Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Arterial Graft

arterial graft in русский (Россия)

Related Terms

  • Blood Vessel Graft
  • Bypass Grafting
  • Coronary Artery Bypass Graft (CABG)
  • Revascularization

Specialists

  • Thoracic Surgeon
  • Vascular Surgeon

Comorbid Conditions

  • Cerebrovascular disease
  • Coronary artery disease
  • Diabetes mellitus
  • Peripheral vascular disease
  • Renal disease

Factors Influencing Duration

Duration depends on the underlying condition and the site and type of graft (bypass, patch, replacement). Length of disability may be affected by complications (e.g., postperfusion pump syndrome, infection, graft problems, pulmonary embolism), continued ischemia in the limb, or amputation. Age and the presence of chronic disease (e.g., diabetes, coronary artery disease, atherosclerosis) or other medical conditions also will have an impact on length of disability.

Medical Codes

ICD-9-CM:
39.56 - Repair of Blood Vessel with Tissue Patch Graft
39.57 - Repair of Blood Vessel with Synthetic Patch Graft
39.58 - Repair of Blood Vessel with Unspecified Type of Patch Graft

Overview

© Reed Group
Arterial grafting is a surgical procedure performed to repair a blocked or damaged artery. Graft material may be veins or arteries from the individual's own vascular system (autograft), blood vessels removed from cadavers, or prosthetic material (polyester or polytetrafluoroethylene). Arterial grafting procedures are most commonly performed on the arteries of the heart (coronary arterial bypass graft, or CABG), legs, kidneys, and intestines, or on the abdominal aorta.

Arterial diseases caused by atherosclerosis, such as coronary artery disease (CAD), peripheral vascular disease, and aortic aneurysm, are conditions that commonly require this procedure.

Atherosclerosis is a complex, progressive disease in which medium-size and large arteries gradually become narrowed and may eventually be blocked due to accumulation of fatty deposits in the artery walls (atherosclerotic plaques). Vascular injury is believed to start the process, beginning with endothelial cell injury in the inner lining (endothelium) of artery walls, followed by vascular inflammation, and finally the accumulation of lipids, cholesterol, calcium, and cellular debris (plaque) in the inner layer of the damaged arteries. The original endothelial damage is caused by oxidation of "bad" cholesterol (low-density lipoprotein or LDL cholesterol), infectious agents, toxins (including those from smoking tobacco), consistently elevated blood glucose (hyperglycemia), and elevated levels of a biochemical (homocysteine) known to contribute to atherosclerosis (hyperhomocysteinemia).

Ultimately, diminished blood flow and oxygen delivery to the tissue supplied by the blocked artery result in organ-specific symptoms such as pain caused by lack of oxygen (ischemia). The rupture of plaque causes more acute events; for example, obstruction of cardiac vessels may result in heart attack (myocardial infarction), an obstructed carotid artery may result in stroke, and the abdominal aorta blocked by plaque may develop an aneurysm (a weak spot where the blood vessel balloons out) that can rupture and result in hemorrhage and death. Atherosclerosis of the arteries of the legs (iliac, superficial femoral, tibial) is known as peripheral vascular disease. Atherosclerosis may also occur in arteries of the intestinal tract and kidneys.

Individuals with atherosclerosis who have localized obstructions that cause ischemia and increase the individual's risk of experiencing life-threatening acute events may need to have the obstruction removed surgically (endarterectomy) and/or bypassed with another blood vessel (bypass surgery, coronary artery bypass grafting or CABG) to open the artery and restore the flow of blood and oxygen.

Source: Medical Disability Advisor



Reason for Procedure

This procedure is performed to repair blocked or damaged arteries, restore adequate blood flow and the delivery of oxygen to organ tissue, and relieve pain. Arterial disease due to atherosclerosis, such as coronary artery disease or peripheral vascular disease, is a common reason for performing this surgery; surgery is a solution when medical management of atherosclerosis has failed to maintain the patency of affected vessels. Arterial grafting reduces the complications of atherosclerosis and reduces the risk of death from life-threatening vascular events such as heart attack, stroke, or ruptured aneurysm.

