Popular bypass technique may raise risks

There’s nothing too glamorous about bypass surgery. Your chest gets cracked wide open and the surgeon probably uses veins stripped from your legs to reroute blood around the blocked arteries that feed your heart.

Photo by CarbonNYC via Flickr

The good news is that when those new pipes are put in properly they can last a decade or longer. But when minimally invasive techniques are used to pluck those veins from the legs instead of the more painful direct approach, the outcome of bypass might not be as solid, according to a study just published in the New England Journal of Medicine.

Patients whose bypass grafts were obtained the less invasive way were more likely to have reclogging after a year than those whose veins were obtained the old-fashioned way. (46.7 percent vs. 38.0 percent). Worse, at three years patients with endoscopically harvested veins were more likely to have had serious problems, including death.

The less invasive approach to extracting blood vessels for use as replacements for coronary arteries is popular – used about 70 percent of the time – because it doesn’t hurt as much and infection rates are lower. But this study, despite its limitations (it was observational and not prospective) raises questions about the best way to go. “The decision about the best way to harvest veins for [bypass] has just gotten a lot more complicated,” writes cardiologist Harlan Krumholz for Journal Watch.

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