PERI-PROCEDURAL OUTCOME OF SAPHENOUS VEIN GRAFT INTERVENTION
Abstract
Background: Patients who develop recurrent myocardial ischemia after coronary artery bypass graft(CABG) surgery are often referred for percutaneous coronary intervention. The objective of this
study was to evaluate the clinical characteristics and peri-procedural outcomes in patients with prior
CABG referred for percutaneous coronary intervention (PCI) over a 3 year period. Methods: Data
were collected on patients who underwent coronary interventional procedures following CABG
surgery. We evaluated angiographic procedural success and immediate outcome among patients who
had undergone such procedures from Nov 2006 to Oct 2009 (n=113). Results: Patients in the 2006-
2009 cohort had mean age 58.2 years, more patients were male (109 vs 4) and were more likely to
have hypertension (57.5%), hyperlipidaemia (72.6%) and family history of ischemic heart disease
(IHD) (65.5%), but less likely to have smoking (42.5%). Acute closure of stent leading to procedural
failure was seen in 1 (0.9%) patient, sub-acute thrombosis of stent was seen in 1 (0.9%) patient,
dissection or perforation of target vessel was seen in 3 (2.7%) and 1 (0.9%) patients respectively.
Slow flow phenomenon was seen in 13 (11.5%) and post-procedural cardiac enzymes were raised in
6 (5.3%) patients. Conclusion: Success rates of saphenous vein graft (SVG) intervention and
survival rate have improved with time as a result of improvements in technique and greater use of
stents, filter devices and adjunctive medications.
Keywords: Percutaneous coronary intervention, saphenous vein graft, Ischemic heart disease, IHD
References
Bourassa MG, Enjalbert M, Campeau L, Lesperance J.
Progression of atherosclerosis in coronary arteries and bypass
grafts. Ten years later. Am J Cardiol 1984;53:102C-107C.
Johnson WD, Kayser KL, Pednaza PM: Angina pectoris and
coronary bypass surgery: Patterns of prevalence and recurrence
in 3105 consecutive patients followed upto 11 years. Am Heart J
;108:1190-7.
Savage MP, Douglas JS Jr, Fischman DL, Pepine CJ, King SB
rd, Werner JA, et al. Stent placement compared with balloon
angioplasty for obstructed coronary bypass grafts. N Engl J Med
;337:740 -7.
J Ayub Med Coll Abbottabad 2012;24(3-4)
http://www.ayubmed.edu.pk/JAMC/24-3/Tariq.pdf
Verghese M, Berger PB, Lennon RJ, Gersh BJ, Holmes DR, Jr.
Comparison of percutaneous interventions for unstable angina
pectoris with and without previous coronary artery bypass
grafting. Am J Cardiol 2000;86:931-7.
Laird-Meeter K, ten Katen HJ, Brower RW, van den Brand
MJ, Serruys PW, Haalebos MM, et al. Angina pectoris, 1 to 10
years after aortocoronary bypass surgery. Eur Heart J
;5:35-42.
Brower R, Laird-Meeter K, Serruys P, Meester G, Hugenholtz
PG. Long-term follow-up after coronary artery bypass graft
surgery: progression and regression of disease in native coronary
circulation and bypass grafts. Br Heart J 1983;50:42-7.
Campeau L, Lesperance J, Hermann J, Corbara F, Grondin CM,
Bourassa MG. Loss of improvement of angina between 1 and 7
years after aortocoronary bypass surgery: correlations with
changes in vein grafts and in coronary arteries. Circulation
;60:11-5.
Dorros G, Johnson WD, Tector AJ, Schmahl TM, Kalush SL,
Janke L. Percutaneous transluminal coronary angioplasty in
patients with prior coronary artery bypass grafting. J Thorac
Cardiovasc Surg 1984;87:17-26.
de Feyter PJ, van Suylen RJ, de Jaegere PP, Topol EJ, Serruys
PW. et al. Balloon angioplasty for the treatment of lesions in
saphenous vein bypass grafts. J Am Coll Cardiol
;21:1539-49.
Reul GJ, Cooley DA, Ott DA, Coelho A, Chapa L, Eterovic I.
Reoperation for recurrent coronary artery disease. Arch Surg
;14:1269-75.
Vouhe P, Grondin CM. Reoperation for coronary graft failure:
clinical and angiographic results in 43 patients. Ann Thorac Surg
;328-34.
Loop RD, Cosgrove DM, Kramer JR, Lytle BW, Taylor
PC, Golding LA, et al. Late and arteriographic results in 500
coronary artery reoperations. J Thorac Cardiovasc Surg
;675-85.
Krause AH, Page US, Bigelow JC, Okies JE, Dunlap SF.
Reoperation in symptomatic patients after direct coronary artery
revascularization. J Thorac Cardiovasc Surg 1978;75:499-504.
Lytle BW, Loop FD, Cosgrove DM, Taylor PC, Goormastic
M, Peper W, et al. Fifteen hundred coronary reoperation: results
and determinants of early and late survival. J Thorac Cardiovasc
Surg. 1987 Jun;93:847-59.
