Can anyone who has had a bypass tell me why surgeons tend to use a vein and an artery (for a double bypass) instead of 2 arteries? I was so grateful to have the op that I didn't ask I've known of people who have had a single bypass and a vein had been used instead of an artery!?
One of my neighbours had a tripple a few years ago and they used 2 veins and 1 artery??
It would be great if anyone else knows why this is.
Surgeons will generally use one of the two mammarian arteries as a graft to replace the LAD artery. Arteries have a different composition to veins, they're much stronger to handle the higher arterial blood pressures. The LAD is the most critical of the heart arteries, so it makes sense to use the strongest possible graft to replace it. The mammarian artery is conveniently located in the chest (it only needs severing at one end) and most importantly it has a much better track record than veinous grafts for resisting re-stenosis (where the grafts become clogged again).
My understanding is surgeons would use more arteries for grafts if they were available, but they're not. There's research work to try and develop artificial arteries, or to use "transplant" arteries from cadavers, but unfortunately none of these projects have so far been successful.
Over time the veinous grafts do become somewhat tougher, in some amazing process that isn't yet fully understand, they respond to the higher pressures and greater turbulence and change into something that's a bit closer to an artery. Unfortunately they're especially vulnerable in the first few years until this process takes place, things like nicotine for example in the bloodstream can irritate the delicate inner linings and once plaque becomes established in a veinous graft it can spread very quickly. Also veinous grafts are vulnerable to being damaged when they are removed and then filled with a saline solution while they wait for the surgeon to attach them to the heart. Trials are currently being conducted to see if they're more resilient if a little more tissue is left around the veins when they're harvested from the patient's arm or leg.
Thank you so much for your reply!! I wasn't told anything really, apart from the risks of surgery. Very little patient focused care both pre and post op, and no info at all on discharge apart from a bag of medication. I'm sure others have had different experiences depending on where you live? I think it really is a post code thing. I am very grateful for my operation though !! Thank you again for your explanation. It's always really nice when at least one person takes the time to reply to someone. Take care Chappychap
Hi Chappychap,
I wonder do you have a medical background? you seem to be very knowledgeable!
I never thought to ask why a vein was used when i was in hospital!! the technician came round with a scan machine that found the best and strongest vein in my leg!! i suppose i just went with the flow. i dont smoke and i dont touch alcohol and i have overhauled my diet in the past 3 years and now eat very healthy food with no snacks. clean food i call it!! dont get me wrong, i enjoy my food and follow a diet which does not exclude certain food groups. i guess i will just have to get over my anxiety and believe what the surgeon said, that the operation was a success with no complications.
I'm an economist by training, so unfortunately no medical knowledge! But after bypass surgery I read quite widely on the subject, asked lots of questions of doctors that I know, and had a few private consultations with cardiologists.
It's actually a fascinating subject, not just where cardiac medicine is today, but the history and where research might take us tomorrow.
If you're feeling good after your surgery, and you're taking your medication and living a healthy life, then I'd say relax and enjoy your new angina free life!
The big date in the diary for patients like you and I is our annual cardio check up with our GP,. That's when we get the data that can tell us how well we're really doing. If we can ensure that all those numbers, from blood pressure, to BMI, lipid data, and HaB1c scores, etc, are all looking good then our risks really aren't much different to the average person of a similar age.
Good luck!
Thank you thank you thank you!!! You have no.idea how much you've eased my mind!! All i needed was answers and explanations !! Thank you for giving me them. How far on are you in your recovery from bypass surgery? I'm only 8 weeks in..sadly the sfyrr care was lackingni my hospital here in Scotland. It wasn't till I got home that I found out I should have been doing certain things to aid my recovery whilst in hospital.
Hi again,Did you experience occasional faster heart beat after your bypass op? I'm 8 weeks post op now and am feeling really well. I have had 2 episodes of this now, one at 4 weeks and one this morning..It went away and settled down after a few minutes of focused breathing..I'm just wondering if this is something thst is normal after this op? I was on bisoprolol 7.5 mg before the op so a very very slow heart rate and pulse. Now I've been reduced to1.25mg, so of course my jesrtbis now beating a bit faster. My GP explained that before the op my cardiologist wanted my heart to beat slowly so as not to put too much stress on it. Now , they are happy for my heart to start WORKING!! I understand this logic but just wonder if the occasional fast heart beat is something others have experienced? I can't seem to find anything when I Google? Not that I am a fan of Dr Google!!
Sorry for the late reply, we're only just back from a trip away.
I'm not medically qualified but my understanding is that the occasional episode of faster heart rate isn't that big a deal, but if this persists then I would take it to your GP, Open heart surgery can trigger a temporary (and almost always fixable) episode of atrial fibrillation or other types of arrhythmia. So if this occurs again I would get it checked out.
Thank you so much chappychap. I hope you enjoyed your trip away. Also I telly appreciate your replies Thank.you again.
I'm coming up to the fifth anniversary of my bypass surgery, and I can honestly say they've been some of the very best years of my life (okay, the first few weeks after getting home weren't always full of laughs!).
I'm sorry to hear that you've been left to get on with things. Here are links to a few articles that you may find useful.
In England most hospitals give open heart surgery patients a booklet like this when discharged, even though they're issued by an individual hospital I've collected quite a few and they're all very similar,
lhch.nhs.uk/media/1099/card...
