INTERESTING FACTS: HEART SURGERY & ANGIOPLASTY
How many angiographies are possible?
Sometime back a very interesting patient visited me. He is a heart patient for the past 12 years. One bypass surgery and four angioplasties have been performed on him. He was still on about 10 types of medicines. He proudly explained that altogether he has been catheterized (angiographied inclusive of angioplasties) seventeen times! All ‘because they were necessary for his health.’ Three of these angioplasties have been performed in a Delhi hospital over the years. Proud enough!
Eight months in a hospital after Angioplasty.
Another of my patient from Assam visited me with a sad story. During his angiography, which was followed by an angioplasty the catheter went through the wall of the femoral artery (thigh artery), instead of the lumen. This not only damaged the artery but also developed an infection in the thigh. As a result, a bypass graft had to be done in the thigh artery-as the original artery sloughed off to prevent an amputation of the leg. The patient had to stay in a Delhi hospital for the next 8 months. Only consolation was that the hospital sponsored the whole cost for these eight months.
Cardiac Screening fooling people by another name
Knowing that people fear getting Angiographies, one hospital, few months back thought of a new idea. They named it “Cardiac Screening” where the angiography would be done through the hand artery-instead of the thigh. The difference was that the catheter would be introduced to the heart artery by a different route which was narrower (obviously this meant more chances of damaging the inner wall). Newspapers also flashed this as a new method to know the blockages without Angiography. Hundreds of common people fall prey.
Bypass Surgery in Canada-following Angiography
The other day one of my patient’s son called me on phone from Canada. His friend had just got an Angiogram and he wanted me to talk to him. He was very impressed by the SAAOL camp and wanted to help his friend. After hearing his blockage percentages I warned him that he might be advised for an immediate surgery and that he should not rush for it. Instead I asked him to follow SAAOL. Prompt came the reply “Doctor, they have put me in the waiting list for Bypass Surgery and my turn is expected after 1 year”
If this is the dictum in an advanced country like Canada — why are the surgeons in so much of hurry? To save the patient (from what?) or to help them!
Angioplasty was supposed to replace Bypass Surgery
In the early nineties when coronary angioplasty came into existence, it was claimed that it would replace bypass surgery. But the fact is that both these techniques grew in number rapidly. Neither of them reducing the frequency of the other. Similarly, all the newer angioplasties did not replace the older ones. In fact the numbers kept increasing. Lancet, the most prestigious medical journal of the world observed in 1992 “Evident over the past decade is the ever lowering threshold for carrying out bypass as well as Angioplasty… even asymptomatic patients are not exempt”.
Multi-vessel Angioplasty
One advantage, which Angioplasty has over bypass, is that the body doesn’t need to be cut badly in the middle. The major disadvantage is that the rate of reblockage is 10 times faster. Previously angioplasty was being done only in those who had one blockage. But recently even for two-three blockages (multi vessel blockages) also angioplasties are being done, giving the bypass surgeon a tough competition. Multi vessel angioplasty is far worse than single vessel angioplasty, as the chances of reblockage are very high.
Customer oriented price of Bypass and Angioplasty
Bypass Surgery costs Rs. 70,000 to Rs. 6 Lacs in different parts of India. For Angioplasty the cost varies from Rs. 60,000 to 4 Lacs. For the repeat operations the costs are even higher. Some hospitals charge more for preponing the surgery. These are tremendous possibilities of bargaining also. Even a good political connection will help. Few hospitals offer angiographies for Rs. 2500 also. While the hospital charges Rs. 50,000 for a stent, knowing someone in the stent making company the same stent would cost Rs. 15000. It has more business value. But where is the service to the patient?
Why don’t we stop plain ballooning?
When a new expensive stent needs to be placed after angioplasty/ballooning — why the simple procedure was not stopped? Once the stent is also to be upgraded, why the older stents are not discarded? Well, all of them spin money. 1 lac or 2 lacs — both are ok!
Hope you liked this blog
This article is written by Dr. Bimal Chhajer (Best Heart Doctor)
