Bypassing bypass surgery by growing new arteries

~ Carolyn Thomas

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. How did any of us even get born?

Also, 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 can lead to a heart attack) can “wake up” 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 continue to unravel.  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 of permanent damage 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 help those tiny collaterals to kick into creating that detour around a blockage.(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 program.”

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. My misdiagnosis also meant that I’d been sent home from Emergency despite my textbook cardiac symptoms (central chest pain, nausea, sweating and pain down my left arm) – ironically signalling the pre-existing collateral vessels to get ready because my heart was in trouble. This collateral growth is called arteriogenesis; it happens through a remodeling process of those pre-existing small collaterals.

Some researchers suggest that your blood type may affect the likelihood that your body will produce collateral circulation.  Having O type blood, for example, was found to be an independent predictor of good coronary collateral circulation among heart attack patients.(1) 

Not every collateral will work when it needs to. 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). Only one in three patients with coronary artery disease has sufficient pre-existing 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(3), a longer duration of angina, and the location of the blockage.

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

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1. S Celebi et al.  “Blood Group Types O and Non-O Are Associated With Coronary Collateral Circulation Development”;  Clinical and Applied Thrombosis/Hemostasis. January 2020.
2. 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.
3. 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.

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NOTE FROM CAROLYN:  I wrote more about amazing ways the human body tries to keep you alive during a heart attack in my book  “A Woman’s Guide to Living with Heart Disease“.(Johns Hopkins University Press).   You can ask for it at bookstores (please support your local independent bookseller!) or order it online (paperback, hardcover or e-book) at Amazon –  or order it directly from my publisher Johns Hopkins University Press (use their code HTWN to save 30% off the list price).

 

Published by Carolyn Thomas

86 thoughts on “Bypassing bypass surgery by growing new arteries”

    1. Sheila, it’s ALWAYS your right to get a second opinion! But having read all about collateral arteries in this blog post, it’s also likely that the first opinion you heard was actually correct, as bizarre as this seems at first. Discuss this with your physician so you feel okay with what’s happening. Best of luck to you…

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  2. Respected sir…this is dhanraj here…..sir actually my popliteal artery get entrapped into medial head of my gastrocnemius muscle…and get occluded ….can u pls suggest anything else from this side.Drs are suggesting for bypass…I wan to know about any such natural bypass like possibilities.thanks

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  3. Hi, everybody that posted regarding these natural bypasses. Are the collaterals good enough? If there is 100% blockage, and collaterals do develope, is a CABG necessary?

    I have a 100% blockage and collaterals are keeping me alive but when I asked my cardiologist he refused to answer me and I wonder why. I also found out that if a CABG is performed, the heart will sense it as unnatural and it will not grow anymore collaterals in the future if other blockages developed.

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    1. I found out the same yesterday. I have grown new collaterals to take over the 100 percent occluded Femoral Artery. I recently read about this in a book and had no idea that it was happening to me at the time. The book was the Biology of Belief. by Bruce Lipton. Simply amazing. I have to have a stent and what you have brought up is my exact question also. Will it damage any further modes of self healing in my body?

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  4. October 26,had heart attack. Had all test-nuclear stress,echo stress,pft lungs,CT chest all came back good. Finally told doctor my attack was the same as my first 12 years earlier. Which I had a Cath and 2 arteries opened by angioplasty. He finally agreed to a Cath. He had not much more than introduced the dye into heart and instantly stopped and told me I needed bypass surgery. Total of 7 blockages. Don’t put much trust in any stress test. I had passed all with flying colors.

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    1. A good cautionary tale, Stephen, for all heart patients to be their own best advocates. Having the same symptoms as your previous heart attack should have been the FIRST words out of your mouth at the ER. Hope you are doing much better by now…

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      1. Thanks for your reply, that was the first remark out of my mouth. Fell upon deaf ears. 6 weeks later I basically had to tell Dr I wanted a Cath.

        It is a shame that we have to manage our own health care even when you are under Dr care. However, I went to University Of Tn. Medical Center in Knoxville TN. Big mistake, After 1 night stay and 2 days I was going to be discharged. Told them I was not leaving until I saw cardiologist. They sent 2 that were residents and 1 that was a electrophysioligist, that wanted to do an ablation.