One of the most important things after discharge is to complete the breathing exercises about five times per day, and go for a daily walk (building up to about a mile after six weeks). I appreciate you have some mobility challenges, but these really will make a big difference to how fast you recover from open heart surgery,
kentcht.nhs.uk/cardiac-reha...
acprc.org.uk/Data/Publicati...
Finally, congratulations on quitting smoking. I know just how tough that is, but believe me there's nothing else that will improve your health nearly as much. Nicotine in our bloodstream severely irritates the delicate lining of our arteries, for many of us it was nicotine alone that originally triggered the plaque that has grown in our arteries. So by stopping smoking you have taken a genuinely massive step towards a healthier future!
Hi,That's one of the things I didn't get when I was in hospital.....the breathing exercises!! I found out through this forum that i should have been given them!
Hi Momander, I had a double bypass a few years ago where they used two artories. They used both my left and right mammary artories. I don't know how common it is to use the right mammary artory. However, as I am having angioplasty and a stent this Friday as that graft has failed then maybe it's not the best artory to use!
Hello Momander. I had triple by pass in 2015. Brilliant explanation from ChappyChap and like him. My knowledge comes from wanting to get to know and understand my body again after op (as some odd things occur from inevitable nerve damage) by reading up as much info from internet as I could find and asking questions of my cardiologist. American papers are quite well published in cardio matters and there is quite a bit of helpful research done. But like Chappy said also. You sound to have taken whatever advice you were given about diet and lifestyle seriously and making a good recovery. I could not believe how much better I felt after having the procedure. Good luck for the future and keep us posted on your progress 🙂🙂
Some interesting questions and answers.I did a lot of research pre op because i did everything possible (looked for every argument i could find, every bit of evidence that suggested their was a better alternative to the op).I didn't find very much and what i did was dismissed out of hand.
I had angina upon exertion, but i lost weight and took statins so this disappeared.The cardio investigation carried on with tests.I could run on a treadmill at 5mph.My thinking was if i got fitter the heart problem would resolve.An angiogram showed a narrowed left main before it trifurcated ,and an LAD with about 30mm of distal stenosis.
They said this is hard to stent and long lesions rarely/never get better and that's why you need a bypass.My argument was that a bypass is such a serious op that diet and lifestyle would be a better option.My additional argument was that i had a slow thyroid and this had caused the heart problem (probably) and now i was on levothyroxine this wouldn't be an issue.Further research by me said that a natural bypass is possible where we grow collaterals to take over the function.
All of my arguments got knocked down and i agreed to the op.Then he said CABGX4 and he set me off again, i had been thinking CABGx2. I'd read about using mammary arteries that are in the chest and did he think he could use mine, he didn't see any reason why not.I said heart bypass surgery was not something i wanted to repeat if a vein failed.I argued that what might be a perfect and very satisfying astheatic solution for a surgeon might not be for the patient.I wanted solid rugged plumbing that was robust, not something that had me back in two years later.When I was far from convinced there was anything wrong with me in the first place.
My wife was very embarrassed that she had such an opinionated idiot and worried i'd offended the surgeon and i might lose the operation.I ended up with CABGx2 because the other two were too narrow (apparently).I thought that was a pretty solid op with a history of success.
Answer above mine says his are starting to block which of course is a concern i didn't know about.
A great explanation from ChappyChap. My surgeon used a vein from my right leg and an artery from my left arm. He told me that veins have to learn to become arteries. He used my vein to bypass my right coronary artery which had been stented the previous year, so sharing the load, giving the vein time to acclimatuse to its new role. He used the artery to bypass partially blocked vessels on the left side of my heart. There was no mention of using my mammory arteries - I guess that is down to the surgeon's preference.
It's "fun" having my pulse taken by nurses where the artery has been removed. They seem oblivious to the scar running up my arm. I just wait until it dawns on them. 😁
Hi there,Thank you for your reply. Unfortunately mu hospital wasn't that great with communication apart from rhe legal obligation to tell me all rhe risks about the operation. I wasn't given any more info than that. There are only 2 hospitals in Scotland that do this operation and I know of someone who went to rhe other one and had a completely different experience? Perhaps it depends on the surgeon?
I found my surgeon very factual and willing to discuss all aspects of the operation, including the risks involved. I am sure that this is down to the individual and perhaps the policy of the hospital.
Hi My original surgeon was absolutely brilliant and a true gentleman
.thete was a cancellation o the waiting list and I ended up getting another surgeon who was very matter of fact and business like. No disrespect to him at all!! Just a completely different personality. A brilliant surgeon I was told!! but also I was told he was a procedural surgeon and preferred operating than speaking with patients!! This came from consultants who worked with him
They were not being unkind!! Just pointing out what was well known on the ward. I guess you gel with some people and not with others.
Hello I think there are more than 2 Hospitals in Scotland that do bypass surgery? I had mine in the ARI.
regards
In 2001 I had a Brain Haemorrhage caused by a leaking AVM.
An AVM is a tangle of veins and arteries normally in the brain, this can cause Arterial Blood to pass directly to a Vein without it's pressure being reduced. The vein then becomes weak due to this pressure and then leaks or even bursts. You are born with an AVM and it takes about 50 years for the vein to become weak enough so it can't withstand the Pressure. I was very lucky this happened in the US and I had a brilliant Neuro Surgeon who was from the UK to do the treatment required, ( which was in the $300k plus range ).
When I was being assessed in a small Hospital prior to being moved 120miles to a major unit the Dr just said " this is more serious than your Heart Attack " how to reassure a patient LOL
Regards
Just trying to give a little more information on Veins and Arteries
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