# Coronary artery bypass surgery question (need answer by August 20) **URL:** \ **Category:** Factual Questions\ **Created:** [August 3, 2012, 3:10pm UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302 "2012-08-03T15:10:21Z")\ **Posts on this page:** 15\ **Page:** 1
**Author:** ![panache45](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/panache45/32/64_2.png) [@panache45](https://boards.straightdope.com/u/panache45)\ **Post date:** [August 3, 2012, 3:10pm UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/1 "2012-08-03T15:10:21Z")
In coronary bypass surgery, a vein or artery from another part of the body is grafted to the coronary arteries, increasing the blood flow to the heart. But what happens to the part of the body the donor vessel came from? If a vein in the leg is harvested, how does this affect blood flow in the leg? Or are some vessels redundant? ---
**Author:** ![bup](https://avatars.discourse-cdn.com/v4/letter/b/6bbea6/32.png) [@bup](https://boards.straightdope.com/u/bup)\ **Post date:** [August 3, 2012, 3:17pm UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/2 "2012-08-03T15:17:50Z")
> [@](#): > > [Internal mammary (thoracic) arteries (IMA). IMAs are proven to exhibit superior long-term results with \>90% patency more than 10 years after surgery. The IMA can be used with its origin left intact (in situ graft) or detached and then re-attached to another blood vessel as a T-graft or a free graft > > • Using the Radial Graft > > • Saphenous veins. The saphenous vein is one of a number of veins in the leg that carry blood back towards the heart. The vein may be removed and used as a bypass graft with little effect on the leg because other veins are able to augment its ability to return blood to the heart. The saphenous vein lies beneath the skin on the innermost portion of the leg from the ankle to the groin. It may be removed via a standard surgical incision or using a minimally invasive endoscopic technique.]([http://www.cvtsa.com/coronaryarterybypassgrafting/c-542.html](http://www.cvtsa.com/coronaryarterybypassgrafting/c-542.html)) I don’t know what ‘using the radial graft’ means, but the first one appears to mean they can just shorten your IMA without much problem, and the third one appears to be your case of some redundancy being built in. ---
**Author:** ![beowulff](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beowulff/32/542_2.png) [@beowulff](https://boards.straightdope.com/u/beowulff)\ **Post date:** [August 3, 2012, 4:22pm UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/3 "2012-08-03T16:22:46Z")
I had a vein removed from my right calf for my CABG. I asked the doctor about the effect on my leg, and he said “oh, there are plenty of extra veins in your leg.” I don’t notice any difference in strength or endurance in my right leg vs. my left. ---
**Author:** ![Jake](https://avatars.discourse-cdn.com/v4/letter/j/f475e1/32.png) [@Jake](https://boards.straightdope.com/u/Jake)\ **Post date:** [August 3, 2012, 7:34pm UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/4 "2012-08-03T19:34:37Z")
You should ask the doctor (surgeon) to use an artery from your arm (as I did). Much more durable than a vein. It will leave a scar along your arm, but it’s worth it. (Surviving from a multiple 5 replacement bypass for 12 years now, and the Doc. says everything’s good!) And, no problem with my arm at all. 😛 ---
**Author:** ![MindsEye\_Watering](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mindseye_watering/32/3619_2.png) [@MindsEye\_Watering](https://boards.straightdope.com/u/MindsEye_Watering)\ **Post date:** [August 4, 2012, 3:25am UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/5 "2012-08-04T03:25:29Z")
> [@Jake](#): > > You should ask the doctor (surgeon) to use an artery from your arm (as I did). Much more durable than a vein. It will leave a scar along your arm, but it’s worth it. (Surviving from a multiple 5 replacement bypass > for 12 years now, and the Doc. says everything’s good!) And, no problem with my arm at all. 😛 It seems that venous grafts (saphenous veins) are less durable than arterial grafts. Of my three grafts performed five years ago, the two venous grafts that I had are completely closed and the arterial graft is still open. All the research that I have performed on the net seems to indicate that this is an issue, but I am not a doctor and YMMV. There seems to have been no impact on my legs because of the removal of the saphenous veins. Talk to your cardiologist/surgeon about this. Good luck with your CAGB! ---
**Author:** ![Senegoid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/senegoid/32/6606_2.png) [@Senegoid](https://boards.straightdope.com/u/Senegoid)\ **Post date:** [August 4, 2012, 3:41am UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/6 "2012-08-04T03:41:38Z")
> [@beowulff](#): > > I had a vein removed from my right calf for my CABG. I asked the doctor about the effect on my leg, and he said “oh, there are plenty of extra veins in your leg.” I don’t notice any difference in strength or endurance in my right leg vs. my left. So, our bodies come factory-delivered with plenty extra veins in the legs, but no spare arteries in the heart? What was the Intelligent Designer smoking that day? ---
