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  1. #1
    Senior Member miamijim's Avatar
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    Assuming most here are familiar with bypass surgery and its technique and most are familiar with cardiac catheterization and its techniqes i have this pic to share.

    First a little history. This patient had coronary artery bypass grafting (CABG) in the past. Veins from the leg were used to 'bypass' blocked arteries in the patients heart. Just as native coronary arteries can develop blockage veins and arteries used to do the bypasses can develop blockages as well. If these veins and arteries develop blockages the same techniques are used in the cathlab to open them up, ballon angioplasty and stenting, as are used on native coronary arteries. The patient in question was in the cathlab to have a vein graft opened up. A stent was placed to open it. When the guide wire was being removed it became stuck to the stent. The cardiologist pulled and the wire snapped. Several attempts were made at retrieval of the wire but all were un-successful.

    Eventually the patient was brought into surgery. The picture below is the vein graft opened up. Easily visible is the mesh stent and broken catheter wire.[IMG]http://[/IMG] [IMG]
    WWW.CYCLESPEUGEOT.COM 2005 Pinarello Dogma; 1991 Paramount PDG 70 Mtb; 1976? AD Vent Noir; 1989 LeMond Maillot Juane F&F; 1993? Basso GAP F&F; 1989 Terry Symmetry; 2003 Trek 4700 Mtb; 1983 Vitus 979

  2. #2
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    not gross?

  3. #3
    Lets Ride Trekke's Avatar
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    Why
    Phil

  4. #4
    Roadie otoman's Avatar
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    Let's just hope that a gastroenterologist or a colorectal surgeon don't decide to share their pictures of what they have taken out of people...
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  5. #5
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    Quote Originally Posted by otoman
    Let's just hope that a gastroenterologist or a colorectal surgeon don't decide to share their pictures of what they have taken out of people...

    I think photos of such nature would be very interesting.


    And thank, thank you for submitting that photo, it is interesting...very interesting.

    Did you know that an individual who undergoes a colonoscopy (sp) has a risk of kidney failure? I learned that from a lawyer. You probably guessed as much.

    This picture is making me think of changing careers. I should become a surgeon instead of a boring Commercial Loan Analyst. Yea, that's it Wait, there is the insurance issues to consider.


    Hummm.

  6. #6
    cab horn
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    Could someone explain what we're looking at. It looks like dog hair stuck in a piece of half cooked bacon.

  7. #7
    Faith-Vigilance-Service Patriot's Avatar
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    Looks like that chunk of Rawhide bone my German Shepherd Dog barfed up on the kitchen floor.
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  8. #8
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    For those not used to seeing gross specimens, the full resolution version of that is magnified lots and lots of times. A bypass graft is perhaps around a centimeter in diameter.

  9. #9
    Flatman RoadToad's Avatar
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    Quote Originally Posted by Patriot
    Looks like that chunk of Rawhide bone my German Shepherd Dog barfed up on the kitchen floor.
    HA HA HA

    RT
    BRING THE HEAT

  10. #10
    Fight the good fight
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    How did you get a neat picture like that?

  11. #11
    Senior Member miamijim's Avatar
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    I work as cardiovascular perfusionist. My primary job is to operate the heartlung machine during open heart surgery. I was asked to take a picture of the specimen by the srugeon. That particular picture is not magnified. I cropped down the original 5.1 megapixel picture to meet the forum size requirements. An actual vein bypas graft is closer to 5mm in diameter or about the size of a standard #2 pencil with an inner lumen diameter of 2mm for arterial grafts and a touch more for veins.
    WWW.CYCLESPEUGEOT.COM 2005 Pinarello Dogma; 1991 Paramount PDG 70 Mtb; 1976? AD Vent Noir; 1989 LeMond Maillot Juane F&F; 1993? Basso GAP F&F; 1989 Terry Symmetry; 2003 Trek 4700 Mtb; 1983 Vitus 979

  12. #12
    Fight the good fight
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    What a cool job. You get to witness some incredible skills - the dexterity required for such a job is remarkable. Do you worry that modern technology will replace you. I'm referring to those machines that are capable of actually performing the surgery -or does the surgeon only need worry about that?

    I certainly hope nobody attempts to make a robot that will replace the dentist! Not that I like dentist that much but...a robotic dentist...

  13. #13
    Senior Member miamijim's Avatar
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    Be Ready, thanks for the kind words. Currently there is no machine that can do open heart surgery on its own. Robotic assist surgery exists but a surgeon directs the robotic arms. Robotic surgery is more of catch phrase for marketing people, "we do robotic surgery at XYZ hospital." consider this, I have never heard of a person of prominance that was operated on without a heartlung machine being used. 'Off pump' surgery may be touted as being better (in some instances its better) but have a patient ask why President Clinton was done 'on pump' and listen to the answer.!!! As invasive cardiology technologies advance more patients that would have previously needed open heart surgery are able to avoid it. The number of individuals in our country that are of the age where heart disease is prevelant is rapidly increasing. Estimates are the operative population will double in the next 10-20 years. If 50% of all potential patients are taken care of in the cath lab that still leaves us with the same number of patients needing surgery. We see fewer 'straight' coronary cases each year but see an increasing number of coronary/valve and valve only cases. Am I worried about my job being phased out? NO!!!!!

