Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Artery Collapse Post Heart Bypass Surgery?
Question: Hi. My mom had triple bypass surgery in 2014 in January. She was 66 years old. Never smoked, no diabetes, no overweight. Healthy life style. Major problem is blood pressure. But she controls it well. In 2015 in October she had angioplasty. Doctor told me that her 2 arteries collapsed behind heart those arteries that surgent installed during open heart surgery and only 1 front artery is fine. How could it happened to have it just 1.5 years later after open heart surgery? Angioplasty doctor looked very disappointed.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello xxxxxxx!
Welcome and thank you for asking on HCM!
I understand your concern and would like to explain that even though CABG (coronary artery bypass graft surgery) is considered a more sustainable solution than PCI (percutaneous coronary angioplasty) for coronary artery disease, it is a fact that bypass grafts (used in CABG), especially vein grafts may become occluded a few years after surgery.
As your mother has undergone a multiple bypass is very likely that besides one of the vessels that may have been bypassed with an arterial graft, the other ones may have been treated with vein grafts.
Nearly half of the vein grafts may become occluded seven to ten years after surgery. But sometimes they may be complicated even before.
This may happen because of an increased inflammation inside the vein grafts in certain individuals; may also be related to coronary lesion specificities and even by the surgical strategy chosen.
In such cases, complicated coronary arteries become addressed by angioplasty and stent implantation (when feasible).
If such is not the case, a new CABG is indicated, but with higher surgical risks than the previous procedure. Arterial grafts could be optimal for offering more stable conditions.
Meantime, medications could be of some help to reduce symptomatology, but an adequate drugs combination should be reviewed by her attending doctor.
If you could upload reports of her coronary angiography, her CABG procedure and her last coronarography (after bypass), I could give a more concrete medical opinion.
Hope to have been helpful to you!
Feel free to ask me whenever you need!
Greetings!
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello xxxxxxx!
Welcome and thank you for asking on HCM!
I understand your concern and would like to explain that even though CABG (coronary artery bypass graft surgery) is considered a more sustainable solution than PCI (percutaneous coronary angioplasty) for coronary artery disease, it is a fact that bypass grafts (used in CABG), especially vein grafts may become occluded a few years after surgery.
As your mother has undergone a multiple bypass is very likely that besides one of the vessels that may have been bypassed with an arterial graft, the other ones may have been treated with vein grafts.
Nearly half of the vein grafts may become occluded seven to ten years after surgery. But sometimes they may be complicated even before.
This may happen because of an increased inflammation inside the vein grafts in certain individuals; may also be related to coronary lesion specificities and even by the surgical strategy chosen.
In such cases, complicated coronary arteries become addressed by angioplasty and stent implantation (when feasible).
If such is not the case, a new CABG is indicated, but with higher surgical risks than the previous procedure. Arterial grafts could be optimal for offering more stable conditions.
Meantime, medications could be of some help to reduce symptomatology, but an adequate drugs combination should be reviewed by her attending doctor.
If you could upload reports of her coronary angiography, her CABG procedure and her last coronarography (after bypass), I could give a more concrete medical opinion.
Hope to have been helpful to you!
Feel free to ask me whenever you need!
Greetings!
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answer. I d be so happy to upload all medical docs that you mentioned, but i don't know how to upload though this website. If you know please, let me know.
Mom's cardiologist right after angioplasty decided to change mom's blood pressure medication. What is it for? And how could it help to determine in 3 weeks(doctor wants to see her) if she still needs stent or she will be fine without it. If she has blockage, it will stay there anyway from my understanding. And most likely doctor knows it as well. If it so, maybe instead of wasting time, just do stent and don't wait all 3 weeks? Thank you.
Mom's cardiologist right after angioplasty decided to change mom's blood pressure medication. What is it for? And how could it help to determine in 3 weeks(doctor wants to see her) if she still needs stent or she will be fine without it. If she has blockage, it will stay there anyway from my understanding. And most likely doctor knows it as well. If it so, maybe instead of wasting time, just do stent and don't wait all 3 weeks? Thank you.
Brief Answer:
Following opinion:
Detailed Answer:
Dear XXXXXXX
I would explain that, if your mom's coronary arteries or (venous) bypass grafts are occluded and these complications produce overt myocardial ischemia, then a prompt coronary revascularization by angioplasty with stent implantation would be recommended (no delay is justifiable).
But, if no actual evidence of any serious coronary occlusions and clinical consequences derive, then it is more rational to optimize her current medication (including blood pressure medications, etc) and monitor the symptomatology and lab tests.
At this point, the clues that should be considered are her coronary angiography results coupled with clinical consequences (presence of underlying cardiac ischemia or no).
Whether indicated revascularization would be better performed by a new CABG or percutaneous angioplasty, it will depend on technical grounds and by other co-variates (like co-morbidity, overall cardiac performance, etc).
For a better professional opinion you can upload your mom's medical data by using upload reports (I think there should be such an option on the screen).
Another alternative (if the first is not feasible) is by using my direct link (direct question) as follows:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Best wishes,
Dr. Iliri
Following opinion:
Detailed Answer:
Dear XXXXXXX
I would explain that, if your mom's coronary arteries or (venous) bypass grafts are occluded and these complications produce overt myocardial ischemia, then a prompt coronary revascularization by angioplasty with stent implantation would be recommended (no delay is justifiable).
But, if no actual evidence of any serious coronary occlusions and clinical consequences derive, then it is more rational to optimize her current medication (including blood pressure medications, etc) and monitor the symptomatology and lab tests.
At this point, the clues that should be considered are her coronary angiography results coupled with clinical consequences (presence of underlying cardiac ischemia or no).
Whether indicated revascularization would be better performed by a new CABG or percutaneous angioplasty, it will depend on technical grounds and by other co-variates (like co-morbidity, overall cardiac performance, etc).
For a better professional opinion you can upload your mom's medical data by using upload reports (I think there should be such an option on the screen).
Another alternative (if the first is not feasible) is by using my direct link (direct question) as follows:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Best wishes,
Dr. Iliri
Note: click here to Consult a cardiac surgeon online. to know the best treatment option for your heart-related issues
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
