home
RSS
November 17th, 2010
05:10 PM ET

What causes new blockages to form so quickly?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesday, it's Dr. Otis Brawley, a chief medical officer for the American Cancer Society.

Question asked by Angi Garton of Chariton, Iowa:

My mother had triple bypass surgery one year ago. She was having chest pain again and hospitalized. There are more blockages, one right below a bypass and 70 percent blockage through a bypass. Also one bypass has failed. Her cholesterol and blood pressure are in good ranges and under control. What would have caused the new blockages so quickly from a year ago?

Expert answer

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).

The heart muscle is threatened when one or more of the arteries carrying oxygenated blood through it is partially or completely blocked. It can be blocked by a cholesterol plaque, a blood clot or a combination of the two. Heart muscle beyond the blockage cannot get enough oxygenated blood. This can cause the chest pain called angina. Prolonged decreased blood flow can cause death of heart muscle which is referred to as a myocardial infarction or a heart attack.

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. More severe blockages have to be treated with an angioplasty, angioplasty and placement of a stent, or with a coronary artery bypass graft. 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. A stent, a tiny tube, can be left behind to keep the artery open. A coronary artery bypass is an open-chest surgery. A surgeon takes a piece or graft of artery or vein from elsewhere in the body. The graft is then stitched into the coronary artery so that blood can detour around the blockage. Think of a CABG as creating a detour or alternative route for blood flow around a partial or completely blocked artery. All of these treatments are designed to allow muscle beyond the blockage to get oxygenated blood.

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. The condition of the patient is factored into the decision to use one or the other. In surveys more than 80 percent of CABGs are done with the right or left internal mammary artery. In the first five years after surgery, the internal mammary artery grafts are less likely to occlude compared with the saphenous vein.

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. It occurs in 35 to 40 percent by five years after the operation and 40 to 50 percent at 10 years. Factors that predispose to saphenous vein graft disease, include the size of the vein graft. Smaller diameter veins being at higher risk. Remember women are likely to have smaller vein grafts and are thus at higher risk than men. Other risk factors include length of the vein grafted (longer being at higher risk), smoking history before and after surgery, hypertension in the weeks after surgery, and lipid abnormalities in the weeks after surgery. Interestingly diabetes and poor blood sugar control appear to have little role as a risk factor for early occlusion of the grafts but is a risk factor later.

One percent of left internal mammary artery grafts and six percent of right IMA graphs develop blockages within three months of surgery. Over the long term, 10 to 15 percent of internal mammary grafts develop occlusion. Factors that increase risk of IMA occlusion include the area of the heart that needs to be grafted and the severity of the blockages being bypassed. A more severe blockage in a coronary artery correlates with decreased chances of a blockage in the graph presumably because of higher blood flow in the graph.

IMA grafts are generally preferred because they have a higher long-term patency rate. Sometimes the internal mammary artery cannot be used, necessitating the use of the saphenous vein. In select cases, some surgeons are now using the radial artery from the forearm or the the right gastroepiploic artery (from the stomach).

Studies show that one can decrease risk of occlusion of both the veinous and arterial grafts and the coronary arteries by aggressively reducing LDL-cholesterol with statin therapy and possibly through blood pressure control to low normal levels. Patients also generally benefit from low-dose aspirin therapy, some doctors prefer the antiplatelet agent clopidogrel instead of aspirin. Avoidance of smoking, controlling the serum glucose in diabetes is also important. Unfortunately these reduce but do not eliminate risk of occlusion.

I will discuss angioplasty and cardiac stents next week.


soundoff (1,257 Responses)
  1. appomannoni

    buy erectile dysfunction medications online kayamy help with erectile dysfunction naturally
    online doctor erectile dysfunction slilicy what erectile funtion meds work the best
    discount erectile dysfunction pills sicAdofs erectile spray

    June 15, 2021 at 19:16 | Report abuse | Reply
  2. https://thuocladientu123.com

    Best view i have ever seen !

    https://maps.google.ae/url?q=https://thuocladientu123.com

    June 15, 2021 at 20:22 | Report abuse | Reply
  3. RV Repair Near Me Now

    Can I simply just say what a comfort to uncover someone that really understands what they are discussing over the internet. You certainly realize how to bring an issue to light and make it important. More people have to check this out and understand this side of the story. I was surprised you aren't more popular given that you surely possess the gift.

    http://boosterblog.com/vote-864130-668401.html?adresse=http://ocrvcenter.com/concrete-truck-collision-repair-shop-near-me&

