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For nearly a decade, Christine Hoeck, 60, of Hartford, WI, had been living with bony deformities in her left foot. She had a bunion and a hammer toe that had caused a recurring skin irritation, which made walking uncomfortable. But Christine never expected that seeing a podiatrist to fix her foot would uncover a serious vascular issue — a blockage preventing blood from flowing to her head, neck and right arm.

Hammer Toe and Bunion Issue Leads to Work up for Peripheral Artery Disease

In February 2020, Christine saw Froedtert & the Medical College of Wisconsin podiatrist Jessica Minder, DPM, at Froedtert West Bend Health Center to discuss surgery on her left foot. Dr. Minder was concerned Christine may not have adequate blood flow down her left leg so she referred her to Froedtert & MCW vascular surgeon, Abby Rothstein, MD.

“My toe was purple at the time,” Christine said. “The doctors knew something wasn’t right and wanted to run some tests.”

The blood pressures in Christine’s legs were different, and Dr. Rothstein noted the pulse in Christine’s right hand was significantly decreased. These symptoms are typical in patients who have peripheral artery disease (PAD), which causes narrowing of the arteries and reduces blood flow. Christine also had significant narrowing of the left common iliac artery, which is located in the pelvis and goes down the left leg.

“We were planning an angiogram and a stenting procedure to reopen the left common iliac artery,” Dr. Rothstein said. “But Christine developed neurologic symptoms that were evidence of another blockage.”

Stroke-Like Symptoms Prompt Testing That Reveals Blockage in the Brachiocephalic Artery

Christine started having drop attacks — she would get lightheaded, lose her balance and fall for no reason. She was even hospitalized for one of the falls. Christine also developed a facial droop on her right side. Dr. Rothstein ordered an ultrasound and CT scan of the arteries in the neck that lead to the brain. The tests revealed a blockage of the brachiocephalic artery, also known as the innominate artery, which comes off the aortic arch and supplies blood to the head, neck and arms.

“Narrowing and blockages are caused by extremely dense plaque in the vessels,” Dr. Rothstein said. “Your body will compensate for the lack of blood flow, and it can ‘steal’ blood from the brain to get enough blood to the arms because all of those vessels interconnect. For Christine, blood to the right arm was going down the right vertebral artery — backwards and the opposite direction it should be flowing — which is a tell-tale sign of that ‘steal.’”

Brachiocephalic Artery Blockage Treated With Bypass Surgery

For some people, placing a stent to prop the artery open or using a balloon to create more space in the artery are treatment options, but the location of Christine’s blockage required bypass surgery. Froedtert & MCW vascular and cardiothoracic surgeons often collaborate on complex cases, so Dr. Rothstein reached out to Froedtert & MCW vascular and interventional radiologist Robert Beres, MD, and Froedtert & MCW cardiothoracic surgeon Lyle Joyce, MD. Christine’s surgery took place in August 2020 at Froedtert Hospital.

“We made an incision in the upper part of the chest and divided the brachiocephalic artery at the area of the blockage,” Dr. Joyce said. “We replaced the blocked section of the brachiocephalic artery with a synthetic graft. Then, we performed an endarterectomy, a procedure to scrape out the plaque that extended from the brachiocephalic into the right subclavian artery. Now, blood flow to Christine’s right arm and the right side of her brain is normal.”

Christine recovered quickly from the bypass procedure. Six weeks later, she saw Dr. Rothstein again at Froedtert West Bend Hospital to have the stent placed in her left common iliac artery. She resumed podiatric care a few months later for surgery on her left foot.

While Christine’s vascular issues are resolved, her atherosclerosis means she is still at risk for plaque to build up in her arteries and cause future blockages. Smoking is one of the most important risk factors for atherosclerosis, and Christine is actively working on quitting.

“After being a smoker for 45 years, I just can’t risk it anymore,” Christine said. “I’m so grateful to Dr. Rothstein for being my advocate and to everyone involved for taking such good care of me. I want to live a healthy, active life, and I want be there for my children and grandchildren.”

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