January 29, 2005
Complications, Hypoglycemia
Question from Trail, British Columbia, Canada:
My brother died in October of 2002, while he was undergoing triple bypass open heart surgery. The surgeon said that his blood vessels were like tissue paper, brittle and friable. They kept trying to sew his grafts to the cardiac vessels, but they just wouldn’t maintain hemostasis. My brother never made it off of the operating table. Why were his blood vessels so fragile? The surgeon said they used my brother’s harvested saphenous vein graft and mammary artery as graft.
In the spring of 1982, my brother was diagnosed with type 1 diabetes 1982 and when he was younger, he was in denial about the severity of his condition. He did suffer from several hypoglycemic episodes. Could this have caused the fragility of his blood vessels? My brother did not drink alcohol and his only weakness was pizza and McDonald’s in which he indulged once weekly. He did, in the last 10 years of his life, have one glass of red wine a day, which he felt would help his circulation.
My brother underwent angiogram and angioplasty to his LAD (left anterior descending coronary artery) exactly three months before his open heart operation. Why didn’t the physicians at that time realize that my brother’s blood vessels were so fragile and proceed accordingly?
I realize that my brother is gone, and nothing can help him now, but these questions are on my mind. Perhaps you could help me put some of these questions to rest.
Answer:
I am very sorry about the death of your brother. It sounds like the extent of the atherosclerosis involving his vessels in his heart was extensive. Type 1 diabetes is a chronic disease and the blood vessels of the heart are one of the targets. The process that ultimately affected your brother’s blood vessels was a chronic one. It was not advanced for only a few months, but this was a process that had existed for years. Even if he did not smoke, the extent of blood vessel involvement may have been determined by his overall level of blood sugar control, the presence of elevated lipids, the presence of a positive family history, and his degree of blood pressure control. All these risks factors, if present, may have made the disease worse. When the physicians that evaluate heart disease decide on an intervention, they try to do the least invasive procedure to get the job done. It is not uncommon for angioplasty not to hold an artery open and have to move to bypass surgery It is a function of the extent of the disease. Although not being a cardiac surgeon myself, I think it likely that the surgeon always is faced with a possibility that the blood vessels may not work well in someone with longstanding diabetes. This is one of the risks. I am very sorry this did not work for your brother.
JTL