    June 15, 2021 at 22:20 | Report abuse | Reply
  4. RV Repair Near Me Now

    This is the perfect webpage for anybody who really wants to understand this topic. You understand so much its almost tough to argue with you (not that I actually will need toÖHaHa). You certainly put a fresh spin on a topic that's been written about for many years. Excellent stuff, just great!

    https://go.onelink.me/v1xd?pid=Patch&c=Mobile20Footer&af_web_dp=http://thaifeedmill.com/สมาพนธปศสตวและเพาะเลยงสตวนำ/บทความสมาพนธปศสตว/tabid/81/articleType/ArticleView/articleId/3880/--250-2562.aspx

    June 16, 2021 at 01:54 | Report abuse | Reply
  5. RV Repair Seal Beach

    Excellent post. I definitely appreciate this website. Keep it up!

    https://horizoninteractiveawards.com/index.php?URL=ocrvcenter.com/rv-repair-shop-cathedral-city-california

    June 16, 2021 at 02:25 | Report abuse | Reply
  6. appomannoni

    is erectile dysfunction reversible kayamy erectile on demand
    erectile doctors new orleans slilicy can erectile dysfunction be hereditary
    will erectile dysfunction go away sicAdofs what erectile dysfunction herbs effect her es

    June 16, 2021 at 03:01 | Report abuse | Reply
  7. Camper Repair Shop Near Me

    http://www.mundijuegos.com/messages/redirect.php?url=http://www.ocrvcenter.com/rv-repair-shop-carlsbad-california/

    June 16, 2021 at 04:32 | Report abuse | Reply
  8. RV Repair Near My Location

    http://www.ymg-ssz.jp/cms/modules/wordpress0/wp-ktai.php?view=redir&url=https://www.ocrvcenter.com/motorhome-upgrade-near-me/

    June 16, 2021 at 04:43 | Report abuse | Reply
  9. Camper Repair Places Near Me

    An impressive share! I have just forwarded this onto a colleague who had been doing a little research on this. And he actually ordered me lunch due to the fact that I stumbled upon it for him... lol. So let me reword this.... Thank YOU for the meal!! But yeah, thanx for spending some time to discuss this matter here on your blog.

    http://e-tsuyama.com/cgi-bin/jump.cgi?jumpto=ocrvcenter.com/rv-repair-shop-pomona-california/

    June 16, 2021 at 07:07 | Report abuse | Reply
  10. RV Repair Shops Near My Location

    Oh my goodness! Amazing article dude! Thank you, However I am having troubles with your RSS. I donít know why I am unable to subscribe to it. Is there anybody else having the same RSS issues? Anybody who knows the answer can you kindly respond? Thanx!!

    http://drugoffice.gov.hk/gb/unigb/www.ikeanded.com/util/urlclick.aspx?obj=DIListing&id=45397&url=constructionhow.com

    June 16, 2021 at 08:18 | Report abuse | Reply
  11. RV Repair

    http://www.luminous-lint.com/app/iframe/photographer/Frantisek__Drtikol/http://www.ocrvcenter.com/rv-repair-shop-woodland-hills-california/

    June 16, 2021 at 10:46 | Report abuse | Reply
  12. appomannoni

    erectile pills without a doctor prescription kayamy botox for erectile dysfunction
    erectile band slilicy erectile enhancement pills
    erectile clinic sicAdofs discount erectile dysfunction

    June 16, 2021 at 11:04 | Report abuse | Reply
  13. RV Repair San Clemente California

    https://images.google.com.ni/url?q=https://zx110.org

    June 16, 2021 at 12:48 | Report abuse | Reply
  14. RV Repair Shop Near My Location

    Great info. Lucky me I ran across your website by accident (stumbleupon). I have book-marked it for later!

    https://ichikawa.genki365.net/gnki02/common/redirect.php?url=https://www.ocrvcenter.com/rv-repair-shop-universal-city-california/

    June 16, 2021 at 12:58 | Report abuse | Reply
  15. internet providers near me

    http://xdv.videomodel.com/__media__/js/netsoltrademark.php?d=www.ocrvcenter.com

    June 16, 2021 at 13:47 | Report abuse | Reply
  16. oil change near me

    Good post. I am experiencing many of these issues as well..

    https://www.advice4debtni.com/__media__/js/netsoltrademark.php?d=ocrvcenter.com

    June 16, 2021 at 14:57 | Report abuse | Reply
  17. fast food restaurants near me

    https://heliarc.com/__media__/js/netsoltrademark.php?d=https://www.ocrvcenter.com/

    June 16, 2021 at 15:04 | Report abuse | Reply
  18. greek food near me

    I really like reading an article that can make people think. Also, many thanks for permitting me to comment!

    http://inlandwestern.net/__media__/js/netsoltrademark.php?d=http://www.ocrvcenter.com

    June 16, 2021 at 15:23 | Report abuse | Reply
  19. 에볼루션카지노

    If you desire to improve your knowledge just keep visiting
    this web page and be updated with the newest news posted here.

