[Value and limits of bypassing the distal ileum in the treatment of hypercholesterolemia]
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J O Defraigne1, J Pirenne, J C Swinnen
1Service de Chirurgie Cardio-Vasculaire, Centre Hospitalier Universitaire du Sart-Tilman, Liège, Belgique.
Insights
Partial ileal bypass (PIB) effectively lowers total plasma cholesterol in hyperlipidemic patients. However, this surgical intervention alone is insufficient for preventing multifactorial atherosclerosis progression.
Area of Science:
- Cardiovascular Surgery
- Metabolic Disorders
- Atherosclerosis Research
Background:
- Investigates the efficacy of partial ileal bypass (PIB) in managing hyperlipidemia among patients with a history of vascular surgery.
- Examines the impact of PIB on total plasma cholesterol (TPC) and total plasma triglycerides (TPT) in a cohort of 8 adults.
Observation:
- Patients with hyperlipidemia (types IIB and IIA) underwent PIB, with hypolipidemic drugs discontinued prior to surgery.
- Vitamin B12 injections were administered post-surgery, with plasma lipid levels monitored at 3 months and 1 year.
Findings:
- PIB significantly reduced TPC levels at both 3 months and 1 year post-surgery.
- TPT levels were significantly reduced at 3 months but not at 1 year.
- Despite lipid normalization, coronary artery disease progression was observed in some patients.
Implications:
- Partial ileal bypass is effective in normalizing total plasma cholesterol levels.
- PIB as an isolated procedure is insufficient to halt the progression of multifactorial atherosclerosis.
- Further research into comprehensive management strategies for atherosclerosis is warranted.
Abstract:
Partial ileal bypass (PIB) was performed in 8 young adults (5 males and 3 females, mean age 37 +/- 5 years) with a history of vascular surgery (aorto-coronary bypass, ACB, n = 6; stroke, n = 2), presenting with hyperlipidemia (II B: n = 7; IIA: n = 1). None of the patients had diabetes, 2 had mild hypertension, and all were cigarette smokers. Hypolipidemic drugs were discontinued prior to PIB. Following bypass surgery, patients received vitamin B12 injections twice monthly. Total plasma cholesterol (TPC) and total plasma triglycerides (TPT) were assayed at 3 months and 1 year after surgery. The mean follow-up period was 84 months. Mean TPC level was significantly lower (3.96 +/- 0.57 preoperatively vs 2.19 +/- 0.79 (p less than 0.001) and 2.54 +/- 0.76 (p less than 0.01) 3 months and 1 year postsurgery, respectively. Mean TPT level was significantly lower 3 months after the intervention (4.85 +/- 2.37 vs 2.33 +/- 0.62, p. less than 0.02), but not after one year. Similar trends were observed throughout the follow-up period. One of the ACB patients died of drowing, while three others had recurring angina pectoris symptoms. Coronary angiography showed that, despite low TPC levels, coronary artery disease had extended either to other vessels not included in the former bypass, or beyond the anastomoses. Patients with a history of stroke were asymptomatic. PIB is effective in normalizing TPC. Nonetheless, this isolated procedure is insufficient to prevent the evolution of multifactorial atherosclerosis.