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Bypass Surgery in a Different Vein

New 'detour' method avoids major surgery

TUESDAY, May 29, 2001 (HealthDayNews) -- Call it a detour, not a bypass.

Heart surgeons report a new, less traumatic procedure to let blood flow around a blocked artery. Instead of sewing a segment of an artery in a loop to bypass the clogged section, surgeons in Germany rerouted blood flow to a neighboring vein -- without opening the patient's chest.

The nonsurgical technique is most immediately applicable to perhaps 100,000 Americans with fat-clogged arteries which can't be repaired by bypass surgery or angioplasty, says Dr. Stephen N. Oesterle, director of invasive cardiology services at Massachusetts General Hospital and leader of a group reporting the procedure in today's Circulation, A Journal of the American Heart Association .

Nearly 400,000 Americans undergo bypass surgery in this country annually because of blocked coronary arteries. Others have balloon angioplasty, in which a deflated balloon is threaded into the artery and then expanded to widen the arteries. But some patients can't be helped by either procedure because their arteries are too severely clogged.

The new procedure is called percutaneous in situ coronary venous arterialization (PICVA). It takes advantage of the fact that veins, which carry blood back to the heart, don't get clogged by fatty deposits and often run next to arteries. PICVA connects an artery to a vein so the vein carries blood past the blocked portion of the artery.

As described in the journal article, the first step to create the blood-flow detour was inserting a flexible tube, called a catheter, into a leg artery and guiding it by ultrasound into the coronary arteries. The catheter then was inserted in the top of the blocked artery that was causing severe chest pain. Once the catheter was in place, a needle was pushed through the wall of the artery into a vein next to it. A wire then was threaded into the vein, which was expanded by inflating a balloon.

Next, the vein just beyond the widened segment was blocked so that blood would flow in the right direction. The report says since the procedure was done on a 55-year-old man in November 1999, the patient's persistent chest pain has stopped, and he has been living a far more normal life.

The procedure was done in Germany because European regulations allow faster use of newer techniques than in the United States, Oesterle says. "We hope to begin trials in the United States later this year."

Oesterle says most surgical cardiac procedures can be done by catheterization. He calls PICVA "the apotheosis of minimally invasive surgery."

However, Dr. Timothy J. Gardner, chief of cardiothoracic surgery at the University of Pennsylvania Medical Center, says much more work is needed to see how well PICVA works.

The journal reports a "one-successful-case" outcome, Gardner says. "This new and very innovative technique must be proven safe and effective in many patients, especially those with more common patterns of coronary artery obstructions, before it is suggested that it will replace conventional angioplasty or bypass surgery," he says.

More time is needed to see if the procedure eventually will cause damaging complications, such as too much blood flow into the coronary veins, Gardner says.

Dr. David Faxon, president-elect of the American Heart Association, says even if PICVA is successful, "it won't be a solution for everyone."

"The reality is that veins are not always located that close to an artery, so it wouldn't work under certain circumstances," says a statement by Faxon.

Oesterle says, "Our ultimate goal is to replace traditional coronary artery bypass with a procedure that does not require surgery."

What To Do

While the new technique is studied, heart patients can ask about minimally invasive bypass surgery, done at many advanced medical centers, which reduces the size of the incision and shortens the recovery period.

For more information about bypass surgery, check the American Heart Association or the National Heart, Lung and Blood Institute.

Or, read these previous HealthDay stories.

SOURCES: Interviews with Stephen N. Oesterle, M.D., director of invasive cardiology services, Massachusetts General Hospital, Boston; Timothy J. Gardner, M.D., chief of cardiothoracic surgery, University of Pennsylvania Medical Center, Philadelphia; May 29, 2001, Circulation, A Journal of the American Heart Association
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