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February 2009 Issue

John Hutto, MD, and Joseph Giglia, MD, perform a vascular surgery procedure.
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Minimally Invasive Surgery Can Change the Lives of Vascular Disease Sufferers

By Amanda Harper
Published February 2009

Treating patients with serious vascular conditions is a careful balancing act—especially when the patient’s overall health is further compromised by poor lung function, elevated cholesterol, high blood pressure or other health issues.

So when Arthur Norman discovered he couldn’t avoid major vascular surgery, he was taken to University Hospital for specialized care.

University Hospital, which is staffed by UC vascular surgeons, is the only place in Greater Cincinnati performing complex, minimally invasive vascular surgery operations.

Norman, a 66-year-old lifetime smoker, had developed a bilateral blockage in his iliac arteries, the vessels feeding blood to his lower body, and an expanding abdominal aortic aneurysm (AAA). Both are serious health problems—together, they can quickly become fatal. Norman said his health had deteriorated so severely that it impacted his quality of life.

“My legs hurt so bad I could barely walk,” he recalls. “My doctors found an aortic aneurysm that had been increasing in size a few years earlier, so when I started having trouble in my lower body, too, my doctors suggested I get both problems fixed at the same time.”

Vascular surgeon Joseph Giglia, MD, UC associate professor of surgery, performed his surgery at University Hospital.

Giglia specializes in treating complex vascular conditions using minimally invasive techniques, including laparoscopic and endovascular surgery.

The human vascular system is a complex arrangement of vessels comprised of arteries, which carry oxygen-rich blood away from the heart and distribute it throughout the body and veins, which return blood to the heart.

Vascular problems occur when fat and cholesterol (plaque) build up on artery walls. As plaque increases, the arteries harden and become narrow. In the aorta, this can cause the vessel to stretch and weaken, forming a bulge in the vessel wall. If that bulge (called an aneurysm) ruptures, it can rapidly result in death.

Norman’s respiratory function was severely impaired due to a lifetime of smoking and ever-worsening vascular problems, so he was not a good candidate for traditional vascular surgery, which requires a major incision and long periods of recovery.
Because of this, he had been turned down several times for surgery while his aneurysm continued to expand.

“It is very uncommon for surgeons in the United States to use laparoscopic techniques to treat lower-body vascular blockages and virtually unheard of for abdominal aortic aneurysms,” explains Giglia. “In 2006, our practice introduced the completely laparoscopic bypass procedure to treat blockages in the lower extremities and we’ve now introduced this advanced technique to abdominal aortic aneurysms.”

Norman, who had surgery at University Hospital on Nov. 10, 2008, was the first person to undergo a laparoscopic-assisted AAA repair in the Greater Cincinnati, and possibly the Tristate area.

“We were able to apply the same minimally invasive technique used to repair blockages in the lower extremities to fix Mr. Norman’s aortic aneurysm,” says Giglia. “By using advanced, minimally invasive surgical techniques, we’re able to give very fragile patients a viable option for recovery and a better quality of life that was not possible before.”

Medicare Screening Benefits
According to the American Vascular Society, about 200,000 people are diagnosed with abdominal aortic aneurysm annually, and many others live with the lifethreatening condition without realizing they are at risk for rupture and death. Men over age 60 who smoke and have high blood pressure are at the most risk.

New Medicare Part B health insurance enrollees are eligible for a preventive abdominal aortic aneurysm screening. Upon completion of a physical examination, which is mandatory for new Medicare patients, male patients who have smoked at least 100 cigarettes during their lifetime and anyone with a family history of vascular disease can request the abdominal aortic aneurysm screening exam.
The test is done using ultrasound, a technology that uses sound waves to create a picture of organs and other structures inside the abdomen.

If vascular problems are found, the patient may be referred for additional screening exams to determine the best course of treatment.

Appointments must be made in advance by calling (513) 558-3700, and patients will be required to show a current Medicare insurance card.

About Minimally Invasive Surgery for Treating AAA
UC vascular surgeons specialize in minimally invasive vascular techniques not available at other Greater Cincinnati hospitals. This includes laparoscopic (minimally invasive surgery), a method of operating inside the abdomen through small ports using a fiber-optic light source, camera and specialized instruments.

Endovascular surgery, another type of minimally invasive surgery, is done through two small incisions in the groin. The patient is given local anesthesia, and remains awake to avoid further compromising of his or her heart rate and blood pressure.

For more information, call (513) 558-3700.

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