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St. Luke’s vascular surgeons pioneer incisionless bypass treatment for blocked leg arteries


St. Luke’s University Health Network vascular surgeons are first in the Lehigh Valley area to offer a new, incisionless procedure that restores blood supply to the leg by bypassing long, chronic total blockages in the main blood vessel of the leg called the superficial femoral artery.

Percutaneous transmural arterial bypass, or PTAB, creates a bypass around the diseased artery with Dacron coated metal stent tube, branded as TORUS. This technology takes advantage of the fact that there is usually a large, healthy femoral drainage vein that runs right next to the blocked femoral artery.

St. Luke’s is the first hospital in the Lehigh Valley and Northeastern Pennsylvania using the minimally invasive procedure, and one of only three programs in the state currently, noted St. Luke’s chief of vascular surgery, Dr. Sharvil Sheth. This novel limb-saving treatment, called DETOUR by its manufacturer, Endologix, is currently being provided to patients with advanced peripheral artery disease (PAD) who are too high-risk to undergo surgery or have failed prior traditional balloon and stent treatments.

“This minimally invasive procedure has been proven to be a safe and effective treatment, and provides hope to several high-risk patients, who may also suffer from diabetes, kidney and heart disease,” Sheth said. “Restoring blood flow in a leg enhances the patient’s ability to walk painlessly, so they can partake in physical exercise, which helps improve their overall health.”

Unlike traditional methods for treating hardened blocked arteries, including balloon angioplasty and stents – which can have a higher rate of failure – or bypass surgery requiring multiple large incisions along the leg, in this PTAB technique, a surgeon passes a stent from healthy femoral artery in the groin into the adjacent femoral vein and then re-enters into healthy popliteal artery around the knee. It’s like taking a detour in a car, when one of the outbound lanes of the interstate highway is converted to an inbound lane in case of accident or construction, before it rejoins the original inbound lane. In the leg, the outbound lane is usually double the size of the inbound lane and can easily accommodate this extra traffic.

To date, St. Luke’s vascular surgeons Dr. Lynne Doctor, Dr. Michael Qaqish, and Sheth have successfully treated three patients with this technique. The incisionless bypass procedure takes place in a St. Luke’s hybrid operating room at its Allentown or Bethlehem campus, requiring about two and a half hours to complete. Patients are discharged the same day on oral blood thinners.

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