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Can Patient With Vein Graft Go For 12 Years Without Graft Occlusion?
Question: I am a 68 year old male who had 4 vessel bypass surgery 12 years ago. I did not have a heart attack. I am having my annual stress test next week and am very nervous because I have been reading a lot on the Internet which my cardiologist has told me not to do. It seems from what I am reading that I should be worried twelve years after cabg. In my operation at Toronto General Hospital the LIMA went to the LAD and the XXXXXXX went to OM1. Leg vein was used for OM2. I am on 40mg of Lipitor and 10mg of Altace. I take one 325mg aspirin per day and fish oil, vitamin D supplements as well as 1 gram of folic acid a day, My blood pressure is well controlled at about 120/80. My HDL is 1.5 and my LDL is under 2. (Canadian measures). My triglycerides are low as well. I exercise five days a week doing 3.8 miles of walking briskly five days a week and moderate weight training (as I was taught at cardio rehab) three days a week. I do not smoke and I am not overweight. I watch my diet carefully. Last year's cardio echo was normal. I don't know why I am so nervous now. Can people with some vein graft go on for longer than 12 years without graft occlusion? Should I be as worried as I am? I know worry is not good! I also know that you can give no guarantees, but I would like an opinion from a real cardiologist before my test next week. Thanks, XXXXXXX
Brief Answer:
I would explain as follows :
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
Regarding your concern, I would explain that all you have read about a longer lifespan of arterial graft compared to vein grafts is true.
There exists the probability that after ten years from surgery more than half of vein grafts become problematic , showing even total occlusion.
But that is only a probability and when speaking of probabilities it is necessary that some factors should be present to turn it true.
All I want to say is that a short life patency of the grafts vein (and even arteries) begins to be determined from the very first action of graft implantation (CABG). Traumatic graft preparation and anastomosis lead to early intravascular inflammation and near future occlusions. And this is true not only for veins, but also arterial grafts.
Also arteriosclerotic progression is observed in coronary grafts as well.
If coronary risk factors are treated properly, such as in your case, the probability of graft occlusion becomes quite small.
Now, turning to your direct concern, I would explain that, judging from your heart condition (in terms of physical functional class), your perfect lipid profile and blood pressure control, as well as the absence of smoking and diabetes, coupled with a healthy diet and a daily lifestyle, I would say that your anxiety and fears about the stress test results are not rational.
You shouldn't be afraid of that cardiac test, as such an effort you are exerting daily and you are feeling perfect.
So relax and don't worry about it!
Now returning again to the internet theory, I would explain you that from my daily clinical practice I have noticed vein grafts with a perfect patency even more than twenty years after surgery, as well as accelerated atherosclerotic occlusion of arterial graft only a few years after CABG.
So, to conclude I recommend you not to rely on those internet statistics, but just keep going on your right way as you are doing so far.
Hope to have been helpful!
Feel free to ask me whenever you need!
Greetings!
Dr. Iliri
I would explain as follows :
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
Regarding your concern, I would explain that all you have read about a longer lifespan of arterial graft compared to vein grafts is true.
There exists the probability that after ten years from surgery more than half of vein grafts become problematic , showing even total occlusion.
But that is only a probability and when speaking of probabilities it is necessary that some factors should be present to turn it true.
All I want to say is that a short life patency of the grafts vein (and even arteries) begins to be determined from the very first action of graft implantation (CABG). Traumatic graft preparation and anastomosis lead to early intravascular inflammation and near future occlusions. And this is true not only for veins, but also arterial grafts.
Also arteriosclerotic progression is observed in coronary grafts as well.
If coronary risk factors are treated properly, such as in your case, the probability of graft occlusion becomes quite small.
Now, turning to your direct concern, I would explain that, judging from your heart condition (in terms of physical functional class), your perfect lipid profile and blood pressure control, as well as the absence of smoking and diabetes, coupled with a healthy diet and a daily lifestyle, I would say that your anxiety and fears about the stress test results are not rational.
You shouldn't be afraid of that cardiac test, as such an effort you are exerting daily and you are feeling perfect.
So relax and don't worry about it!
Now returning again to the internet theory, I would explain you that from my daily clinical practice I have noticed vein grafts with a perfect patency even more than twenty years after surgery, as well as accelerated atherosclerotic occlusion of arterial graft only a few years after CABG.
So, to conclude I recommend you not to rely on those internet statistics, but just keep going on your right way as you are doing so far.
Hope to have been helpful!
Feel free to ask me whenever you need!
Greetings!
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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