A Heart Bypass Can Use Various Blood Vessels — Which Is Best?

Talk to your surgeon about what kind of graft is right for you

A Heart Bypass Can Use Various Blood Vessels — Which is Best?

Contributor: Faisal Bakaeen, MD

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If your doctor says you need heart bypass surgery, you’ll want to know how it will work and what you can expect along the way.

Surgeons use coronary artery bypass surgery when your heart can’t get sufficient blood flow because of conditions like coronary artery disease, which is a narrowing or blockage of arteries around the heart.

To create a new pathway and increase the amount of blood flowing to the heart, a surgeon can take blood vessels from other parts of your body. These vessels will serve as grafts to bypass blocked arteries.

The most common vessels used for grafts are saphenous, which are from the leg, or radial, which are from the arm. However, physicians at Cleveland Clinic have seen over the last three decades that it’s best to use arteries from the chest wall — the internal mammary arteries.

Leg veins as grafts less durable

The veins that come from the legs often are used for arterial bypass because they are longer. This allows the surgeon to reach any artery in the heart.

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What we have learned over time, however, is that they are not durable. They don’t last as well. So instead, we tend to use them to bypass less important arteries that lead to the heart.

For a longer-lasting bypass, the vessels of the chest wall are preferable. By using these, we see fewer complications and better quality of life after a bypass. These arteries over time are much less likely to succumb to the plaque buildup called atherosclerosis than are those from the leg.

Why chest wall arteries are best

Studies show that those who had grafts from mammary arteries or both mammary and saphenous veins have less risk of death or a heart attack than those with only grafts from the leg. They also are less likely to have to return to the hospital after surgery or have another heart operation.

Coronary artery bypass surgery with mammary arteries also produces better outcomes for patients with coronary artery disease than surgery to insert stents. These better results show up even five years after the procedure and beyond.

There are a couple of drawbacks to using mammary arteries.

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First, because of their shorter length, they can only be used to bypass blockages close to the heart. Second, they do take some time to detach from the chest wall. This means they can’t be used when surgery is critical or needs to happen quickly.

Talk to your doctor

To achieve the best results for your bypass, talk to your physician about the kind of vessels he or she will use for your graft. Ask why they’re best.

It’s also a good idea to find out what potential side effects you can expect and what your long-term outlook is after the procedure. Ask your doctor to explain anything you don’t understand. It’s always a good idea to find out as much as you can before your surgery.

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