Arteries Make Better Grafts Than Veins

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DEAR DR. DONOHUE: I had a triple coronary artery bypass in April 1998. The vessel used for the grafts was taken from my leg.

A cardiologist tells me that the leg vessel graft needs replacement in eight years. It is not as good as grafts taken from arteries in the arm or the chest wall. I feel fine. It has been 10 years since my operation. Am I living on borrowed time? Why isn’t the leg vessel as good as the others? — W.P.

ANSWER: Hold on a minute. Predictions about the longevity of grafts for clogged arteries are hazardous. The source of the graft is not the sole factor in its life span. The general health of the person getting the graft is most important. Diabetes, for example, has a negative effect on all blood vessels, including grafts. If graft recipients make major changes in how they live — watch their weight, keep their cholesterol low, get exercise, pay attention to blood pressure and don’t smoke — then their grafts are bound to stay healthy for a long time.

The leg vessel you speak of is a long and large leg vein. Veins are not the same as arteries. Arteries have to stand up to pressure that is much higher than it is in veins, so arteries are tougher. At five years, 75 percent of vein grafts are functioning well, and at 15 years, 50 percent are still in good shape. Some last much longer.

The “chest wall” graft isn’t from the chest wall. These grafts come from arteries within in the chest. They are directly hooked up to heart arteries, so they have long lives — as long as arteries have. Most of these grafts stay open for 20 or more years.

Many heart surgeons use an arm artery as the source of their grafts. The arm does quite well with only one major artery. These grafts are better than vein grafts. They’re arteries. They have a life span between that of a vein graft and that of the inner chest artery graft.

The booklet on coronary artery disease discusses this common problem in depth. Readers can order a copy by writing: Dr. Donohue — No. 101W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My question is brief. Has anyone ever had a heart attack or dropped dead while taking a stress test on a treadmill? — R.W.

ANSWER: Somewhere around 1 in 2,500 have had a heart attack while undergoing a stress test. Deaths have been reported to be 1 in 10,000.

Those numbers make it sound like stress tests are dangerous. They aren’t. The heart-attack problem is actually not as great a problem as it sounds. The people who experienced a heart attack would have had one shortly and, most likely, in circumstances that might not have been favorable for treatment and recovery. A heart attack during a stress test occurs in a place where emergency treatment is readily available.

The deaths are tragic and inexplicable.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

© 2008 North America Synd., Inc. All Rights Reserved

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