Have you or someone you know ever been told by a doctor that a heart artery is blocked and needs a bypass? We have all heard the word 'bypass'. Imagine that there is heavy traffic on a road, and then this is like building an alternative route for vehicles to pass through. When a blood vessel supplying blood to the heart is blocked, a new route, that is, a new blood vessel, is connected to the heart, which is simply called bypass surgery. But have you ever wondered where a blood vessel is taken to build this new route? Most often, a healthy blood vessel from your own body is used for this. That is the process that we are going to talk about today, in which that blood vessel is taken from one part of the body and transplanted to the heart.
What does it mean to 'harvest' a blood vessel?
Simply put, this is like harvesting a blood vessel. To be precise, it involves surgically removing a healthy blood vessel from a part of your own body (usually an arm or leg) and using it as an alternative to a blocked artery in your heart. The blood vessel taken in this way is called a ``graft.''
One end of this graft is connected to the body's main and largest artery, the aorta, and the other end is connected to the blocked artery in the heart below the blockage. Then, blood flows through the newly connected artery to the heart without any obstruction, bypassing the blocked part. This surgery is called Coronary Artery Bypass Grafting (CABG) in medicine.
Where do these blood vessels come from?
There are two types of blood vessels most commonly used for bypass surgery.
1. Radial Artery in the hand
This is a major blood vessel that runs from the inside of your arm from your elbow to your wrist . This is the artery that you can feel when you feel your pulse. It's located very superficially to the skin.
"Then if this artery is removed, won't blood flow to the hand?" You may have such a question. Don't be afraid. Our body is designed in a wonderful way. We have another major artery, the ``Ulnar Artery,'' which runs parallel to this ``Radial Artery'' in our hand. After the radial artery is removed, the other artery performs the entire function that was performed by that artery.
2. Saphenous Vein in the Leg
This is the longest vein in our body. It is a vein that carries dirty blood back to the heart. It runs from the bottom of the body all the way to the thigh. Removing it will not cause any problems. Because there is a deeper venous system in the leg. After the saphenous vein is removed, the function that it did is taken over by the deep venous system.
What do you do before surgery?
Before deciding to perform this surgery, the doctor will perform several tests to determine the exact size and location of the blockage in your heart. Based on the results, he will decide whether the most suitable vein for the bypass is in your arm or leg.
| Test type | Simply put, |
|---|---|
| Complete Blood Count | Checking the types and amounts of cells in the blood. |
| Chest X-ray examination | Taking care of the basic condition of the heart and lungs. |
| Scans such as CT, MRI, or Vascular Ultrasound | Taking detailed pictures of the inside of the body and blood vessels. |
| Angiogram | A special fluid is injected into the blood vessels and X-rays are used to pinpoint the blockages. |
In addition, it is extremely important to follow the instructions your doctor gives you before surgery.
- Fasting (abstaining from eating and drinking) for several hours before surgery.
- If you smoke, stop it completely.
- You may be asked to temporarily stop taking some medications (including vitamins and herbal remedies).
How is the surgery done?
The surgery to remove the blood vessel is similar to a bypass surgery. You are put under general anesthesia. There are two main methods for removing the blood vessel.
1. Endoscopic Surgery: This involves making one or two very small incisions in the skin of the arm or leg and inserting a very thin tube (endoscope) equipped with a camera and surgical instruments. The doctor carefully removes the blood vessel while watching on a monitor. The scar caused by this is very small.
2. Open Surgery: In this, the blood vessel is removed by making a large, long incision where the blood vessel is located and opening the skin.
During bypass surgery, your heart and lungs may be temporarily switched to a ``Heart-Lung Bypass Machine.`` The surgeon then takes the previously removed healthy blood vessel ``graft`` and transplants it into the heart bypassing the blockage.
What are the advantages and risks of this method?
This method of grafting a vein from the body is the main reason for the success of bypass surgery. There are several advantages to doing this, especially with the endoscopic method.
Benefits:
- Faster recovery and less pain.
- Reduced time spent in the hospital.
- No large scars and reduced risk of infection .
- Reduced risk of bleeding and blood clots (Hematomas).
Risks:
As with all surgeries, there are some risks involved, but these do not occur in everyone.
- Bleeding or bruising at the incision site.
- Blood Clots.
- Numbness or loss of sensation in the area due to damage to the nerves surrounding the incision.
- Swelling (Edema).
- Infectious conditions.
The most important thing is that your main focus after surgery should be on recovering from the bypass surgery. By following your doctor's instructions carefully, you can avoid many of these risks.
When you need to see a doctor urgently
When you return home after surgery, do not ignore any discomfort. If you experience any of the following symptoms, seek medical advice immediately or go to the Emergency Department (ETU) of the nearest hospital.
- Chest pain or a feeling of tightness in the chest (Angina).
- Sudden cold sweat .
- Difficulty breathing (Dyspnea).
- Signs of infection, such as yellow fluid draining from surgical wounds and fever .
Finally, studies have shown that bypass surgery using the radial artery or internal mammary artery is more successful over time than using the saphenous vein. This is because arterial walls are stronger than veins, so they are less likely to become blocked again. However, your doctor will review all of your medical records to determine which vein is best for you and how to access it.
Take-Home Message
- During heart bypass surgery (CABG), a healthy blood vessel, often from your own arm or leg, is used to create a new path for blood to the heart.
- This is a surgery that is performed very successfully all over the world and saves many lives.
- The function of the blood vessel that is surgically removed is automatically performed by other nearby blood vessels, so there is no harm to the body.
- It is imperative to follow medical instructions exactly to ensure a speedy recovery after surgery and avoid complications.
- Never ignore chest pain, difficulty breathing, or signs of wound infection and contact your doctor immediately.
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