Just saw on the news that David Letterman had quintuple bypass surgery. Does anybody know why it always seems to be the arteries to the heart that clog up instead of the other arteries in the body? One never seems to hear about a triceps bypass surgery for example.
dont have an answer . . damn good question!
Bypass surgery IS commonly done to arteries:
to the legs:
Aorto-femoral bypass
Femoral-Popliteal bypass
to the kidneys:
renal artey bypass
I don’t know why, but when carotid arteries are blocked, the preferred procedure is opening the artery, stripping out the lining, and replacing it with a Goretex/Teflon sleeve. This is called endarterectomy.
For arteries to the heart, legs & kidneys, arterioplasty (opening a balloon on a cathether inside the blood vessel to increase the diameter & the blood flow) is a common alternative to bypass surgery. Stenting (placing a spring-like device inside the artery to hold it open) or roto-rooting are also options for all of these.
Sue from El Paso
Experience is what you get when you didn’t get what you wanted.
I think that all the bodies arteries do develop stenosis. It is just that the arteries to vital organs cause major symptoms i.e. stroke, t.i.a., heart attack, angina, high blood pressure, leg pain (claudication) etc. Alot of the time, the body is able to develop collateral circulation to the organs to maximize blood flow. If it can’t quickly enough or oxygen consumption exceeds oxygen delivery tissue damage occurs.
The coronary arteries are much smaller in diameter than most people are aware.
Cholesterol deposits can occur elsewhere but if they attach in these narrow vessels, then when complete obstruction occurs to blood flow, bypass surgery may be necessary or angioplasty as mentioned above. Its hard to believe that 24 hrs after a 5 graft open heart surgery that Letterman was subjected to that he is feeling great and cracking jokes. Its extremely uncomfortable post-op.
The three main coronary arteries (Left Anterior Descending, Left Circumflex, Right Coronary) are roughly 4-6 mm in diameter. Actually the concept of fatty streaks (most of us get these by age 20) growing into atherosclerotic plaque (common by age 40 in men, 50 in women) and progressing gradually from 25% occlusion to 50% occlusion to 75% occlusion to 100% occlusion is pretty outdated. The current concept is that fatty streaks do evolve into cholesterol plaques, but that it is specific qualities of each individual plaque that determines whether that plaque is likely to progress to full occlusion or not - often a “mild” 40% occlusion is more likely to rupture, and instantly cause total occlusion than a 70% lesion.
Some of the things that go into making a plaque more susceptible to rupturing are:
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Inflammation. Systemic inflammation makes plaques less stable. This is typically treated with aspirin, and some docs advocate Vitamins E & C to help clear up free-radicals which are thought to be higher in inflamed tissues.
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High insulin levels, even if sugar levels are normal. Treated by encouraging weight loss, exercise, lower carbohydrate intake.
PET PEEVE TIME: Bypass surgery is NOT open-heart surgery!!! The coronary arteries lie outside the heart, and so sewing new blood vessels to go around the blockages in them does not require cutting into the heart.
An example of open-heart surgery is replacing a heart valve. This does require the the heart be opened & sewn back up.
This rant is not directed at you, skelton - this misunderstanding is so common, I almost think I’m tilting at windmills. I’ve even heard other docs misuse this term. However, this in no way is intended to minimize the extensive nature of this surgery; this is major surgery in anyone’s book. It’s just not open heart surgery…
Sue from El Paso
Experience is what you get when you didn’t get what you wanted.
Actually, you are right. Its not open heart surgery, its open chest surgery. But when placed on the heart-lung machine and the heart ceases to beat and is cooled down for an hour or so, it is a big-time surgery. And once again, I do not believe that David Letterman neither felt great nor cracked jokes 24 hrs after surgery. It may be a necessary surgery but I wouldn’t wish it on anyone. I had 6 grafts one yr ago. The OP posed a very interesting question. Why are arteries in the lower extremities occluded far more than arteries in the upper extremities? I don’t know. Would be interested hearing from any of the vascular docs out there on the subject.
I had a 5 artery heart bypass about 8 months ago and believe me I wasn’t cracking jokes just after surgery!
Feel better than ever now though…