    Jim
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  14. #14
    Senior Member Bontrager's Avatar
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    Nice stent. The sad thing is that the doc in the cath lab and the manufacturer of the stent is probably gonna get sued by the patient if they haven't already. And guess who's gonna be on the plaintiff's stand - you got it - the surgeon!

    U still a tech, Jim? I'm assuming you harvested the GSV...
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  15. #15
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    I bet the patient was asked to sign a waiver of his right to sue!

    I think you are right, perhaps the stent could have been sturdier, maybe even pliable. We don't want it breaking -they could've used one of my bobby pins!

    Seriously now. During times like this, I am definetly for cloning. How about you? How do you feel about cloning?
    Last edited by Be Ready; 02-15-05 at 10:04 AM.

  16. #16
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    Quote Originally Posted by Sessamoid
    For those not used to seeing gross specimens, the full resolution version of that is magnified lots and lots of times. A bypass graft is perhaps around a centimeter in diameter.
    xxx cool!

    You know, if that had been left in...as in gone un-noticed, it would have made the patient very uncomfortable.

  17. #17
    Senior Member Bontrager's Avatar
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    Quote Originally Posted by Be Ready
    You know, if that had been left in...as in gone un-noticed, it would have made the patient very uncomfortable.
    They most likely wouldn't have felt it as-is. Any rare occurences of nerves on the vessel would have been severed when they harvested the graft.

    Wait a minute.. this is a bike forum.. wtf?
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  18. #18
    Senior Member Bontrager's Avatar
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    Quote Originally Posted by Be Ready
    I bet the patient was asked to sign a waiver of his right to sue!
    I know surgeons that have had legal issues even though the patient signed a consent form that implies no guarantees and lists some of the potential risks of surgery including death.

    I'm not sure if in the U.S. you can sign away your right to due process. I know I did when I had my house built (signed not to sue the builder) but I highly doubt I can't sue if all the roofs cave in on my street.
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  19. #19
    Senior Member Ebbtide's Avatar
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    Thanks for the lesson. Sounds like a bit of a scare for the patient/family. My mother went into ful arrest at home last April. My father and EMS performed CPR and it actually worked. Since then mother is doing well all things considered. The technology and treatment of heart disease has come such a long way in recent years its amazing. Keep up the good work!

  20. #20
    Senior Member Bontrager's Avatar
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    Quote Originally Posted by Ebbtide
    The technology ... of heart disease has come such a long way in recent years its amazing.
    What's more amazing is that humans haven't changed except for our crappy diets
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  21. #21
    Senior Member Ebbtide's Avatar
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    Quote Originally Posted by Bontrager
    What's more amazing is that humans haven't changed except for our crappy diets

    After watching a loved one go down, literally, I have since quit smoking (a 20 year habit) and follow a low fat diet with an very active lifestyle. OT, but my brothers and sisters seem to think both parents, grandparents, and great parents having heart attacks were a coincident. I'm not taking any chances and will end up burying them all.

  22. #22
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    I know what you mean Ebbtide. I have a husband 6'3" 297 lbs. Last week, the DR. told him his Triglicerides were very high. So high, that upon his revisit in 6 months, if it they don't come down, he is going to put him on meds.

    But, my husband is not taking this seriously! He is now drinking more alcohol instead of focusing on a positive diet and consistent exercise. I don't know what to do.

    I did get him a Trek 3500 because he likes to bike. I feel helpless though. Oh, I also signed him up for the Meditterrainian Diet -

  23. #23
    Senior Member miamijim's Avatar
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    Quote Originally Posted by Bontrager
    Nice stent. The sad thing is that the doc in the cath lab and the manufacturer of the stent is probably gonna get sued by the patient if they haven't already. And guess who's gonna be on the plaintiff's stand - you got it - the surgeon!

    U still a tech, Jim? I'm assuming you harvested the GSV...
    Actually in the U.S. perfusionists, my profession, arent techs. We are an allied health profession and i consider myself to be a medical specialist versus a tech who may only have a certificate or a 2-year degree. In the U.S perfusionists dont harvest SVG's. (with a few exceptions)

    The patient in question had a previous open heart operation, thats why there was a SVG to stent. I dont beleive thers any legal recourse for the patient, as it should be.

    Be Ready, I've been trying to get another cool picture. If I do you can show it to your husband. Everyone knows oil floats on water. Well, it floats on blood as well. Occasionaly we have a ptients whos blood has oils floating on top. Its crazy to see. The surgeons gloves get a nice oily sheen to them.
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  24. #24
    By-Tor...or the Snow Dog? hi565's Avatar
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    Quote Originally Posted by hair07
    not gross?
    That was exactley what i was thinking!
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