**Author:** ![MindsEye\_Watering](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mindseye_watering/32/3619_2.png) [@MindsEye\_Watering](https://boards.straightdope.com/u/MindsEye_Watering)\ **Post date:** [August 4, 2012, 2:53pm UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/7 "2012-08-04T14:53:49Z")
> [@MindsEye\_Watering](#): > > Good luck with your CAGB! Dang. **CABG.** ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [August 4, 2012, 5:15pm UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/8 "2012-08-04T17:15:29Z")
If a vein from the leg winds up being used, there will likely be no noticeable effect save for the scar. That said, it is possible to have some degree of swelling after the operation, which can persist indefinitely. Presumably that is a reflection of the absence of the vein (it was doing _something_, after all) and the trauma to the leg when harvesting the vein. Any trauma to the leg, especially one where the veins have been involved, increases forever the risk of a skin infection in the leg (cellulitis). Nevertheless, leg cellulitis is uncommon after vein harvesting for a CABG. Further, should it ever occur, it’s usually a very mild disease easily treated with antibiotics (often given by mouth). ---
**Author:** ![Rhaegar](https://avatars.discourse-cdn.com/v4/letter/r/51bf81/32.png) [@Rhaegar](https://boards.straightdope.com/u/Rhaegar)\ **Post date:** [August 4, 2012, 8:25pm UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/9 "2012-08-04T20:25:38Z")
Arteries carry blood TO the leg, veins carry deoxygenated blood FROM the leg. Harvesting veins does not cause any problems usually except that the leg will probably swell more as the blood return from that leg would be compromised slightly. ---
**Author:** ![aux203](https://avatars.discourse-cdn.com/v4/letter/a/77aa72/32.png) [@aux203](https://boards.straightdope.com/u/aux203)\ **Post date:** [August 4, 2012, 8:47pm UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/10 "2012-08-04T20:47:49Z")
> [@panache45](#): > > In coronary bypass surgery, a vein or artery from another part of the body is grafted to the coronary arteries, increasing the blood flow to the heart. But what happens to the part of the body the donor vessel came from? If a vein in the leg is harvested, how does this affect blood flow in the leg? Or are some vessels redundant? This… is a complicated question. To put it mildly. Discuss it with your surgeon. An internet message board is a terrible resource for this sort of thing. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [August 4, 2012, 9:19pm UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/11 "2012-08-04T21:19:18Z")
> [@aux203](#): > > This… is a complicated question. To put it mildly. Can you please elaborate? I mean, “But what happens to the part of the body the donor vessel came from? If a vein in the leg is harvested, how does this affect blood flow in the leg? Or are some vessels redundant?” seems fairly straightforward to me. ---
**Author:** ![Senegoid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/senegoid/32/6606_2.png) [@Senegoid](https://boards.straightdope.com/u/Senegoid)\ **Post date:** [August 4, 2012, 9:38pm UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/12 "2012-08-04T21:38:00Z")
> [@KarlGauss](#): > > Can you please elaborate? I mean, “But what happens to the part of the body the donor vessel came from? If a vein in the leg is harvested, how does this affect blood flow in the leg? Or are some vessels redundant?” seems fairly straightforward to me. I heard (second-hand) a vague explanation given by a doctor once: Something to the effect that “the blood will find its way back to the heart.” Yeah, vague alright. The point: Removing veins from the leg isn’t just for heart artery replacement. It’s also a typical treatment for varicose veins. That was the context when my mother had it done, many years ago. And that’s where the above vague explanation came from. It’s roughly what the doctor told my mother. ---
**Author:** ![aux203](https://avatars.discourse-cdn.com/v4/letter/a/77aa72/32.png) [@aux203](https://boards.straightdope.com/u/aux203)\ **Post date:** [August 4, 2012, 9:51pm UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/13 "2012-08-04T21:51:16Z")
> [@KarlGauss](#): > > Can you please elaborate? I mean, “But what happens to the part of the body the donor vessel came from? If a vein in the leg is harvested, how does this affect blood flow in the leg? Or are some vessels redundant?” seems fairly straightforward to me. What happens after you harvest the saphenous vein from your leg varies widely depending on the patient and their condition. Some people don’t notice any long term effects. Some do. A fair number will have minor to major short term complications… which can predispose them to long term