        Word of warning. Don’t go to a training hospital. Total of 8 weeks for diagnosis. Trust Your Judgement About Your Own Body. If you think about it even when going to primary Dr. You tell him what is wrong with you by your symptoms. He just gives meds.

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        1. Stephen, I’m sorry you had to feel like you had to fight to get appropriate care. That’s awful! But if no patients went to training hospitals, we would have NO trained physicians out there. That’s just reality. It’s how well-supervised those trainees are that is the issue. Almost every day, I hear from my women readers all over the world who tell me that their heart disease was misdiagnosed at a hospital that wasn’t a teaching hospital.

          Another reality for many of us is that we don’t have an option. The local hospital that has a cardiac unit is often the only game in town!

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  5. I had a cardiac arrest at 55 and they revived me and found I had a complete blockage of my LAD artery. My collaterals took over and that has been 23 years ago. I have had a stress test about every year and the last test had my EF at 70. after I had my heart attack it was in the 30s and it has been going up gradually through the years.

    At 78 I can still do about anything I want to. I am thankful every day for these vessels and God.

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    1. Congrats on your outstanding Ejection Fraction numbers, Bill. What a great feeling that must have been each year to watch those 30s rise steadily upward! You’ve had 23 successful years as a cardiac arrest survivor!

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      1. Thank you for your comment and your support. My cardiologist told me it was a natural bypass and I was one of the lucky ones to survive this. He didn’t want to do any other procedure at that time just wait and see how I do. It is a wonderful thing how the body can heal itself along with the right medication that I still take. I believe in Gods help also. It also make me feel good to know other heart patients have had the same experience and I hope this will give them more encouragement as they go through life. I am also glad that I have found your website.

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    2. Thanks for your post. It is good to hear of another person like me. I had a cath last week and my LAD was 100% blocked like yours. My two new collaterals took over as well. I had scored a zero=perfect on my Cardiac Calcium Score test 5 years ago and told I likely would never had a plaque issue in my arteries. So, this has been a shock. I will have to schedule bypass surgery this week due to another artery 80%, one 40% and I think they will leave the last 30% alone. We are lucky.

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    3. Did they put any stents during the time they found out complete blockage of your LAD? I wonder how the collaterals started when you had a cardiac arrest >

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    4. My right artery is blocked and my heart is proper work and no pain and no other problem my cardiologist said your heart natural bypass and your heart is ok

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  6. I was recently told by my primary care dr. that I had a heart attack, although I didn’t know it. I went to a heart specialist and after numerous tests he confirmed that I had a heart attack. I had a 100 percent blockage on my right side of my heart. He then told me that my heart did a double bypass on its own. I guess I was pretty lucky. I have quit smoking and started exercising and feel pretty good. Just thought I would share this with you.

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    1. Wow, that is a pretty amazing success story, John! Congrats on quitting smoking and starting to exercise – both very smart strategies for your future heart health! You are lucky, for sure – now don’t forget to put your hand on your chest and pat your hard-working heart every day while saying: “THANK YOU for helping me to survive what many do not!” Best of luck to you…

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  7. I have a family whose been suffering from bypass surgery, he had a blood clot after surgery and D’s found out he has a scar with dead tissues, he is in come right now with high creatinine, he’s under Renal replacement therapy for 24 hours, what could be his chances to stay alive, he also have a continuous seizure and cardiac arrest, what is the possible treatment to save him?

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    1. Hello Ads – I’m not a physician so of course cannot comment on your family member’s condition. I can tell you that studies suggest that renal replacement therapy is required for about 5% of all bypass patients. It’s very frightening to helplessly watch somebody so sick, but it sounds like he is getting good care. Nobody can accurately predict how he will do longterm with this very serious condition, but this study for example found that 75% of such patients have good functional quality of life afterwards. Best of luck to him and your family…

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    2. Hi I am 51, just learned after my angiogram that my heart did grow new arteries. The cardio surgeon said that there is enough oxygen going to the heart so no bypass is needed and I do have a 100% blocked artery in which the stent would not work. It is possible but not every person is that lucky.

