Bypass grafts

Surgeons use several different blood vessels as bypass grafts. These blood vessels are available because other pathways can carry blood to and from the tissues of your chest, arms, and legs. The surgeon decides which graft(s) would be best depending on the location of the blockage, the size and number of blockages, and the size of your coronary arteries.

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Internal mammary arteries (thoracic arteries, IMA grafts): The internal mammary artery is the most commonly used vessel for bypass grafts because it has proven to remain patent or open the longest and has thus produced the best long-term results. The arteries usually can remain attached at one end and the free end can then be attached to the blocked coronary artery just below the obstructed area. If the surgeon completely detaches the mammary artery at both ends, it is called a "free" mammary artery. Over the past decade, more than 90 percent of all patients have received at least one internal mammary artery graft.

Radial artery: The radial artery is the second most commonly used arterial graft. The arm has two arteries, the ulnar and radial arteries. Most people receive blood to their arm from the ulnar artery and will not have any side effects if the radial artery is used. Careful preoperative and intraoperative tests determine if the radial artery can be used. If you have certain conditions (such as Raynaud's, carpal tunnel syndrome, or painful fingers in cold air) you may not be a candidate for this type of bypass graft. The radial artery incision is in your forearm, about 2 inches from your elbow and ending about 1 inch from your wrist. After this type of bypass, patients are routinely placed on a medication called a "calcium channel blocker" for about six months after surgery to help keep the radial artery widely open.

The gastroepiploic artery to the stomach and the inferior epigastric artery to the abdominal wall are less commonly used for grafting.

Saphenous veins: These veins are removed from your leg, then sewn from your aorta to the coronary artery below the site of blockage.

To bypass the blockage, the surgeon makes a small opening just below the blockage in the diseased coronary artery. The graft is sewn into the opening, redirecting the blood flow around this blockage. If a saphenous (leg) or radial (arm) vein is used, one end is connected to the coronary artery and the other to the aorta. If a free mammary artery is used, one end is connected to the coronary artery while the other remains attached to the aorta. The procedure is repeated until all affected coronary arteries are treated. It is common for three or four coronary arteries to be bypassed during surgery.

A note about minimally invasive vein removal: Minimally invasive saphenous vein removal is accomplished by a small incision in the groin and one to two 1-inch incisions in the leg, near the knee. The surgeon uses special instruments to delicately remove the vein and close the incision with little blood loss and small risk of infection. Removing the saphenous vein by this method reduces patient discomfort and results in smaller scars and a quicker recovery.