Arterial grafting is also done to repair weakened sections of arteries (aneurysms) and to prevent rupture of the aneurysm. An aortic aneurysm is likely to be life-threatening if it ruptures. Grafting is often done to repair this type of aneurysm prior to rupture and, in some cases that are diagnosed early, immediately after rupture.

Arteries severely damaged by trauma may also be repaired with grafting.

Source: Medical Disability Advisor



How Procedure is Performed

Arterial bypass grafting is performed by a vascular surgeon in the operating room. General anesthesia is used more often than spinal (epidural) anesthesia. The location of the incision depends on the location of the diseased artery. Arterial grafting in the legs may be performed through incisions in the groin area or in the legs, abdominal aortic aneurysm is repaired through an abdominal incision, and coronary arteries are repaired through a chest (thoracic) incision. The arteries or veins that are grafted (also called “conduits”) to replace the diseased portion of an artery are determined by the specific artery receiving the graft. In coronary artery autografting, the internal thoracic artery (internal mammary artery) in the chest may be used. The large saphenous vein from the leg may be used in a peripheral artery graft or a coronary artery graft, and the radial artery from the forearm is another possible conduit. Cadaver blood vessels or synthetic vessels may also be used. During the surgery, x-rays using contrast medium (arteriograms) help visualize blood flow through the artery being repaired. Surgery may take several hours, depending on the severity of the disease and the difficulty of repair. The hospital stay may be about 4 days if there are no complications.

Coronary artery bypass surgery is a common type of arterial graft surgery. In coronary artery bypass grafting (CABG), the surgeon re-routes the blood flow through a “new” section of grafted blood vessel to bypass the blocked section of coronary artery. In most cases, the individual's own internal thoracic artery is used for the graft, although a vein in the leg (saphenous vein) may also be used. Studies have shown that the internal thoracic artery stays open (patent) substantially longer than the saphenous vein (Morrow 1382). The individual is not harmed by the diversion of the flow of these blood vessels, because other blood vessels can supply blood to areas ordinarily supplied by the graft vessels. Prosthetic material can successfully be used to repair large arteries, but natural blood vessels are better suited for repair of small arteries.

In preparation for coronary artery bypass surgery, the chest is opened, and the individual may be put on a heart-lung machine that takes over the blood circulation and oxygenation functions of the heart and lungs (cardiopulmonary bypass). This allows the individual to survive while the heart stops beating so that the surgeon can operate on the heart while it is still.

Some coronary artery bypass surgery is now being done “off pump”, meaning the heart-lung machine is not used, and the individual’s heart keeps beating and keeps pumping blood to the organs. This can be done for certain patients who are at increased risk for complications from cardiopulmonary bypass, such as those who have heavy aortic calcification, carotid artery stenosis, prior stroke, or compromised pulmonary or renal function. Not all patients are a candidate. The selection of patients who undergo off-pump surgery is made at the time of surgery.

The coronary artery is cut below the blocked area, and the downstream (distal) end of the internal thoracic artery or harvested vein graft is sewn to the coronary artery with a stitch (suture) finer than a human hair. If the internal thoracic artery is used, its origin remains intact; the artery is dissected away from the chest wall and moved to supply the blocked coronary artery. If necessary, a side cut (incision) is made in the graft, and a sequential attachment (anastomosis) can be made to an additional section of the heart. For vein grafts, the graft is measured to provide enough length to reach the ascending aorta (the large artery leaving the heart and delivering blood to the body) when the heart is both contracting and expanding. The graft is cut to the appropriate length, and the upstream (proximal) end is connected to the aorta. Additional bypass grafts are performed as needed by following the same procedure.

In a peripheral artery bypass graft, the saphenous vein is left in place, the valves inside the vein are removed, and branches of the vein are tied off. Both ends of the vein are then attached (anastomosed) to the blocked artery on either side of the blockage. When the vein is diseased or otherwise unsuitable, synthetic material may be used for the bypass graft. When the radial artery from the forearm is used, a section of the artery is dissected, blood in the arm is rerouted, and the graft is sutured into place to replace the diseased portion of artery in the leg.

