Interventional cardiology saves a leg

Three-time kidney transplant patient Laurie Sharp was destined for a leg amputation. A catheter-based procedure best known for fixing hearts kept her on two feet.
June 12th, 2019

Laurie Sharp’s health care story is a saga of three kidney transplants and a slew of serious complications spanning three decades. If you’re in a hurry, through, here’s the gist, and it’s well worth remembering: Interventional cardiology saves more than hearts.

Sharp, 52, was born with bad valves at the base of the tubes connecting her kidneys to her bladder. These faulty ureterovesical valves allowed urine to reflux back into the kidneys. She was 17 before it was diagnosed; by then, the damage had been done. When she was 29, she received one of her mother’s kidneys.

A photo of Laurie Sharp
Laurie Sharp still has two feet thanks to her own persistence and the work of CU School of Medicine interventional cardiologists at UCHealth.

The 1995 transplant at what’s now UCHealth University of Colorado Hospital at the Anschutz Medical Campus (UCH) was a success, but it came with a strange complication: About a year after the transplant, her left calf cramped severely if she walked more than a few dozen yards. Soon, her whole foot hurt. Physicians diagnosed a blood clot in the left common femoral artery – the side opposite of where her mother’s kidney had been transplanted. The clot choked blood flow to her lower leg, which caused the cramping.

The prescribed treatment suited the active Sharp well: She should exercise a lot, they told her, because doing so would spur the growth of collateral blood vessels (natural bypasses) that would ultimately reroute flow to her left leg. So she walked, she did elliptical machines and she did exercise classes. It took about three years, all told, but it worked. Her leg was fine again.

Sharp’s first child, Kayla, was born before the transplant; her second, Sophia, came five years after that, in 1998; and her third, Spencer, came in 2003. Sharp knew that pregnancy was hard on kidneys (it’s hard on the whole body, after all), but her UCH doctors monitored her closely and the babies were all healthy. Unfortunately, Sharp didn’t fare as well. The kidney failed.

Kidneys two and three

She went on dialysis – not easy to balance with three young children – for 20 months, until November 2006, when a friend donated a kidney for a second transplant at UCH.

Sharp’s leg was fine this time, but her 5’1” frame began shedding weight. She dropped from about 120 pounds on down to a skeletal 70 over the course of a several of years – a reaction to antirejection medications. When her doctors cut back the dose, her kidney function worsened. By 2015, not only did the second kidney start to fail, but her leg also started hurting again. She was back on dialysis and ended up with an infection she picked up on an airplane. It became life-threatening and kept her in the hospital for two-and-half weeks at UCH. While Sharp was there, a CU School of Medicine medical fellow noted skin peeling from Sharp’s toes and told her she was at risk of losing the foot.

A photo of Dr. Ehrin Armstrong
Dr. Ehrin Armstrong

While still on dialysis, she underwent a femoral artery bypass in November 2016. The vascular-surgery procedure involved sewing in a synthetic tube to replace the blocked section of the artery. As can happen, the bypass itself soon clotted and became blocked.

She was on dialysis for 18 months until her husband Mark’s participation in a kidney transplant chain brought Sharp a third kidney in October 2017 – the wait a result of Mark’s rare blood type. This time, she maintained her weight and was healthy, renally speaking. But her leg and foot really hurt. As months passed, the leg’s circulation dropped to the point where she had to sleep with her left leg hanging down from the bed to keep blood flowing to it with the help of gravity.

“So where people usually jumpstart their lives again, I couldn’t walk,” Sharp said. “I was debilitated in a different way.”

Vascular surgeons told her what no one wants to hear: the blocked graft in her leg was irreparable. The only option was to amputate below the knee.

“I had already gone through so much,” Sharp said. “I was like, ‘Are we going to start taking limbs now? I just had a really hard time digesting it. I was born with the kidney problems. This was borne of something else.”

Help would arrive from an unexpected place: interventional cardiology.

A photo of Dr. Kevin Rogers
Dr. Kevin Rogers

Not just the heart

Interventional cardiology traditionally involves minimally invasive heart procedures that use catheters to open up arteries or replace faulty heart valves. But interventional cardiologists also apply their expertise to arteries and veins far from the heart. Sharp, determined to exhaust all options before resorting to amputation, pressed her providers and reached out to family and friends.

CU School of Medicine and UCHealth interventional cardiologists Dr. Ehrin Armstrong and Dr. Kevin Rogers were alerted to Sharp’s case in late July 2018. Her pinkie toe had gone black, and Sharp was by then “on track to lose her leg,” as Rogers put it. Armstrong and Rogers believed they could restore blood flow by opening up the clotted tube graft from the prior vascular surgery. The challenge would be to ensure that it didn’t clot again, the key to which would be ensuring good blood flow above and below the graft. Rogers went over the plan with Sharp at the UCHealth Heart and Vascular Center. There were risks, but if it worked, she could keep her leg. Either way, it had to happen quickly.

The procedure Rogers and Armstrong performed in early August 2018 was to have taken about an hour and a half. It proved more challenging than they had expected, involving a tricky catheter transit across the main clot, zapping the clot with a laser, and using balloons to widen arteries and stents to keep them open. Sharp lost a lot of blood in the process, but four hours later, the interventional cardiology team had restored blood flow to her left leg.

On two feet

Eight months later, Sharp wore open-toed shoes on a sunny April morning outside UCH’s Courtyard Cafe. She had just been in for a routine kidney check whose numbers would turn out good. She sees Rogers every three months. He says that, having made it several months without clotting, the interventional cardiology fix stands a good chance of holding. The toes of her left leg looked no different than those of her right. They and the rest of Sharp’s feet had recently carried her about, pain-free, during a family trip to Mexico, and she had the suntan to prove it.

“This isn’t a cure-all. They’ve talked about cleaning it out again down the road,” Sharp said. “But how would I describe it? Spectacular.”

As Sharp walked back inside and down the hall toward the Anschutz Outpatient Pavilion parking valets, she said she usually makes a point of avoiding talk about her health. But she wants to get the word out, she says. If amputation comes up, “get a second, third, or fourth opinion” – and don’t forget about interventional cardiology.

“That’s why I have my leg today,” she said. “That’s why I can walk through this hall.”

About the author

Since 2008, Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado. He was a 2007-2008 Ted Scripps Fellowship recipient in Environmental Journalism at CU.

His latest book, "The Laser That’s Changing the World," tells the story of the inventors and innovators who saw, and ultimately realized, the potential of lidar to help solve problems ranging from smokestack-pollution detection, ice-sheet mapping, disaster recovery, and, ultimately, autonomous-vehicle guidance, among many other uses. His first book, "From Jars to the Stars," recounts how Ball Aerospace evolved from an Indiana jar company - and a group of students in a University of Colorado basement - to an organization that managed to blast a sizable crater in the comet 9P/Tempel 1. "Jars" won the Colorado Book Award for History in 2012.

Todd graduated with a business degree from the University of Michigan, where he played soccer, and with a master’s degree from the Fletcher School of Law and Diplomacy at Tufts University. Before becoming a journalist at the turn of the millennium, he was an IT and strategy consultant. He once spoke fluent Japanese and still speaks fluent German.

When not writing, he spends time with teenage daughters and wife Carol, plays soccer, and allows himself to be bullied by a puggle he outweighs by a factor of seven.