    June 16, 2021 at 15:45 | Report abuse | Reply
  20. mcdonald's near me

    Pretty! This was an extremely wonderful post. Thanks for supplying these details.

    https://urlxray.com/display.php?url=http://www.ocrvcenter.com/

    June 16, 2021 at 16:13 | Report abuse | Reply
  21. pharmaceptica

    chloroquina https://pharmaceptica.com/

    June 16, 2021 at 17:11 | Report abuse | Reply
  22. discount tire near me

    Hello, I do believe your blog may be having web browser compatibility issues. Whenever I look at your site in Safari, it looks fine but when opening in IE, it has some overlapping issues. I merely wanted to provide you with a quick heads up! Aside from that, fantastic site!

    http://baoviet.com.vn/Redirect.aspx?url=http://www.ocrvcenter.com/

    June 16, 2021 at 18:24 | Report abuse | Reply
  23. appomannoni

    which erectile dysfunction drugs work best kayamy discount erectile dysfunction drugs
    erectile disorder dsm 5 criteria slilicy what erectile dysfunction pill is the best
    erectile with long time sicAdofs natural erectile supplements

    June 16, 2021 at 18:59 | Report abuse | Reply
  24. movie theater near me

    https://www.literacylaunch.net/__media__/js/netsoltrademark.php?d=http://www.ocrvcenter.com/

    June 16, 2021 at 19:55 | Report abuse | Reply
  25. used car dealers near me

    https://lifepad.com/__media__/js/netsoltrademark.php?d=www.ocrvcenter.com

    June 16, 2021 at 19:56 | Report abuse | Reply
  26. good food near me

    An outstanding share! I've just forwarded this onto a colleague who has been doing a little homework on this. And he in fact ordered me breakfast due to the fact that I stumbled upon it for him... lol. So allow me to reword this.... Thank YOU for the meal!! But yeah, thanks for spending the time to talk about this topic here on your website.

    http://writecodeonline.com/__media__/js/netsoltrademark.php?d=http://www.ocrvcenter.com/

    June 16, 2021 at 20:40 | Report abuse | Reply
  27. RV Repair Nearby

    This web site definitely has all the info I wanted about this subject and didnít know who to ask.

    https://www.schornsteinfeger-duesseldorf.de/redirect.php?url=http://ocrvcenter.com/rv-repair-shop-saugus-california

    June 16, 2021 at 22:05 | Report abuse | Reply
  28. RV Repairs Near My Location

    https://gbcode2.kgieworld.com/gb/ocrvcenter.com/rv-repair-shop-bell-gardens-california/hot/

    June 16, 2021 at 23:20 | Report abuse | Reply
  29. ups near me

    This is a topic that is close to my heart... Best wishes! Exactly where are your contact details though?

    https://echoson.eu/en/aparaty/pirop-biometr-tkanek-miekkich/?show=2456&return=https://www.ocrvcenter.com/

    June 17, 2021 at 00:02 | Report abuse | Reply
  30. Sprinter Repair Shops Near Me

    Great web site you have got here.. Itís difficult to find excellent writing like yours nowadays. I truly appreciate individuals like you! Take care!!

    http://emex.ru/error?url=https://ocrvcenter.com/rv-repair-shop-tustin-california

    June 17, 2021 at 00:32 | Report abuse | Reply
  31. Camper Repair Places Near Me

    http://www2.golflink.com.au/out.aspx?frm=logo&target=ocrvcenter.com/motorhome-furniture-repair-near-me

    June 17, 2021 at 02:42 | Report abuse | Reply
  32. appomannoni

    for erectile dysfunction ptx kayamy erectile booster method pdf
    erectile performance slilicy prostate cancer erectile dysfunction
    erectile capacity sicAdofs erectile definition

    June 17, 2021 at 02:44 | Report abuse | Reply
  33. RV Repair Around Me

    https://sc.sie.gov.hk/TuniS/http://ocrvcenter.com/rv-repair-shop-burbank-california

    June 17, 2021 at 04:11 | Report abuse | Reply
  34. RV Repairs Near Me

    http://www.bcdairy.ca/dairyfarmers/index?URL=https://www.ocrvcenter.com/rv-paint-shop-near-me

