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Norman Melser: Limb Ischemia

The Challenge: An Avid Runner Loses Use of His Right Leg

Mr. Norman Melser is a healthy, 68-year-old retired landscaper and pastor with a passion for running. His average weekly running distance was around 40 miles. Every year he participated in various races, as well as the Pittsburgh marathon.

On April 17, 2013, he suddenly felt severe pain in his right leg, before it eventually became numb and weak. He went to an outside hospital where he was diagnosed with limb-threatening ischemia (lack of blood flow to the foot).

The Path to UPMC

He was immediately transferred to UPMC Presbyterian. By the time he arrived to the hospital his foot was cold, with loss of sensory function and increasing weakness.

A CT scan revealed an artery “ballooning” behind the knee, full of clot. Part of this clot had migrated down to all three small arteries of the distal leg — allowing no blood flow to the foot.

This is a condition that can lead to amputation or residual walking disability, depending on the extent of the ischemia, timing of management, and outcome of the overall treatment.

Conventional surgical techniques require complex, open clot removal through the small leg arteries and bypass — many times with suboptimal results.

The Solution: Minimally Invasive Catheter Directed Thrombolysis

Rabih Chaer, MD, and Efthymios Avgerinos, MD — UPMC vascular surgeons — managed Norman's condition with minimally invasive techniques. For 36 hours he underwent catheter directed thrombolysis.

Catheter directed thrombolysis is the infusion of clot busters through a catheter that's placed within the clotted arteries. This minimally invasive procedure is done through a single puncture at the groin.

All of Norman's arteries cleared up and his aneurysm was subsequently covered intraluminally with a stent.

“Doctors Chaer and Avgerinos are very special,” says Norman. “I was extremely appreciative of their encouragement to continue running. Dr. Avgerinos even said before discharge, ‘Now run for the hills! It’s good for the circulation!’”

Norman was discharged within five days and returned to running a month later. This year, he completed the Pittsburgh half marathon with the amazing time of 1 hour and 57 minutes.

Norman's treatment and results may not be representative of similar cases.

Read more vascular condition patient stories