angioplasty in grafts

My father (78 yrs) had bypass (CABG) in 1996. He is chronic asthmatic. Now since the last year, he has developed off and on chest pain. He is diabetic but he is controlling it with diet. He is taking all recommended heart medicine like antiplatelet, blood thining, anticlotting, calcium channel blocker and inhalers for asthma. In 2006 angiograpghy shows all native vessels i.e LAD occluded,LM short,parent RCA=proximal total occlusion and grafts
SVG to RCA totally blocked, SVG to D1 =ostial 80% blocked.LIMA to LAD patent, SVG to D1 severe posterior disease. SVG to OM1/OM2 fine. SVG to RCA total osteal occluded.
Echocardiography done today shows mildly posterio inferio wall hypokinesia grade 1/2 MR. grade 1AR. Last friday, he had severe chest pain with EKG showing ST depression 5. Now it is St depression is 1.He is painfree.Doctors want to go for angioplasty but it is risky too. angioplasty in grafts is dangerous . They may burst and haemorrhage can occur. tell me what to do.Should we opt for angioplasty or only continue on medication


This discussion is related to Second CABG Risk?.

[ed34]

I think if your Father is pain free and on the best medication for his condition, then personally I would opt to continue as he is without further intervention. It is important that he does report any further degredation in his condition, like shortness of breath increasing or chest pains. I cannot tell you which decision to make because I am not a Doctor, that choice is something you need to carefully consider. 80% is high, but if he is pain free then one has to assume medication is keeping his heart relaxed and the vessel patent enough to allow a good enough flow. I have not heard of stenting to bypass grafts being more risky than stenting coronary arteries. Maybe they are worried the grafts have degraded slightly?
I do know it is more risky to attempt a second bypass surgery. Research has shown that stenting grafts produces much better results than second surgery. I am a bit concerned about why they feel it's dangerous to stent the grafts, so if it was my decision, I would remain on medication and seek further opinions on this in case it is required in the future.
Perhaps you could ask if it's less risky to treat the blockage/s in the native coronary arteries, so the graft isn't really relied upon. It could be there are just one or two blockages to deal with. Have they said if your Father has developed collateral vessels? which are tiny arteries that form on the heart to produce a natural bypass? some people form these and some people unfortunately do not. If he has enough collateral vessels feeding the area, then it's unlikely the graft will be needed anyway. When was the last time he had a nuclear perfusion scan (thallium) to see how well the muscle is being oxygenated?

[kenkeith]

If your father is asymptomatic, it doesn't make much sense to do a risky intervention. I have been on medication for more than 6 years, and I have a totally blocked LAD and 72% blocked circumflex artery.  I have no symptoms, but I take a nitrate prior to workout (aorbic exercise).

Mitral valve regurgitation 1/2 MR is acceptable (minor leakage), and AR 1 is also minor leakage and acceptable. Wall hypokinesis indicates the heart wall movement has some impairment.  The significance of that would be weaker contraction and less blood pumped with each heart beat.

I don't see any medication given for chest pain (angina)...doesn't your father have nitro for chest pain?

[kay2486]

my father had angioplasty and is fine, there is a risk of peircing an artery then this is bad that would be it im afraid. do what you feel is best, if he were fine on the meds leave it as that, if docs say its not life threatening then he'll be fine only do what YOU feel comfy with