    June 17, 2021 at 04:12 | Report abuse | Reply
  35. Camper Repair Near Me

    http://vladinfo.ru/away.php?url=http://www.ocrvcenter.com/rv-furniture-repair-near-me

    June 17, 2021 at 04:56 | Report abuse | Reply
  36. RV Repair California

    https://bytecheck.com/results?resource=https://www.ocrvcenter.com/rv-repair-shop-paramount-california

    June 17, 2021 at 06:34 | Report abuse | Reply
  37. IKimediumb#randeom[a..z]k

    community action council olympia community first credit union university blvd , pills ivermectin buy ivermectin community work synonym. houston community college biology labs community bank branch locations . community. colleges near me ivermectin for sale , community action council bourbon county positive words ks1 community colleges near me dental hygiene community acquired pneumonia oral antibiotics US 25e92ee , planning process uk , community america blue ridge .

    June 17, 2021 at 07:20 | Report abuse | Reply
  38. Nearest RV Repair

    https://earth-policy.org/?URL=https://ocrvcenter.com/rv-repair-shop-yucca-valley-california

    June 17, 2021 at 08:04 | Report abuse | Reply
  39. Camper Repair Shops Near Me

    http://recklinghausen.de/inhalte/startseite/ruhrfestspiele_kultur/musik_und_theater/musik__choere_und_vereine/index.asp?db=17&form=RedirectAction&redirecturl=www.ocrvcenter.com/rv-repair-shop-national-city-california

    June 17, 2021 at 10:25 | Report abuse | Reply
  40. appomannoni

    erectile vacuum kayamy erectile pictures
    10 best erectile slilicy fast erectile dysfunction drugs
    best erectile dysfunction medicine sicAdofs erectile function index 5

    June 17, 2021 at 10:55 | Report abuse | Reply
  41. dog park near me

    There is definately a lot to know about this topic. I really like all of the points you made.

    http://www.beerdrinkersofamerica.com/__media__/js/netsoltrademark.php?d=www.masternearme.com

    June 17, 2021 at 13:21 | Report abuse | Reply
  42. breakfast near me

    Greetings, I believe your blog may be having internet browser compatibility issues. When I look at your blog in Safari, it looks fine but when opening in I.E., it's got some overlapping issues. I just wanted to provide you with a quick heads up! Apart from that, great website!

    https://genki365.net/gnka01/common/redirect.php?url=https://www.reviewnearme.com/

    June 17, 2021 at 13:28 | Report abuse | Reply
  43. dominos near me

    http://vhs.rockyvista.net/__media__/js/netsoltrademark.php?d=wholesalenearme.com

    June 17, 2021 at 14:03 | Report abuse | Reply
  44. qt near me

    http://adimgmt.com/__media__/js/netsoltrademark.php?d=www.bulknearme.com

    June 17, 2021 at 14:11 | Report abuse | Reply
  45. smoothies near me

    http://www.ulyssespartners.biz/__media__/js/netsoltrademark.php?d=bestshopnearme.com

    June 17, 2021 at 15:42 | Report abuse | Reply
  46. IKimediumb#randeom[a..z]j

    friends with benefits meaning community bridges phoenix phone number , Ivermectin 3 mg sale ivermectin.in.net community bank keyser ave. community action near me positive feedback loop labor . positive reinforcement and job satisfaction ivermectin tablets for sale , community east community colleges near ucla culture def positive urea breath test Canada 25e92ee , positive feedback loop breastfeeding , community nutrition synonym .

    June 17, 2021 at 17:08 | Report abuse | Reply
  47. appomannoni

    erectile after prostate surgery kayamy erectile pills without side effects
    erectile dysfunction injections slilicy can erectile dysfunction be mental
    erectile help sicAdofs erectile icd 10

    June 17, 2021 at 19:12 | Report abuse | Reply
  48. food delivery near me

    I was able to find good information from your content.

    http://minpress.ru/wp-content/plugins/wp-js-external-link-info/redirect.php?url=https://wholesalenearme.com/

    June 17, 2021 at 20:15 | Report abuse | Reply
  49. bicycle shops near me

    http://marentes.com/__media__/js/netsoltrademark.php?d=www.quotenearme.com/

    June 17, 2021 at 22:01 | Report abuse | Reply
  50. thai restaurants near me

    You have made some really good points there. I checked on the net for more info about the issue and found most people will go along with your views on this site.

    https://www.domainsherpa.com/share.php?site=https://www.quotenearme.com

    June 17, 2021 at 22:51 | Report abuse | Reply
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

Post a comment


 

CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service. Comments are not pre-screened before they post. You agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Service.

Advertisement
About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.