Bypassing bypass surgery by growing new arteries

by Carolyn Thomas  @HeartSisters

The human body is endlessly fascinating, isn’t it? Consider how humans get started in the first place – only after one tiny sperm, one of hundreds of millions, has somehow negotiated its way past the lethal acid coating the vagina and made its long journey up to the waiting egg.  The odds are stupefyingly against that one brave little sperm. 

And then, consider the heart.

Before my heart attack, I had never heard of the heart’s little collateral arteries. These are small, normally closed arteries that, in times of dire need (like a blocked coronary artery that leads to a heart attack) can wake up, open wide, and enlarge enough to form a kind of detour around the blockage, thus providing an alternate route of blood supply to feed the oxygen-starved heart muscle. Do-it-yourself bypass surgery!

Consider also the example of Juliet’s life-saving collateral arteries. At the age of 46, this young mother of two in London, England suffered a heart attack due to Spontaneous Coronary Artery Dissection (SCAD).

Like most SCAD patients, she had no cardiac risk factors, and was very healthy at the time. (Just the day before, she had gone on a 40-minute run). But her early heart attack symptoms were initially misdiagnosed, and she now suspects that the tear in her artery may have unravelled further by the time she underwent a diagnostic angiogram. Juliet ended up with five stainless steel stents implanted along the length of her torn Left Anterior Descending (LAD) coronary artery.

But then things went from bad to worse for Juliet, as over the next three months, her stents re-stenosed (blocked) due to scar tissue build-up. She explains:

“During the period of re-stenosis and for about a year after, I suffered angina pain on exertion and most particularly after eating. Unfortunately, the stents subsequently failed, and my LAD is now 100% occluded with scar tissue. But that part of my heart is now functioning on collateral circulation. The chest pain symptoms disappeared slowly as my collateral arteries developed.

“It was a happy surprise to discover how wonderfully a heart can adapt with collaterals, and although I would love to still have the use of my LAD, I am doing fine without it!

“My cardiologists said these collateral arteries would have started to develop as soon as my LAD started to re-stenose, especially as I went straight back to running, post-cardiac rehab. I am surprisingly well and happy to be alive.”

Collaterals

Drawing of the coronary artery circulation with (left panel) and without (right panel) collateral artery growth between the right coronary artery (these are the small red blood vessels in the left illustration) and the blocked artery.  The grey area below the blockage shows the area of the heart muscle at risk in the absence of collaterals. (Illustration by Anne Wadmore, London, UK). From BMCMed.

Some researchers suggest that, because Juliet was already a physically active runner, her own collateral arteries may have already started this important process called arteriogenesis, which is defined as the transformation of pre-existing collateral artery pathways into conducting vessels.

In 2004, Swiss researchers, for example, found that enhanced physical exertion (like running) may indeed cause those tiny collaterals to kick into action.(1)  Study authors explained in the journal, Heart:

“For the first time in a human being with entirely normal coronary arteries, we have shown evidence of enhanced coronary collateral flow in response to an endurance exercise programme.”

I’ve been told the same theory – that my 19 years of distance running contributed to that enhanced coronary collateral flow, which may have been the factor that helped to save me during my own heart attack, despite having a Left Anterior Descending coronary artery that was also fully occluded.

While every human has these amazing little sleeping arteries, not every collateral will work when it needs to – especially if you’re not training for a marathon. And not everybody has functional collateral arteries (a blood flow of 20% to 25% is generally considered sufficient to provide the required blood supply to the heart muscle at rest). One in three patients with coronary artery disease has sufficient collaterals.(2) We don’t know the reasons for this, but genetic factors are likely to play a role. Some factors that may influence whether patients with coronary artery disease develop collaterals include the severity of the coronary blockage(2), a longer duration of angina, and the location of the blockage.

Researchers at Tel Aviv University have developed a protein-based injection that, delivered straight to muscles in the body, may spark the regrowth of tiny new blood vessels, much like the body’s own collateral arteries. Their study was designed to discover a way to prevent leg amputations, but their preliminary tests may suggest potential value to future heart patients whose arteries are fully occluded.

Find out more about Spontaneous Coronary Artery Dissection (SCAD).

.

1  R Zbinden et al.  “Direct demonstration of coronary collateral growth by physical endurance exercise in a healthy marathon runner”. Heart. 2004 November; 90(11): 1350–1351.
2. T Pohl  et al. “Frequency distribution of collateral flow and factors influencing collateral channel development. Functional collateral channel measurement in 450 patients with coronary artery disease.”  J Am Coll Cardiol. 2001;38:1872–1878.
 