morbidity. A lot depends on what the patient’s preexisting comorbidities are. A obese diabetic smoker with preexisting mild venous insufficiency and peripheral vascular disease (which frankly describes a fair fraction of CABG candidates) can have life altering complications from a simple saphenous vein harvest. I’ve seen fairly healthy people pus out their harvest site and develop chronic lymphedema. I’ve seen reconstructions, toe amputations, foot amputations, and chronic non healing wounds all due to “uncomplicated” saphenous vein harvests. Of those options the chronic non healing ankle wound is by far the most annoying imo. Arterial harvest can be just as complicated. Harvesting your IMA is not a benign process. and it greatly increases your risk of sternal wound complications (can be fatal, require multiple additional surgeries, etc). Harvesting the radial artery is usually no big deal, except when some of your fingers start turning black unexpectedly. Or you have mild chronic symptoms of arterial insufficiency for several years. Or you have neuropathy which doesn’t really make sense but what the hell, it happens sometimes. And that’s the tip of the iceberg, frankly. Not to say any of this is common but if you perform a thousand CABG’s a year, you’re going to have a certain population with complications floating around. Coronary bypass surgery should be discussed with your surgeon. The fact that people think there’s a simple answer to some of these questions bothers the hell out of me. It doesn’t seem straightforward to me at all. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [August 4, 2012, 10:16pm UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/14 "2012-08-04T22:16:45Z")
> [@aux203](#): > > What happens after you harvest the saphenous vein from your leg varies widely depending on the patient and their condition. Some people don’t notice any long term effects. Some do. A fair number will have minor to major short term complications… which can predispose them to long term morbidity. A lot depends on what the patient’s preexisting comorbidities are. A obese diabetic smoker with preexisting mild venous insufficiency and peripheral vascular disease (which frankly describes a fair fraction of CABG candidates) can have life altering complications from a simple saphenous vein harvest. > > I’ve seen fairly healthy people pus out their harvest site and develop chronic lymphedema. I’ve seen reconstructions, toe amputations, foot amputations, and chronic non healing wounds all due to “uncomplicated” saphenous vein harvests. Of those options the chronic non healing ankle wound is by far the most annoying imo. > > Arterial harvest can be just as complicated. Harvesting your IMA is not a benign process. and it greatly increases your risk of sternal wound complications (can be fatal, require multiple additional surgeries, etc). Harvesting the radial artery is usually no big deal, except when some of your fingers start turning black unexpectedly. Or you have mild chronic symptoms of arterial insufficiency for several years. Or you have neuropathy which doesn’t really make sense but what the hell, it happens sometimes. > > And that’s the tip of the iceberg, frankly. Not to say any of this is common but if you perform a thousand CABG’s a year, you’re going to have a certain population with complications floating around. Coronary bypass surgery should be discussed with your surgeon. The fact that people think there’s a simple answer to some of these questions bothers the hell out of me. It doesn’t seem straightforward to me at all. Much obliged, thanks. (And, yes, compared to taking the saphenous, arterial harvesting is a different kettle of fish.) ---
**Author:** ![panache45](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/panache45/32/64_2.png) [@panache45](https://boards.straightdope.com/u/panache45)\ **Post date:** [August 5, 2012, 3:44am UTC](https://boards.straightdope.com/t/coronary-artery-bypass-surgery-question-need-answer-by-august-20/630302/15 "2012-08-05T03:44:22Z")
I have spoken with both my cardiologist and my surgeon about this. The surgeon is planning to harvest my internal thoracic artery, plus some secondary veins from my leg. He knows that I already have peripheral vascular disease in my lower legs. I already wear compression stockings, and I’ll have to switch to a higher compression. I also have to do a lot of walking, as soon as I’m able. I didn’t mention in the OP that I’m also having my aortic valve replaced at the same time. At first I wondered whether it’s riskier to do everything at once, but it’s not as risky as having to open me up again at a later date. My cardiologist said that my risk of mortality is 1%. I replied that if I don’t have the surgery my risk of mortality is 100% . . . so I can live with 1%. And yes, I’m diabetic and overweight. I know that this does not bode well. At least I don’t smoke. On the plus side: My surgeon is the Head of Thoracic and Cardiovascular Surgery at the Cleveland Clinic. It doesn’t get any better than that.