Blockage after CABG?

[IAMMOM2]

My Husband (aged 29, yes. 29) had a single CABG done in May of 2009. He is diabetic and it was poorly controlled prior to the surgery (he often went without monitoring blood sugar or taking his prescribed meds for weeks at a time). We were quite shocked to find out that he had a 90% blocked artery that could only be fixed by having a CABG.

We see our family physician regularly, have blood work done regularly, are now on insulin and will soon be starting an actual insulin pump. We see the cardiologist regularly.

His job is fairly physically active/aggressive - but he still has difficulty changing his diet and does not eat low fat/low cholesterol meals, no matter how much the "family" has nagged/begged him to change this.

He has had some sharp/shooting pains since his surgery which the surgeon said was probably related to nerve pain from the actual surgery. He said they may persist for years or may not ever quite go away. They have calmed down dramatically over the last few months but recently started to flare up again.

He is absolutely paranoid and scared that he's got another blockage going on. We had a stress test w/ dye (sorry, not sure what this is called) done in Dec of 09 that came back clear and while his levels are higher than normal for cholesterol/trigylcerides etc, he is doing okay.

My question is, what are the odds that he could have another blockage so soon?

[ed34]

Due to your husbands age, and as it was a single bypass, I would be very surprised if he didn't have an artery graft rather than a vein. You can easily confirm this with the cardiologist.
I had a triple bypass in Sept 07 and by the end of Nov 07 both veins collapsed, but the main artery graft was still intact. I can tell you that I certainly knew when this happened. It was as though the oxygen content in the atmosphere had suddenly dropped by 80%, causing me to gasp for air for about 20 mins. It did settle down, but it was so obvious something had gone wrong. I also started to get angina again, with throat, chest and jaw discomforts and obviously shortness of breath.
A simply way to tell if it's due to a blockage, is if the discomfort gets worse with exercise. I know it probably sounds silly, but a couple of weeks ago I had a stomach bug which felt just like heart symptoms. To test this, I ran up the stairs when the discomfort appeared, just to see if it got any worse. It didn't, even though my pulse increased, there was no extra discomfort at all. I then felt sure it wasn't heart related. A week later the pains all vanished.
One thing I did notice from my bypass experience is that although all the usual pains had gone after around 12 months, it was still very easy to pull muscles after that for about another year. It took a very long time for my chest muscles to fully recover to the point that I had the same strength as before the bypass. I met other patients in cardiac rehab who had received bypass surgery as far back as five years and still found odd chest pains in the muscles.

[kenkeith]

For some insight and statistics. The harvested veins themselves can block over time, this may  result in part simply from the trauma from the surgery, in other words, by removing the vein from the leg and then sewing it to the heart.  The incidence of veins blocking remains high despite advances in anti-platelet and cholesterol medications.

Arterial grafts are preferred to venous grafts and have a better patency rate. A grafted vessel has to carry arterial blood not the venous blood.  The mean coronary arterial pressure is around 40mmhg and this will damage the saphenous venous endothelium more quickly. The reocculsion rate at 10 years for venous grafts  can reach  60%.
.
"Saphenous vein grafts (SVG) remain the most widely used conduit for CABG. However, contemporary patency rates at one-year post CABG remain poor, despite optimal medical therapy. Recent trials (PREVENT IV) demonstrate that up to 45% of all patients have one or more SVG occluded at angiography one year post-CABG; up to 25% of all SVG are occluded at one year post-CABG angiography. Furthermore, patients with at least one SVG occluded had twice the incidence of perioperative MI, and thirteen times the composite endpoint of death, late MI or repeat revascularization at 12-18 months".

Better results with the left internal mammary artery (LIMA) and is the most commonly used arterial graft. LIMA patency rates at 10 years is nearly 90 %  .But the graft patency depends on many factors , like diabetes, age, gender, surgical technique.

At your husband's  young age, it appears after several years there may be further intervention unless proper diet, etc. can prevent any progression of occlusions.

Thanks for your question and if there are any followup, you are welcome to respond.  Take care.

[Detours211]

So sorry to hear what you and your husband are going through.

Was hoping you could let me know how you discovered that your husband had such a blocked artery (90 percent)?

I am his age and feel as though maybe I have similar issues.

Anything you could say would help me out alot.

Take care!