http://www.boston.com/dailynews/149/nation/First_non_surgical_bypass_succ:.shtml

First non-surgical bypass successfully turns veins into artery

By Renee C. Lee, Associated Press, 5/29/2001 00:54

DALLAS (AP) A bypass procedure that transforms veins into arteries without opening the chest cavity could one day offer treatment for patients with severe coronary artery disease who cannot undergo traditional bypass surgery or angioplasty, experts said.

A case study being published in Tuesday's Circulation, a journal of the American Heart Association, documents the first nonsurgical bypass using catheters to make the coronary vein a conduit for blood flow around the diseased coronary artery. The catheters are inserted in a leg and threaded into the coronary arteries.

Dr. Stephen Oesterle, director of invasive cardiology services at Massachusetts General Hospital, and his researchers successfully conducted the new procedure, called percutaneous in-situ coronary venous arterialization, or PICVA, in November 1999 in Germany.

''This is newsworthy because we have explored using the coronary veins. We have shown that the technology can be used in humans,'' Oesterle said.

The study patient, a 53-year-old German man, had severe chest pain from a heart artery blocked by atherosclerosis, a buildup of fatty deposits in vessel walls. He was not a candidate for bypass surgery or angioplasty because his artery was almost completely blocked, Oesterle said.

Now, more than a year after the procedure, the patient remains pain free, he said.

The new procedure is considered safer and less painful than traditional bypass surgery, which requires opening the patient's chest, temporarily stopping the heart and harvesting vessels from the leg or chest.

But Oesterle warns that the procedure would not necessarily be preferrable to angioplasty or bypass surgery.

''If we could do angioplasty, we would do it,'' he said. ''But there are 400,000 patients who can't do it because their arteries are badly diseased or too damaged. We think we can capture a lot of patients who are not candidates for angioplasty or bypass surgery.

''This is an alternative to surgery,'' he added. ''We're still exploring feasibility of it.''

More than 336,000 people in the United States underwent coronary artery bypass surgery in 1998, according to the American Heart Association.

Unlike bypass surgery or angioplasty, PICVA requires only two needle-sized punctures in the upper thigh to insert an ultrasound-guided catheter, which is threaded into the diseased coronary artery. A needle from inside the catheter is pushed through the artery wall and in the adjacent vein.

A thin flexible wire is threaded through the needle and the needle and catheter are withdrawn. Following the wire like a monorail, a small angioplasty balloon is used to widen the channel and a tubular device similar to a stent is inserted to keep it open for blood to pass.

Then the vein is blocked just above the new channel. Blood from the artery is rerouted down the vein, reversing the flow of blood to feed the oxygen-deprived heart muscle.

Oesterle said the procedure requires no anesthesia and takes only a couple of hours. The patient can be released from the hospital the next day, he said.

Dr. Samuel Goldhaber, a staff cardiologist at Brigham and Women's Hospital in Boston who was not involved with the case, said the technique has the potential to revolutionize the way doctors manage patients who require coronary treatment.

''The technique is extremely clever and I personally believe and predict that the device shown in this report will take us one giant step forward in the management of patients with severe symptomatic coronary disease,'' Goldhaber said.

But Dr. Michael Jessen, a professor of cardiothoracic surgery at the University of Texas Southwestern Medical Center at Dallas, said it's too early to make such a claim.

''There's still the question of whether it will help heart function down the line,'' Jessen said.

Both doctors noted that although the results from the case study are encouraging, they are based on only one patient.

-- Anonymous, May 29, 2001