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  9. This happened to my dad too. He, however, was not very physically active, and had been a smoker for years. We consider it an amazing blessing that his 100% blocked artery created its own bypass.

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  10. I’m not a female, but I came across this site. Here’s an interesting one. I am a 25 year old active and healthy male. I was recently diagnosed with AIVC, agenesis of the inferior vena cava. In other words, I was born without a IVC which is the huge vein that supplies blood to your heart. My body has created collateral passageways since my birth to bring blood back to my heart. Pretty insane. I am so glad our bodies are made to adapt to whatever nature throws at it! I still run 30+ miles a week, swim, and lift weights. Somehow I’m alive. 66 documented cases!

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    1. Wow, that IS a rare condition, AJD, and a great example of how amazingly well all parts of the human body are so often able to spring into action during a medical crisis to help save us. Best of luck to you for continued health and resilience…

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  11. My 82 year old Mother had a blockage to her stomach. She was admitted to the hospital with symptoms of fatigue, vomiting and diarrhea. I thought she was going to die. Doctors suggested bypass. The next morning I got a call that she was being released due to her collateral artery was now supplying blood to her stomach. Blew my mind. She is not a runner but she was a masseuse and has pretty strong hands. I always said she has 101 lives.

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  12. On May 16, 2016 I had a Cardio angiogram at Dartmouth, Lebanon, NH and the Doctors explained that I had a 100% blocked artery on the right side of my heart and I do not need bypass surgery or stents because I grew two large collateral arteries! I was amazed!

    Immediately I felt blessed (not lucky…there’s a difference) and went through a gamut of emotions. I thought, I have been rewarded for having been credited for saving two people’s lives on separate occasions (while seriously risking my own life) when I was about 20 years old and again when I was about 23 years old! Then, after some time to process such inexplicable news, I thought that for most of my life I was a positive person and I ran long distance competitively for over 20 years. My faith throughout my life kept me in prayer. My Mom always said, “Prayers work! ” 😀👍

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    1. Thanks so much for sharing your story, Maurice. Those collaterals are indeed fabulous, aren’t they? And while your bravery, positive attitude, and prayers couldn’t have hurt, the reality is that there are many equally brave, positive, religious people who do not survive what you did. My bet is that your decades of running provided you with terrific collaterals to begin with, as many studies have found (here and here, for example). Keep it up!

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    2. hi maurice great to hear of your blessing! in my case, its the phrase ‘ ”only the good die young” Ive been a bad boy for as long as i can remember, smoked since i was 13 years old (and still do at 54 yo ) ive been over weight since i was 8/9 yo? (and still am but have slowly lost weight over the passed 20 years but still up there! i had a heart attack 2 easters ago, blocked LAD 100% NO SYMTOMS until my main circumflex blocked but all i was experiencing was back pain, drove my self to hospital (nearly didnt go in because i couldnt find parking nearby and was feeling slightly better …) anyway as i started to drive home, a car pulled out across the road! …got in to the front desk was slightly out of breath and sweaty …ended up on the gurney a team was rushing around me whilst i was having the heart attack was wisked upstairs , 1 stent in the main, cant unblock the LAD but the collaterals had taken over (And probably for years! ) no damage to the heart! there s more to this story but it looks long winded already …. 2 years on no symptoms no stress , life is great!

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  13. I am 78 years old. currently very obese but on a low carb weight loss program that should get me back under 200 by next spring. I have not had angina or heart attack but because of abnormal stress EKG’s over past 7 years and a few episodes of mild chest discomfort (possibly acid reflux) my cardiologist decided to perform an angiogram. It revealed major stenosis in three coronary arteries; all over 75%, one at 95%. I am now seeing a surgeon to plan for triple bypass.

    However, because of a lack of symptoms, successful weight loss and ability to exercise moderately without any symptoms, we have decided to wait and review the situation monthly. My heart recovery rate after exercise is excellent. (I have not pushed rigorous exercise because of my weight, but as recent as two years ago, I could go an hour on the eliptical at a moderate 3 MPH) The surgeon also made note of the fact that for about 25 years I ran about 3-5 miles a day and completed two marathons. I have been reading about collateral blood supply. This may be at work in my case. We are still focused on bypass surgery but going slow as long as free of symptoms.

