UC Surgeons First to Perform Innovative Bypass Procedure

UC vascular surgeons have become the first in the Tristate to perform a minimally invasive, “laparoscopic assisted” bypass procedure to treat blockages in the arteries that supply the lower extremities.  

The procedure is a significant breakthrough in the treatment of what is known as aortoiliac arterial occlusive disease, a type of peripheral arterial disease. The condition causes large blood vessels in the abdomen and pelvis to become narrowed and restrict blood flow.

According to the American Vascular Association (AVA), as many as 12 million people in the United States suffer from peripheral arterial disease, including 12 to 20 percent of those over the age of 65.

Minimally invasive surgery (also known as laparoscopic surgery), as distinct from traditional open surgery, is a technique for operating inside the abdomen that requires only very small incisions. The surgeon operates through small ports using a fiber-optic light source, camera and specialized instruments.

“Minimally invasive (laparoscopic) surgery gives patients the benefit of faster recovery time and less pain, with the durability of the traditional gold standard surgical bypass procedure,” said Joseph Giglia, MD, interim director of UC’s division of vascular surgery.

The procedure eliminates the need to make a major incision to access the body cavity.

Laparoscopic-assisted surgery, which Dr. Giglia used, is a combination of minimally invasive and open surgery, which nevertheless requires a much smaller incision than the traditional approach.

Peripheral arterial disease is commonly caused by a buildup of plaque on the arterial walls. Plaque decreases the flow of nutrient-rich blood to muscles and tissues in the lower body. Patients with the condition often experience squeezing pain or tightening in the legs and buttocks during exertion.

To surgically bypass a blockage, the blood is redirected through an inverted Y-shaped graft made of synthetic material sewn to the existing artery. By attaching the single end of the Y to the aorta, and the split ends below the narrowed areas of the femoral arteries, the blood can travel around the diseased area and restore proper flow.

Traditional open bypass surgery requires a large incision (12–16 in.) between the breastbone and the tip of the pubic bone. By contrast, Dr. Giglia’s procedure uses only a small incision (4 in.) and several small laparoscopic ports through which he gains access to the affected area.

“Only a handful of centers are performing this procedure nationally,” says Dr. Giglia. “We plan to perform the operation completely with laparoscopic instruments in the near future and—eventually with a surgical robot.”  

Dr. Giglia offers the procedure at the University Hospital.

People may be able to decrease their risk of peripheral arterial disease by controlling body weight, exercising regularly, ceasing to smoke, following the AHA guidelines for eating healthily—and talking to their doctor.