What would you choose - angioplasty or bypass? This question has cropped up after Uddhav Thackeray from Maharashtra’s most popular political family had to choose between angioplasty or bypass. While a layperson often confuses between the two, there is some merit in deciphering this debate even amongst our health professionals. Today, Interventional Cardiologist with Medanta-The Medicity at Gurgaon, Dr. Nishant Tyagi, helps us understand the difference between angioplasty and bypass.
If you have blocked arteries, the doctor would suggest angioplasty or bypass. These are two options in front of you, but what does this mean? Angioplasty involves passing a tiny tube through the artery from the groin. The blocked arteries are cleaned out and a ‘wire-mesh tube is placed in the artery to help keep it open, allowing blood to flow freely through the heart again.’ (Via)
Dr. Tyagi says, “Angioplasty is treating the blockages in the coronary arteries that supply the heart by passing a very small balloon over a wire and inflating it and then putting a stent there in a similar way to open the blockage. It’s done via access through groin or wrist and doesn't require open heart surgery or general anesthesia. The procedure takes only ~ 1hour and patient can go home in 2 days and get back to work in a week.”
A bypass on the other hand involves surgically grafting veins that will change the blood flow away from the clogged area in the artery. Bypass surgery involves operating when the heart is stopped and is stabilized with a pump.
Dr Tyagi explains this complex procedure: “While bypass surgery is a surgical procedure, which requires general anesthesia and opening the chest and rib cage to treat the blockages in the coronary arteries by creating bypass tracts from patients own arteries of veins from the legs to bypass the blockages. The surgery requires 4 hours and patient is usually discharged in 7-10 days and get back to work only after 2-3 months.”
Complex and final as this might sound, an angioplasty or bypass is not a permanent solution. You still have to change your diet and follow an exercise routine to burn excess fat and cholesterol. These surgeries are not a hall-pass to eating junk food. “They are not permanent solutions and no one should have that feeling. It just gives another chance to an individual to change his life style so that blockages don't appear again which includes Quit smoking, regular exercise, eat health food, keep cholesterol under check with cholesterol lowering drugs. The blockages might come again in the same area which has been treated or another area with time. Newer drug eluting stents have a 3-4% or chance of recurrence at the same site. Venous grafts in bypass also degenerate with time and 50% degenerate in a decade while 90% show degeneration in 15 years. So these are just temporary solutions,” reminds Dr. Nishant.
So the question remains, which procedure is a better option for you? Our cardiologist does not hide the truth; he suggests there is a debate at play. He says, “To answer this question, both the surgeon and interventions have there own opinion. There are scientifically made scoring systems of the blockages eg: SYNTAX score, which have been used to find out what is better for which patient. Still most of the decisions are taken up by the treating clinicians and patient wishes and there profile.”
He delves deeper into this perplexing issue, “Half the cases fall into black and white area where decision is simple like - if there are 1-2 short blockages in 1-2 arteries Angioplasty is better. If there are multiple long blockages in all 3 or left main arteries, bypass is better. Then rest of the cases come in the grey area where the decision is difficult as both can be done but depends on - comorbidities (presence of one or more diseases) of the patient like lung condition to sustain a long surgery and general anesthesia. If lungs are not good, a bypass is difficult and so angioplasty is done. Then there are patients who don't wish to get an open heart surgery and leave work for 3-4 months and so an angioplasty is offered. There is also a financial issue - drug eluting stents come from Rs. 55,000 – Rs.1,25,000 and so if multiple are deployed then cost of the procedure increases considerably whereas most cases of bypass are done in 1.5 - 2.5 lakhs.”
Finally here are some useful tips for post surgery recovery. Cardiologist, Dr. Nishant suggests some solutions: “There is a list of rehabilitation and secondary prevention measures to come back into the normal routine with a better life style. We call them lifestyle measures, which are almost similar to those we recommend for primary prevention.
- Quit smoking as this is most important.
- Diet should be good in fruits and vegetables, avoid all fried stuff, avoid saturated fats eg: butter, ghee, dairy products.
- Good control of blood sugars and blood pressure with medication.
- Control of cholesterol with medications.
- Regular exercise - brisk walking for 3-4 km in 30-40 minutes.
- Yoga and meditation.
- Regular follow up for all this with cardiologist every 3-6 months.”
*Image courtesy: © Thinkstock photos/ Getty Images
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