins from the upper legs to bypass the damaged arteries around Coll’s knees and restore adequate blood flow to his lower legs. Recovery from each operation took about five weeks, and Coll was able to return to an active lifestyle and his job at a natural gas company, where he often needs to do a lot of walking.

“It’s been a real success,” says Coll, who recently took his family to Washington, D.C., where they walked for miles visiting museums and monuments.

“Dr. Reifsnyder gave me my mobility back and saved the quality of my life. I have all the respect in the world for him,” he says. 

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