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How will ablation treatment affect future heart surgeries?

This question was asked in Ulmer, South Carolina and has 12 answer(s) as of 06/11/2013.
Heart problems run in my family but I haven't had any yet, just a bit of high blood pressure. I found out in my saphenous vein I have leaky valves. If I have an ablation treatment on my saphenous vein done, can other veins be used in the future if a need arises for heart surgery?


Doctors Answers (12)

The greater saphenous vein is often removed or "harvested" intact with a vein stripping procedure along the inside of the leg and used quickly afterwards by the heart surgeon in an open heart procedure to bypass arterial blockages of the heart's coronary circulation also known as a heart bypass or CABG procedure. In this surgery, a normal saphenous vein which has a larger diameter than the artery is removed and sewn into the side of a heart artery both ahead and behind the blockage creating an alternative open route to arterial blood flow. As a result of pulsating higher pressures with an elevated oxygen content and low acidity, the vein transforms itself over time into an artery with thickened elastic walls. If your greater saphenous vein is normal, or has mild reflux but has not enlarged greatly then it is important to keep this vein for possible use by the heart surgeon some day. However, once the vein has become stretched out, twisted and enlarged as seen in other varicose veins, then it is useless both as a vein and for possible bypass grafting, and ablation of the vein would be helpful. The greater saphenous vein is usually about 3-4mm in diameter with 5mm being the upper end of normal. Although grossly enlarged saphenous veins are not useful in heart bypasses, other veins such as the mamillary can be used and stints have become an excellent option in many cases.

The laser ablation will not limit the ability to have coronary bypass surgery. When the saphenous vein(s) are leaky they are not good for bypass grafts and there are other more suitable alternatives.

If you decide to have your venous reflux treated with radio frequency or laser, should you require coronary artery bypass surgery in the future, the cardiac surgeons would likely use the internal Mammary Artery instead of the saphenous vein. If they end up needing additional vein for the bypass, then they can remove healthy veins from your arms.

A great saphenous vein which is abnormal enough to require thermal ablation for venous insufficiency is no longer an acceptable conduit for a coronary artery bypass graft. Commonly used alternatives for CABG include the radial artery from the forearm and the internal mammary artery in the chest. Many cardiac surgeons actually prefer to use the arteries over the saphenous veins.

You should treat the saphenous veins if you have symptoms. They usually will not use a vein over 4mm for bypass surgery. If you have your saphenous closed, sometimes they enter at the knee and could use the saphenous in the calf for bypass in the future. They could use your mammary or radial arteries or other venous conduits as well.

It is a question of balance. If your veins are bad enough to be disabling, then ablation is probably ok if your have no heart problems. The real question is whether or not you have significant heart disease and your age. You should check with your physician.

Yes. There are other veins that can be used for heart by pass grafts.

With the ablation of the great saphenous vein a person does lose the ability to use that vein as a conduit for possible heart surgery - coronary artery bypass grafting (CABG). This vein can no longer be used for vascular surgeries to improve blood flow to a person's feet should hardening the arteries cause blockages in the arteries supplying blood to the feet. That being said, the damage to the vein because of the pressure in the great saphenous vein secondary to the valves not working, generally the vein is of such poor quality that the heart surgeon or vascular surgeon would not use it for these operations.

Yes. Most cardiothoracic surgeons are using other vessels for their cardiac bypass surgeries (ex: internal mammary, ulnar artery, etc). If the saphenous veins have dysfunctional valves, chances are they will not be used for bypass anyways.

That is a very good question. If your saphenous vein has "leaky" valves it would not be used for a heart bypass anyway. It would not make as a good bypass graft. So either way the cardiothoracic surgeon would most likely use either a radial or mammary vessel for a bypass instead of the saphenous vein.

The internal mammary artery can be used or veins from lower legs or arms and can be employed instead. The varicose you have may not be the best for coronary bypass graft too.

If the ablation has to be done to the great saphenous vein then this vein would not be available for a bypass if you should need it. Remember you have two so the treatment of one would not be a problem. If other saphenous veins are the issue then you can have these treated without worrying about this problem.

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