Laird-Meeter K, van Domburg R, van den Brand M, Lubsen J,
Bos E, Hugenholtz PG. Incidence, risk and outcome of
reintervention after aortocoronary bypass surgery. Br Heart J
;57:427-35.
Kalan JM, Roberts WC. Morphologic changes in saphenous
veins used as coronary arterial bypass conduits for longer than
one year: necropsy analysis of 53 patients, 123 saphenous veins
and 1865 five millimeter segments of veins. Am Heart J
;119:1164-84.
Bourassa MG. The national history of saphenous vein bypass
graft disease. In: Bates ER, Holmes DR, Eds. Saphenous Vein
Bypass Graft Disease. New York, NY: Marcel Dekker; 1998.p.
-76.
Nwasokwa ON. SsCoronary artery bypass graft disease. Ann
Intern Med 1995;123:528-45.
Lawrie GM, Lie JT, Movis GC, Beagley HC. Vein graft patency
and intimal proliferative after aortocoronary bypass: early and
long-term angiopathologic correlations. Am J Cardiol
;38:856-62.
White CJ, Ramee SR, Collins TJ, Mesa JE, Jain A. Percutaneous
angioscopy of saphenous vein coronary bypass grafts. J Am Coll
Cardiol 1993;21:1181-5.
Meester B J, Samson M, Suryapranata et al. Long-term followup after attemted angioplasty of saphenous vein grafts: the
Thoraxcenter experience 1981-88. Eur Heart J 1991;12:648-53.
Stone GW; Reifart NJ; Moussa I, Hoye A, Cox DA, Colombo
A, et al Percutaneous recanalization of chronically occluded
coronary arteries: a consensus document: part II. Circulation
;112:2530-7.
Roffi M; Mukherjee D; Chew DP, Bhatt DL, Cho L, Robbins
MA, et al. Lack of benefit from intravenous platelet glycoprotein
IIb/IIIa receptor inhibition as adjunctive treatment for
percutaneous interventions of aortocoronary bypass grafts: a
pooled analysis of five randomized clinical trials. Circulation
;106:3063-7.
Sharma S. Current Management Of Saphenous Vein Graft
Disease. Internet J Cardiol 2004;2:2 (internet edition)
Chen L; Theroux P; Lesperance J, Shabani F, Thibault B, De
Guise P. Angiographic features of vein grafts versus ungrafted
coronary arteries in patients with unstable angina and previous
bypass surgery. J Am Coll Cardiol 1996;28(6):1493-9.
Pinkerton CA, Slack JD, Orr CM, Vantassel JW, Smith ML.
Percutaneous transluminal angioplasty in patients with prior
myocardial revascularization surgery. Am J Cardiol
;61:15G-22.
Block PC, Cowley MJ, Kaltenbac h M, Kent KM, Simpson J.
Percutaneous angioplasty of stenoses of bypass grafts or of
bypass graft anastomotic sites. Am J Cardiol 1984;53:666-8.
Dorros G, Johnson WD, Tector AJ, Schmahl TM, Kalush SL,
Janke L. Percutaneous transluminal coronary angioplasty in
patients with prior coronary artery bypass grafting. J Thorac
Cardiovasc Surg 1984;87:17-26.
Douglas JS, Gruentzig AR, King SB, Hollman J, Ischinger
T, Meier B, et al. Percutaneous transluminal angioplasty in
patients with prior coronary artery bypass surgery. J Am Coll
Cardiol 1983;745-54.
El Gamal M, Bonnier H, Michels R, Heijman J, Stassen E.
Percutaneous transluminal angioplasty of stenosed aortocoronary
bypass grafts. Br Heart J 1984;52:617-20.
Cote G, Myler RK, Stertzer SH, Clark DA, Fishman-Rosen
J, Murphy M, et al. Percutaneous transluminal angioplasty of
stenotic coronary artery bypass grafts: 5 year's experience. J Am
Coll Cardiol 1987;9:8-17.
Corbelli J, Franco I, Hollman J, Simpfendorfer C, Galan K.
Percutaneous transluminal angioplastyafter previous coronary
artery bypass surgery. Am J Cardiol 1985;56:398-403.
Ernst SM, Vander Feltz TA, Ascoop CA, Bal ET, Vermeulen
FE, Knaepen PJ, et al. Percutaneous transluminal coronary
angioplasty in patients with prior coronary artery bypass grafting:
long-term results. J Thorac Cardiovasc Surg 1987;93:268-75.
Reeder GS, Bresnahan JF, Holmes DR, Mock MB, Orszulak
TA, Smith HC, et al. Angioplasty for aortocoronary bypass graft
stenosis Mayo Clin Proc 1986;61:14-9.
Cooper I, Ineson N, Demirtas E, Coltart J, Jenkins S, WebbPeploe M. Role of angioplasty in patients with previous coronary
artery bypass surgery. Cathet Cardiovasc Diagn 1989;16:81-6.
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