Tom Tiffany was stunned into silence. The scuba diving instructor and motorcycle enthusiast had gone to the doctor for a pain in his left leg. Suddenly he was lying on a bed in a community hospital emergency room being told that his foot â and possibly the entire limb â might have to be amputated.
âI couldnât say anything,â the 41-year-old auto technician recalls. âI was freaking out.â
Fortunately, the community doctors decided to transfer Tiffany by ambulance to UC Irvine Medical Center in Orange, where expert vascular and endovascular specialists treat complex conditions with state-of-the-art techniques. UC Irvine vascular surgeon Dr. Roy Fujitani soon assured him that everything possible would be done to prevent amputation.
âDr. Fujitani is my hero,â Tiffany says.
His medical troubles began in June 2010. For several days, the Laguna Niguel resident had paid little attention to the pain behind his knee â until the big toe of his left foot turned blue and the other toes went numb. By the time he sought care, Tiffany says, it âlooked like a cadaverâs foot. There was no blood in it.â
At the community hospital, he learned that his heart rate and blood pressure were alarmingly high. The diagnosis: atrial fibrillation, also called A-fib â an arrhythmia found in about 2.2 million Americans that can cause blood to pool in the heart and form dangerous clots.
If the heart âthrowsâ a clot into an artery, it can travel to the brain, kidney, liver, intestines or any other organ and block blood flow, with life-threatening consequences. In Tiffanyâs case, clots had traveled to his left leg, resulting in advanced ischemia, or lack of oxygen-rich blood.
When he arrived at UC Irvine, Tiffanyâs heart was still in A-fib. Fujitani immediately ordered a thorough cardiac evaluation to make sure that the patientâs heart was not producing more clots, and he began planning how to restore blood flow to the affected limb. The doctor remembers well Tiffanyâs fear that he would lose his leg.
âHe told me he was a scuba diver, that he was engaged to be married and had a baby with a congenital heart problem. He had all these big things in his life, and he needed to be physically capable,â Fujitani recalls. âI thought to myself, âWe need to take care of this so he can return to his life.ââ
Inside UC Irvine Douglas Hospitalâs advanced catheterization lab, the medical team started rheolytic therapy â a combination of drugs and endovascular surgery performed through small incisions with very thin catheters â to try to dissolve and extract the clots.
This was somewhat successful, but Tiffany had âa tremendous clot burden.â The blockages were in all of his leg arteries, and the older ones were the consistency of hardened rubber cement, making them more difficult to remove and unresponsive to clot-busting medications.
After a second trip to the catheterization lab, Fujitani determined that the next step was open surgery combined with endovascular techniques. âWe had to revascularize every artery in his leg,â he says of the four-hour-plus operation.
Five days later, Tiffany returned home and began a recovery regimen that included increasingly longer stretches of walking and treatment for his heart arrhythmia. He made good progress for a few months, until pain developed in his upper right leg.
Fujitani found that another clot had lodged in the iliac artery descending from the abdomen to the groin. Because there was chronic scarring inside the blood vessel, he performed a bypass to reroute blood flow around the blockage.
But Tiffanyâs troubles were not over. Another clot soon wedged in the iliac artery near the bypass. Just days before Thanksgiving, he made a third trip to the operating room, where Fujitani removed the clot and executed an angioplasty upstream from the bypass.
After each surgery, Tiffany tackled his recovery regimen anew, starting on shaky legs and walking longer and longer distances to increase the delivery of blood oxygen to his leg muscles. He will be closely monitored by Fujitani and heart doctors for the rest of his life.
Tiffany returned to work in January and plans to marry his fiancee, Dezzierea, in June. He relishes family life with his daughter and two stepdaughters and is eager to ride motorcycles again â perhaps even scuba dive.
âTomâs life could be very different if he had not received state-of-the-art combined therapies to revascularize his leg,â Fujitani says. âSurgery with a bypass wouldnât have been enough. Endovascular treatment wouldnât have been enough. Drug treatment wouldnât have been enough. It was all these together that got him through.â
Last year was tough, but Tiffany considers himself fortunate. He jokes about having âsmart blood clotsâ that traveled to his legs instead of lodging in other vital organs.
âIâm lucky to have my foot; Iâm lucky to have my leg,â Tiffany says. âIâm lucky to be alive.â