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Bypass Surgery Made More Passable

Technique comes up with better way to harvest arteries from arm

MONDAY, Dec. 2, 2002 (HealthDayNews) -- When it comes to heart bypass surgery, small veins and arteries can take on the work of big blood vessels, but it's not easy to move them from one part of the body to another. Now, doctors across the country are using a technique that makes it easier than ever before to harvest an artery from a valuable appendage: your arm.

"We hope that this will reduce potential complications," said Dr. Fardad Esmailian, an associate professor of cardiothoracic surgery at the University of California at Los Angeles, who performed his first "minimally invasive" endoscopic arm artery operation last week.

Patients need heart bypass operations when their arteries become blocked and prevent their hearts from properly delivering blood to the body. About half a million Americans undergo the surgery each year.

Doctors typically remove blood vessels from the leg, arm or chest and reconnect them around the heart in a way that allows blood to go around the blockages.

"It's like a detour after an accident. It directs traffic -- or blood -- away from the blockage," said Dr. Eric Eichhorn, medical director at the Cardiopulmonary Research and Technology Institute in Dallas.

Legs and arms can easily survive the loss of a vein or two, Eichhorn said, although some patients might experience some swelling. And veins can carry the heavy-duty blood volume of an artery, he added, noting "veins are actually pretty tough."

But removing a vein or small artery isn't always a simple or painless procedure.

"The leg vein had been traditionally removed by making a long incision in the leg from the groin to ankle level," Esmailian said. "This would cause tremendous amount of pain and discomfort, swelling, high risk of infection, and poor healing in the patients."

About five years ago, Esmailian said, he introduced a surgical method at UCLA that is easier on the patient. Surgeons make two or three one-inch incisions in the leg and use a video monitor to insert surgical tools and remove a vein through the incision.

The harvesting method for leg veins has become routine at UCLA and elsewhere, but some hospitals have yet to adopt it, Esmailian said. The method doesn't work for about 5 percent of patients who undergo it, meaning their veins have to be harvested the traditional way.

Along with doctors in other parts of the country, Esmailian has begun using the harvesting method on arms. In last week's surgery, a quintuple bypass of six blocked vessels on a 72-year-old man, he took out part of the so-called radial artery by making a small cut in the wrist.

The incision is so small that it can be covered by a watch wristband. "The other artery of the forearm should be able to take over the work of the artery that is being removed," Esmailian said.

There are some limitations, however. Surgeons cannot remove arm arteries from 20 percent of heart bypass patients because of limitations on blood flow to their arms, Esmailian said.

The potential side effects are pain, temporary loss of sensation in the thumb and index finger, and potential for loss of the hand if the remaining artery can't take up the slack. But ultrasound tests before surgery eliminate the risk of hand loss, Esmailian said.

UCLA harvests arm arteries in about 60 percent of heart bypass operations, according to Esmailian, who said he and his colleagues probably do them more often than doctors elsewhere.

Eichhorn, the Texas cardiologist, cautioned that the arm artery operations are complex. "You'd want to have somebody who's gotten pretty good experience," he said.

What To Do

For more information on coronary artery bypass surgery, check out the Web sites for Heart-Surgeon.com or the American Heart Association.

SOURCES: Fardad Esmailian, M.D., associate professor of cardiothoracic surgery, David Geffen School of Medicine, University of California, Los Angeles; Eric Eichhorn, M.D., medical director, Cardiopulmonary Research and Technology Institute, Dallas
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