Winter 2009

Case Study: Team Approach Clears Way for Transplant

In 2006, an East Bay nephrologist referred RM, a 57-year-old man with kidney disease and claudication in both legs, to UCSF Medical Center to be evaluated for a potential kidney transplant. Cardiovascular specialist Yerem Yeghiazarians, M.D., conducted a thorough evaluation that uncovered significant ischemic heart disease. Yeghiazarians referred RM to cardiologist J. Eduardo Rame, M.D., to evaluate the patient's suitability for a combined heart and kidney transplant.

Impressed by RM's desire for an active lifestyle and his willingness to work hard at rehabilitation, Rame placed the patient on an aggressive regimen of volume removal, in collaboration with his nephrologist and local dialysis team. This approach was combined with optimization of medicines for ischemic heart failure to improve the patient's capacity for physical activity. Now there was only one barrier to RM's being listed for the combined transplant: his claudication, which would limit his ability to rehabilitate appropriately.

After an angiogram revealed significant peripheral artery disease (PAD) in both legs, Yeghiazarians and vascular surgeon Charles Eichler, M.D., agreed that the popliteal lesion in RM's left leg was amenable to endovascular intervention. They decided on atherectomy and angioplasty, which Yeghiazarians performed successfully in March 2007.

"This improved the claudication in the left leg, but the right leg was still quite limiting," says Eichler. In early April, they brought RM back to address the complete blockage of the popliteal artery in his right leg, but were unable to clear the lesion with an endovascular approach. Therefore, to relieve RM's persistent right leg symptoms, Eichler performed a successful femoral-popliteal artery bypass with a saphenous vein graft.

Today, while waiting at home for his transplant, RM — under the collaborative supervision of his community physicians and Rame — is undergoing cardiac rehabilitation three times a week, walking and enjoying a much-improved quality of life. "We believe he stands to benefit from a combined heart and kidney transplant because of his compliance, his support network and his stamina, now that he's been revascularized and can walk without symptoms of claudication," says Rame.

To contact Yerem Yeghiazarians, M.D., call (415) 353-3815.

To contact J. Eduardo Rame, M.D., call 415-502-4597.

To contact Charles Eichler, M.D., call 415-353-4366.

Related Information

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UCSF Medical Center ranks as the fastest for treating heart attack patients by using balloon angioplasty, according to a National Cardiovascular Data Registry survey of more than 850 hospitals.

Grant to Improve Heart Failure Care
UCSF has been awarded more than half a million dollars to create a new system for discharging elderly heart failure patients, with the goal of reducing readmissions by 30 percent.