Stanley Ingerman went along for most of his life pretty much like a lot of other people. He endured the normal childhood diseases—he remembers measles and chickenpox. As an adult, he hit six feet tall and managed to maintain a healthy weight, give or take a few pounds, into his mid-50s. Then one night he woke up with an incredible pain in his right leg.

"On a scale of one to 10, it was at least a 7.5," Ingerman said. "My toes were turning color. There was no blood flow. The pain I was feeling was all the muscles dying. I sat there and cried. I was in the doctor's office the first thing in the morning."

Ingerman, his doctor said, had developed peripheral artery disease, PAD for short. Like a lot of other people with the condition, he had been a smoker—smoking increases the risk of PAD by two to six times—he was over 60 and the disease's symptomatic pain was in his legs. The arteries carrying blood to his legs had become clogged with fatty deposits. An estimated 8 million people in the United States suffer from PAD.

To treat the condition, Ingerman's surgery followed the standard procedure: The failed artery in his leg was replaced by a vein from his other leg. With luck, it would last several years. Because he was showing signs of high blood pressure, he was advised to reduce the amount of salt in his diet, to lose some weight and to start exercising regularly. He followed all that advice. 

Renewed challenge

"I was doing everything right," Ingerman said. But, eight years later, that first fix finally failed when the artery clogged, and Ingerman went through another surgery. In the 18 months that followed, Ingerman's artery failed three more times and his physicians finally told him he needed to go to Stanford. They had done everything they could.

Ingerman arrived at Stanford Hospital on New Year's Eve and found himself a patient of surgeon Matthew Mell, MD, medical director of Stanford's Vascular Clinic and Lab. "He had a great bedside manner," Ingerman said. "He answered every question I asked and made sure there were no doubts in my mind about what was going to happen. He had a confidence that made me very comfortable. "What Mell found was that a previous bypass had failed and couldn't be salvaged. "Generally, when bypass grafts fail after a period of time it's usually because of the progression of the disease," Mell said.

The average person's body contains about 60,000 miles of blood vessels, a combination of veins, which carry blood to the heart; arteries, which carry blood from away from the heart; capillaries, some thinner than a hair, which branch from the arteries all the way out to our toes and fingers; and venules, the tiny blood vessels that connect to the capillaries as the oxygen-depleted blood begins its journey back to the heart for recirculation. Between 5 to 6 quarts of blood flow around the system in the average adult. The accumulation of deposits called plaque, clumps of debris called clots and inflammation of the vessels (vasculitis) can obstruct blood flow, causing a variety of diseases and raising the risk of stroke and heart attack.

Fortunately, in a short-term response, Ingerman's body had recruited collateral vessels near the collapsed artery to circulate a minimal flow of blood. But the body's natural response would not be enough to sustain real function for Ingerman's leg. If Mell could not create a repair that would reach from Ingerman's groin to below his knee as a substitute for the length of non-functioning artery, Ingerman would lose his leg. Ingerman had a complicated vascular condition brought about by the previous multiple procedures that required intervention that wasn't necessarily straightforward, Mell said. He would have to find a vein in Ingerman's other leg that would be a strong enough to maintain steady blood flow; he would also have to maneuver around the scar tissue from the previous surgeries to attach the new vein.  

Steadied future

Ingerman is much healthier now. "Before this surgery, I was overweight. I was a couch potato. Now I walk 35 miles a week. I watch the foods I eat and I'm much more aware of what my body feels like from day to day, and of my health. I've become sensitized to that. This was a wake-up call."

Mell has told him that even doing everything right, he may develop another clogged artery and might need another surgery. But Ingerman was not overly concerned. "Going to Stanford—just the reputation of the hospital—was enough to put me at ease," he said. With Mell as his doctor, and the success of his most recent surgery, "I'm very calm about things at this point."