69 thoughts on “Bypassing bypass surgery by growing new arteries

  1. Following popliteal entrapment syndrome which I wasn’t even aware existed, my leg developed a collateral artery bypass because I went to the gym to workout and slowly I could increase my walking distance over the course of a year just by using a treadmill and hiking
    In the beginning I couldn’t walk further than 50 yards before my foot went numb with pins and needles.
    Now I can go a couple of miles.
    When I went to an orthopedic surgeon and they took a picture of my blood vessels it shows my dead popliteal artery has been bypassed by my collateral artery and I have very little side effects of my body’s bypass.

    Liked by 1 person

  2. I am a 69 year old male who has been power walking/jogging for 28 years. Last year my cardiologist advised me to have a heart angiogram. I had it done, but they found two blocked arteries. They immediately put me on the list for heart bypass surgery.

    Thank God that hospitals take their time in scheduling their heart surgeries. Three months after the angiogram (during which I stopped all power walking), I asked the same cardiologist to put me on a full stress test. I did this, and passed with 96%. Then with the consent of my cardiologist, I went back to power walking, without the jogging.

    Now, one year and five months after the angiogram, I feel great. I power walk for one hour 4-5 days a week, watch my diet and weight. I cover 6.5 kilometers in one hour during my walk, winter/summer. I’m pretty certain (almost 100%) that heart blood vessel collaterals have saved me from a heart attack.

    I truly believe that a human being must exercise regularly or his/her muscles will start to ‘die’. I hate to be blunt, but I believe this to be a fact.

    Liked by 1 person

    1. Thanks for sharing that amazing story! Some researchers have found similar results (e.g. heart patients divided into two groups: one group has standard invasive treatment, the other rides bicycles, at the end of one year, the cycling group reports better heart health recovery than the treated group!)

      Your 28 years of exercise helped to strengthen your heart muscle, no doubt.

      As cardiologist Dr. John Mandrola says: “You only have to exercise on the days you plan to eat!”

      Like

  3. I had a blockage on left side artery, I could walk only 1 block, stopping 5 times. My heart developed artery on its own – no surgery or stents or medication in 5 days.
    I can run, climb, etc, No sign of trouble.
    Keep exercising and yoga.

    Liked by 1 person

    1. I had a heart attack at the end of July. I had a stent placed into my RCA. My LAD is 90% blocked and my LCX is 50% blocked. Yet, I’ve felt better than before the heart attack and I can exercise easier. I’ve a meeting with my cardiologist on Thursday. I’ll see what he says. At the moment I feel like staying on the meds he’s given me and my changed diet of much more fruit and veg, and reduced fast food. I always walked a lot.

      Liked by 1 person

  4. What kind of test could reveal if you are developing collaterals? Would a stress test do? Or perhaps your own observation in terms of improved aerobic capacity?

    Liked by 1 person

    1. Good question, Tudval. I’m not a physician but I can tell you that generally a stress test would not tell you about collaterals. They may be visible during an angiogram. My understanding is that you wouldn’t be able to tell if your own collaterals were functioning or not.

      Like

  5. Reblogged this on melonpopzdropz … and commented:
    ANGIOGENESIS – has already occurred…. I am scared, I am grateful and I am also thoroughly amazed. Funny fact is, I recently read about the bodies capabilities to do this taking over when another part is damaged and unable to do the job in the Biology of Belief by Bruce Lipton.. Another funny fact is that part of the text fascinated me most.. Its like I already knew I would need to know this .. or something like that. Just another one of that whack explainable type situations.

    Like

  6. Had I known about these collaterals, I wouldn’t have done the PCI and 5 stents 6 mos ago. Was normal and full of energy before the PCI and stenting. Now, I feel very weak and chest discomfort 24 hrs/day. I literally feel like I’m already a dead man, just only still breathing. PCI and stenting is the worst decision I’ve made in my life. And, its irreversible.

    Liked by 1 person

    1. Hello Alex – unfortunately, not everybody has strong collateral vessels that spring into action to appropriately reroute blood flow around a coronary artery blockage. If all of us did, no heart attacks would ever happen.

      I’m more concerned about your debilitating symptoms. Most heart patients start to feel more like their old selves by six months, but a smaller number continue to feel awful despite having newly revascularized arteries. There may be non-cardiac reasons (we know that depression and thyroid issues, for example, can cause symptoms of crushing fatigue and weakness). Something is causing these symptoms, and you need to solve the mystery. Please see your physician, and if you’re unable to get help, seek a second opinion. Best of luck to you…

      Like

    2. Hang in there. I felt the same for about 1 and a half years after the 3 vessel/7 stents I had implanted. But once I phased out the blood thinner, I started to have just a bit more energy which allowed me to increase physical activity more and more. Now it’s 2 years after my angioplasty and feel quite a bit better. If I can get again the progress I’ve made over the last 6 months, I’d be quite happy (i.e. about 80% normal).

      I keep in mind that without the stents I might have gotten to 0% pretty soon.

      Like

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