Dr. Michael Silva’s 83-year-old patient was facing a leg amputation because of peripheral artery disease. She had over 10 years undergone multiple procedures to remove the buildup of plaque.
Doctors had used everything in the toolbox, Silva said.
Last week, she became the first in the Galveston region to undergo a revolutionary, minimally-invasive procedure that will not only change treatment for patients, but also could lengthen the career span of surgeons.
Silva, a University of Texas Medical Branch vascular surgeon, on Thursday performed the area’s first Percutaneous Transmural Arterial Bypass using the Detour system — an alternative to bypass surgery approved by the U.S. Food and Drug Administration last year.
The patient, whose name was withheld under privacy laws, had lost about 75 percent of the blood-flow in her leg.
“You start having trouble healing, even insignificant wounds,” Silva said. “You get a mosquito bite and it won’t heal or it turns bad, and that was her case. She had some significant leg wounds that weren’t healing.”
A traditional bypass surgery would take up to eight hours, leaving at-risk patients under prolonged anesthesia, followed by up to a week in the hospital in recovery.
Thursday’s surgery on Silva’s patient lasted two hours, and she returned home that day.
The procedure requires only two-small punctures to insert a graft stent and maneuver it to route blood around a blockage.
“This procedure is pretty cool because you’re basically doing it through IVs,” Silva said. “When you put this whole graft in, it’s the same basically as when you have an IV in.
“You put the IV, or in our case we call it a sheath because it has a valve on it, in and you work through that. So, really the recovery is about the same as if you had two IVs, one in your leg and one in your ankle.”
And there as an unexpected benefit to very few surgeons working in the field.
A report by the Journal of Vascular Surgeries published in January 2023 found in 2018, there were 3,129 vascular surgeons for 309.8 million people in the United States. Of the country’s 3,145 counties, 17 percent had practicing vascular surgeons.
“That’s a real problem,” Silva said. “We try to get more vascular surgeons out there. We have a training program here and I get about 100 applications for one position a year. We’re just putting out one a year. That’s not going to make a big dent.”
The bypass surgery alone keeps vascular surgeons on their feet for hours. Because each surgery requires X-rays, the surgeon is not only exposed to continuous radiation, but also wears a full-body lead vest that, over time, has been attributed to back problems.
“What was really interesting, when I was training older surgeons, they were more likely to embrace this,” Silva said. “You don’t have 20 patients in the hospital that you have to round on every day. You don’t have to stand up for 12 hours or 8 hours and then do another one.
“I think it’s healthier — it’s healthier for the practice and it’s healthier for the patients. The benefit to the surgeon is sort of the unintended effect of doing these things, and you can do more. You can practice longer.”
The Percutaneous Transmural Arterial Bypass will be a primary surgery for not only patients with blockages, but those with diabetes and kidney disease, he said.
“Every single vascular procedure where we used to open people up needs to be replaced,” Silva said. “Pretty much everything we used to do open, I do closed.”