Source: Medical Disability Advisor



Prognosis

Arterial grafting procedures improve blood flow and oxygen delivery to organs and limbs, usually relieving pain and preventing tissue death. Five years after arterial grafting, 83% of saphenous vein grafts and 88% of internal thoracic artery grafts were still patent, allowing blood to flow through them. After 10 years, the rates were 41% and 74%, respectively (Morrow 1382). However, if the underlying atherosclerosis is not managed medically with appropriate drug therapy and the risk is not modified with lifestyle changes, the arteries treated with grafting may become diseased and blocked again within months or years following surgery.

Source: Medical Disability Advisor



Complications

Postperfusion syndrome is a hopefully transient neurocognitive defect that can occur after cardiopulmonary bypass using the heart-lung machine. Also associated with CABG surgery are heart attack, stroke due to embolism, pulmonary embolism, or graft failure. Sometimes the chest bone (sternum) does not heal completely after being split in two to allow the surgery (nonunion of sternum).

In the legs, surgical complications of arterial grafting procedures may include bleeding (hematoma), clot formation, infection, development of an abnormal pathway between two blood vessels (fistula), and dilation and bending of the artery that resembles an aneurysm (pseudoaneurysm). If the revascularization procedure is unsuccessful and ischemia is severe, amputation may be necessary.

Additional complications of abdominal aortic aneurysm repair include heart attack (myocardial infarction), kidney failure, decreased oxygen supply to the intestines (colonic or intestinal ischemia), respiratory problems, inadequate oxygen supply to the legs (limb ischemia), leg paralysis caused by decreased blood flow to the spinal cord, and stroke. Leakage around the graft may be assessed with digital subtraction arteriography. Long-term complications can also include development of a fistula or development of another aneurysm. Surgical repair of aortic aneurysm is associated with high morbidity and mortality risk (due to rupture); it is not usually performed when life expectancy is limited by disease or age (Pearce).

In coronary artery bypass grafting, in addition to many of the complications mentioned above, grafts may suddenly narrow or go into spasm, blocking blood flow. This effect may be prevented by the use of certain medications.

Within months or years, if lifestyle risk modification is not implemented to reduce or prevent atherosclerosis, arterial grafts may become diseased and blocked (no longer patent). Patency of peripheral artery grafts in the legs can be assessed with contrast-enhanced 3-dimensional magnetic resonance angiography (MRA).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work accommodations following arterial grafting depend on the type of surgery performed and the physical location of the damaged vessel or vessels. Restrictions and accommodations also depend on the presence of chronic disease such as diabetes, coronary atherosclerosis, and arterial disease in other locations. Many individuals who have had arterial bypass procedures are older and may require a longer recovery time as a result of their age and general health. Arterial bypass grafting may require several weeks for recovery. Recovery from arterial grafting to repair an abdominal aortic aneurysm generally takes several weeks to months, and recovery from coronary bypass surgery takes a minimum of 4 to 6 weeks, often longer. Following coronary artery bypass surgery, individuals are advised to avoid excessive use of the arms such as lifting and reaching upward or backward. These cautions may require modification of work responsibilities.

Source: Medical Disability Advisor



References

Cited

Morrow, David A., and Bernard J. Gersh. "Internal Mammary Artery Bypass Grafts." Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Eds. Peter Libby, et al. 8th ed. W.B. Saunders, 2007. 1353-1405. MD Consult. Elsevier, Inc. 5 Oct. 2009 <http://www.mdconsult.com>.

Pearce, William H. "Abdominal Aortic Aneurysm." eMedicine. Eds. Jeffrey Lawrence Kaufman, et al. 15 Dec. 2008. Medscape. 5 Oct. 2009 <http://emedicine.medscape.com/article/463354-overview>.

Rowe, Vincent Lopez. "Peripheral Arterial Occlusive Disease." eMedicine. Eds. William H. Pearce, et al. 8 Jul. 2009. Medscape. 5 Oct. 2009 <http://emedicine.medscape.com/article/460178-overview>.

Source: Medical Disability Advisor






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