![]() ![]() Factors that predispose to saphenous vein graft disease, include the size of the vein graft. It occurs in 35 to 40 percent by five years after the operation and 40 to 50 percent at 10 years. In studies of several thousand people getting CABG using the saphenous vein, 10 percent have graft occlusion within the first few weeks to a year after surgery. In the first five years after surgery, the internal mammary artery grafts are less likely to occlude compared with the saphenous vein. In surveys more than 80 percent of CABGs are done with the right or left internal mammary artery. The condition of the patient is factored into the decision to use one or the other. When CABG is done the surgeon may choose to use the saphenous vein from the leg or the internal mammary artery (IMA) from the chest and armpit for the bypass graft. All of these treatments are designed to allow muscle beyond the blockage to get oxygenated blood. Think of a CABG as creating a detour or alternative route for blood flow around a partial or completely blocked artery. The graft is then stitched into the coronary artery so that blood can detour around the blockage. A surgeon takes a piece or graft of artery or vein from elsewhere in the body. A coronary artery bypass is an open-chest surgery. A stent, a tiny tube, can be left behind to keep the artery open. Angioplasty is when a catheter is passed, usually from the femoral artery in the groin up to the heart and a balloon-like device is placed in the coronary artery to the level of the partial occlusion and inflated to open the blockage. More severe blockages have to be treated with an angioplasty, angioplasty and placement of a stent, or with a coronary artery bypass graft. Minor blockages of the coronary artery are treated with medications that dilate the arteries and lower blood pressure which decreases the workload and oxygen requirement of the heart. Prolonged decreased blood flow can cause death of heart muscle which is referred to as a myocardial infarction or a heart attack. This can cause the chest pain called angina. Heart muscle beyond the blockage cannot get enough oxygenated blood. It can be blocked by a cholesterol plaque, a blood clot or a combination of the two. The heart muscle is threatened when one or more of the arteries carrying oxygenated blood through it is partially or completely blocked. Unfortunately, it is rather common for a patient to have blockages in the coronary arteries and in the bypass after a coronary artery bypass graft (or CABG). What would have caused the new blockages so quickly from a year ago? Her cholesterol and blood pressure are in good ranges and under control. There are more blockages, one right below a bypass and 70 percent blockage through a bypass. She was having chest pain again and hospitalized. My mother had triple bypass surgery one year ago. Question asked by Angi Garton of Chariton, Iowa: Otis Brawley, a chief medical officer for the American Cancer Society. Every weekday, a CNNHealth expert doctor answers a viewer question. ![]()
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