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    1. Al, I really admire what you are doing! I’m not a physician but I think the collaterals theory makes perfect sense (given you have no symptoms despite those blockages – the heart muscle must be getting its oxygenated blood supply from somewhere, and that ‘somewhere’ is typically via the collateral arteries. You can thank your strong athletic history for those. Good luck on your weight loss and exercise program – you can do this!

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  14. Congratulation to all with their collaterals. I had stenosis in four of the arteries of the heart. LAD, RCA, 1 other 100%,and the other 90%. Ejection fraction went to 45. I am not an active person, so my praises have to go to God my maker. Cardiac bypass was the only option. EF now 65-70, B/P couldn’t be better. Thanking God for growing those collaterals with adequate functions. Was told that I should have had a massive heart attack, but God’s mercy I am here.

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  15. I had chest pain come on after a severe sneezing ‘attack’ and could not walk more then a few yards without pain and felt sick continually apart from when eating a meal with wine. Which amazingly took away the sickness & pain.

    After various tests showing no heart damage but mild aortic stenosis I decided to see if I could create a Collateral circulation.

    So I started on the rowing machine at the gym, first 5 mins and built up to 75 mins in about 4 months and slowly I found I could be almost pain free in my usual work and daily living.

    When it first came on, I could only walk about 20 feet without pain, today I walk over 500 yards. I am 71 years old [male] and am feeling really fit and well, plus I find after the session I feel a sense of euphoria for two to three days.

    Norman

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    1. What a great story, Norman! Thanks for sharing this. Chest pain after a “sneezing” attack reminds me of something else: Did your doctors consider costochondritis (an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone)? We know that the chest pain of costochondritis can be caused by many things, including a severe continuous cough, for example, as a result of rapid expansion/contraction of the rib cage. Not to take away from your collateral experiment – which is a fantastic thing to do at any time – no matter what the reason!

      Keep up the good work!

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    2. Norman, thanks for sharing your story… Between you and Carolyn I have some ideas of how to help my 83-year old husband who had CABG last year and is not doing well…He is alive, but not living.!!!! It’s horrible… It was on pump and knew there would be a cascade of issues/serious problems… Saving this to my home page so I can follow up with you brave souls..!!!
      Fran Griffin

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  16. I just completed 40 EECP treatments (Enhanced External Counterpulsation therapy). I had debilitating angina and was unable to exercise. After these treatments, I can now power walk/run up to one hour with no chest discomfort. I have also been taken off three of my five antihypertensive medications from my BP decreasing dramatically from the treatments. I am a believer in EECP!!!

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  17. Another way of growing collateral arteries for people who have too much angina to be able to physically exercise is go through EECP therapy, a non invasive use of cuffs on the legs and buttocks which synchronously squeeze/push the blood back into the heart during its relaxation phase, thus providing more blood to the heart wall and helps to open the small collateral arteries. You can see the improvement on subsequent catheterizations. Many patients get enough relief of angina that they can return to exercise.

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  18. What a truly magical concept this is. Like white blood cells and platelets springing into action when a finger is cut, our bodies are indeed miraculous self-healing machines. Trouble is, not every patient will be as lucky as your U.K. example here, particularly if they are not physically active. This is a compelling reason for increasing our physical fitness – the more we can strengthen our muscles and thus help to build up those ‘collaterals’, the better.

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  19. My cardiologist told me that this is likely what has happened to me, my blockage did not require treatment because of these collaterals. Thank you for helping to inform people of amazing phenomenon.

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  20. Fascinating.

    The human body is endlessly mysterious, isn’t it?

    Thank you for this interesting information, and also for being such a valuable resource for women’s heart health. I have subscribed to receive all of your future updates.

    Thanks again.
    Mika in Tokyo

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    1. My heart grew its own bypass as well…I still smoke and am not physically active just very fortunate indeed.
      very sincerely Daniel Jones

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