[Reconstruction of saphenous vein grafts using Wallstent endoprostheses. Immediate and mid-term results]

Balloon angioplasty of degenerated saphenous vein grafts is associated with a high incidence of restenosis and of cardiac events in the medium and long term. Implantation of stents has reduced the incidence of these complications in patients with focal lesions. The authors report the short and medium term clinical results of saphenous vein grafts reconstruction in cases of diffuse graft disease with Wallstent endoprostheses in a series of 73 patients. All were pretreated with aspirin, ticlopidine and enoxaparine started 72 hours before the procedure and 15 also received c7E3Fab during angioplasty. One hundred and twenty stents were implanted in 90 saphenous vein grafts. There were 5 deaths (6.9%), 2 of which were cardiac, during the hospital period. One patient (1.4%) underwent secondary coronary bypass surgery. Eight patients (11%) suffered distal embolisation resulting in non-Q wave infarction. Clinical follow-up for an average of 13 months (3-26 months) was obtained in 91% of patients. Five (8.1%) died, three of cardiac causes, and one patient (1.7%) suffered a non-lethal myocardial infarction. A repeat revascularisation procedure of the culprit lesion was performed in 9 patients (15.8%). Angioplasty of other lesions was carried out in 7 patients (12.3%). Reconstruction of venous bypass grafts with diffuse lesions by implantation of Wallstent endoprostheses associated with preventive antiaggregant and anticoagulant therapy is associated with a risk of immediate complications. The medium-term results indicate high morbidity and cardiac mortality rates.