Platko WP Hollman J Whitlow PL Franco I Reference

J Am Coll Cardiol 1989; 14: 1645-1650 Abstract

Percutaneous transluminal angioplasty was used to treat 101 patients with saphenous vein bypass graft stenosis at a mean of 50.1 months (range 2 to 196) after coronary artery bypass surgery. The patients presented between March 1981 and April 1987. A total of 107 saphenous vein grafts were dilated at 117 sites. The primary success rate was 91.8%. The incidence of cardiac complications was 7.1%. There were no cardiac complications in 53 patients with grafts implanted less than 36 months before angioplasty (Group 1). The 48 patients with grafts implanted for greater than 36 months (Group 2) had a 12.5% incidence rate of myocardial infarction, a 4% incidence rate of emergent bypass surgery and a 4% incidence rate of death for an overall cardiac complication rate of 14.9% (p less than 0.01). Follow-up was obtained at a mean of 16.8 ± 13.9 months (range 1 to 54) in 87 patients (97% of successful cases). Repeat coronary angiography was performed in 49 patients and revealed restenosis in 30 patients (61.2%), with no difference in recurrence rates for proximal, mid or distal graft sites. Clinical recurrence (defined as recurrence of symptoms, myocardial infarction, repeat angioplasty, surgery or death) was 33.1% for Group 1 patients and 64.1% for Group 2 patients (p less than 0.01).

Summary

The complication and recurrence rates of saphenous vein graft angioplasty are significantly higher when performed for late (>36 months) vein graft failure. All therapeutic options should be carefully examined before proceeding with angioplasty for saphenous vein graft stenosis in this type of patient.

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Key message

There is a 6% likelihood of myocardial infarction, 2% likelihood of emergency coronary bypass surgery, and a 2% mortality rate (associated with angioplasty of saphenous vein graft, SVGs)... All of these complications occurred after angioplasty on grafts implanted >36 months after the operation.

Why it's important

This work evaluated graft age and degeneration on the occurrence of procedural outcome after balloon angioplasty.

Strengths

This single-centre series was one of the first to describe the outcomes associated with SVG intervention.

Weaknesses

The major limitation of the study was the failure to characterize the angiographical appearances of the SVG in an effort to identify predictors of risk. The addition of distal protection devices and coronary stents have markedly improved procedural outcomes in these patients.

Relevance

SVG interventions remain a clinical challenge for the interventional. This study related the procedural outcome to SVG age, suggesting that older SVGs were more friable and susceptible to complications. Over the years, the prognostic importance of the complications occurring during SVG intervention was further characterized [51-57]. Distal embolization was later associated with substantial morbidity and mortality [58]. A number of distal protection devices have been designed to reduce these complications and have now become integrated in contemporary interventional practice.

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