The surgery will treat patients with a rare and debilitating abdominal condition.
A Hamilton vascular surgeon has been “battling” with the health system to introduce surgery to treat patients with a rare and debilitating abdominal condition.
Former Waikato Hospital head of surgery Dr Chris Holdaway, who provides consultations in Tauranga, wants to perform a type of vascular compression surgery currently unavailable in New Zealand.
It would treat patients with Abdominal Vascular Compressions Syndromes (AVCS), a group of conditions occurring when blood vessels are under abnormal pressure, restricting blood flow, which can cause weakness and extreme pain. Holdaway particularly wanted to help young people who also had Ehlers-Danlos Syndrome (EDS), which several sufferers have spoken out about in recent years.
They included Auckland teenager Freya Dibben, who said her life “looks very different” post-surgery and Dunedin’s Olivia Adie, who now goes to school, plays hockey and socialises with friends – all previously “impossible”.
Holdaway said he could perform the surgery but, from his perspective, had faced “blockages” to offering it in New Zealand.
A private hospital that declined to offer the procedure said the public system should test the “leading-edge” treatment first.
Health NZ said the country had a relatively small population and could not offer all treatment options available in other countries, which was recognised by the creation of the high-cost treatment pool – application-based funding for private or overseas treatments.
Holdaway told the Bay of Plenty Times he had seen 86 patients with AVCS in 12 months – 15 of which he had helped travel to Germany for surgery. Most were relatively young, some still in school.
Holdaway said there were four major abdominal vascular compressions.
One was nut-cracker syndrome – associated with the left renal vein – where 80 or 90 per cent of people with AVCS had trouble, he said. The surgery in Germany treated this.
He went to Germany last year to learn from and observe Professor Thomas Scholbach – who scans and diagnoses AVCS – and Professor Wilhelm Sandmann, who operates on patients. Both had a decade’s experience in this and had treated more than 300 patients, but other formal research was scarce.
Vascular surgeon Dr Chris Holdaway. Photo / Alex Cairns
Holdaway returned to New Zealand “all ready to try to get it [the surgery] going”.
He said his attempts to introduce it at Hamilton’s private Braemar Hospital and public Waikato Hospital had been unsuccessful.
He was told to speak to the Ministry of Health, which he said told him it did not have the jurisdiction to approve a new treatment.
“So I’ve been battling away, sending letters off to various people at Waikato and not getting anywhere.”
Holdaway was “so frustrated” by the lack of progress and had requested to meet with Health Minister Shane Reti to seek his help. Reti’s office confirmed it had correspondence from Holdaway and a spokesperson said Reti was taking advice from officials.
What does the surgery involve?
Holdaway explained Professor Sandmann’s surgery involved wrapping a ringed piece of reinforced polytetrafluoroethylene graft, cut down one side, around the left renal vein — a large structure in the abdomen.
The rings stopped the vein from being compressed, eliminating a lot of pain.
Holdaway said he had used these grafts “all my working life” to replace arteries in legs and elsewhere.
“The territory is not new to me. To wrap it around a vein … is not exactly rocket science.”
Holdaway said the surgery was not a “total cure” – it did not get rid of gastric and intestinal complications and patients may still require support for these.
“And that’s where the issue is. [Some] gastroenterologists and some general surgeons say because we can’t get rid of the pain completely, the treatment is a failure.”
Surgeon’s wish before retiring
Holdaway said he “could have retired three years ago” but kept working because there were not a lot of vascular surgeons nor those sharing his interest.
“Before I fully retire, I would like to see a programme set up and some of my younger colleagues taking up the challenge.”
Holdaway audited 11 patients who had surgery in Germany. From the seven responses, almost all reported a “significant” reduction in pain.
“I don’t think we should have a two-tiered health system where those who have the money or the ability to fundraise can go, and those – the vast majority of them – who can’t.”
Holdaway said he could refer anyone from the Midland health region to the high-cost treatment pool.
For patients elsewhere, he had to find someone “prepared to put their head above the parapet” to refer them.
Public system should test surgery first - Braemar Hospital
Braemar Hospital chief executive Fiona Michel said it offered procedures that could be delivered with the highest level of safety and quality.
Applications for new surgical services were considered by the hospital’s clinical committee, which assessed clinical evidence and considered practical requirements such as capacity, cost, resourcing and staffing skillsets.
“It would be unusual to offer a new surgical service in a private hospital, when the same service is not also available in the public system, particularly as the breadth of services at a private hospital are often smaller.”
Michel said the committee respected and had confidence in Holdaway.
“However, they decided that such a leading-edge procedure should be first tested in a New Zealand public service environment, where the multidisciplinary services required to support this procedure could be made available to patients at all times, for the safety of all involved.”
The committee could reconsider Holdaway’s proposal once “successful clinical outcomes” had been achieved for Ehlers-Danlos Syndrome patients publicly, Michel said.
A statement from Health NZ said vascular compression syndromes were a group of conditions where pressure on a blood vessel reduced blood flow. This could occur because of external pressure, loss of support tissues, or abnormal blood vessels.
As this could happen in different parts of the body, there was no one specific “vascular compression surgery”.
An “experimental” surgery that splits a ligament near the stomach may be recommended and performed in some individual cases.
Asked about the surgery Holdaway referred to, treating nut-cracker syndrome, Health NZ said creating the high-cost treatment pool recognised New Zealand could not provide all treatments, technology and expertise available in other countries.
“Because New Zealand has a relatively small population and hence has small volumes of rare conditions and related treatments, we also acknowledge that some patients who have problems which may arise from vascular compression complications may seek overseas treatment, rather than only accessing those which are available here.”
The statement said applications for this funding could only be made by a Health NZ hospital specialist who would provide treatment recommendations and supporting documentation.
