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Total Endovascular Reconstruction of Occluded Saphenous Vein Grafts Using Coronary or Peripheral Wallstents
1Department of Invasiveive Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, United Kingdom.
Insights
Degeneration of saphenous vein grafts (SVG) is common, leading to occlusion. Self-expanding Wallstents show promise in treating SVG disease, offering a viable treatment option for patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Biomedical Engineering
Background:
- Saphenous vein graft (SVG) degeneration is a frequent complication after coronary artery bypass grafting, leading to stenosis and occlusion.
- Re-do bypass surgery and balloon angioplasty alone have limited long-term efficacy for SVG disease.
- Existing stents often have limitations in diameter and length for treating diffuse SVG disease.
Purpose of the Study:
- To evaluate the safety and efficacy of self-expanding Wallstents in managing totally occluded or severely obstructed saphenous vein grafts.
- To assess the clinical outcomes and complications associated with Wallstent deployment in SVG disease.
Main Methods:
- A retrospective review of 26 patients (mean age 64.9 years, 24 males) who underwent Wallstent deployment in SVG.
- Wallstents were deployed in grafts with total occlusion or severe diffuse disease.
- Patients were managed with a routine anti-coagulation protocol.
Main Results:
- Seven patients had total graft occlusion; all had severe diffuse graft body disease.
- The mean length of Wallstent used was 54.1 mm.
- There were 2 major initial adverse events and no in-hospital complications. At a mean follow-up of 18.8 months, 3 major late clinical events occurred.
Conclusions:
- Self-expanding Wallstents are a feasible option for managing degenerated saphenous vein grafts.
- Wallstent deployment in SVG disease demonstrated acceptable safety and efficacy in this patient cohort.
- Coronary or peripheral Wallstents should be considered for the management of patients with SVG degeneration.
Abstract:
Degeneration of saphenous vein grafts (SVG) resulting in severe stenosis and, ultimately, occlusion is common. Re-do bypass grafting is less successful than the original operation. Intervention with balloon angioplasty alone has poor long-term results, and although improved long-term benefit has been demonstrated with stenting, most stents are limited by their diameter and length. The self-expanding Wallstent has a number of properties that make it particularly suitable for this purpose. We reviewed 26 patients, mean age 64.9 years, 24 males, who had Wallstents deployed in totally occluded or severely obstructed SVG. Seven patients had total graft occlusion, all patients had severe diffuse graft body disease. The mean length of Wallstent used was 54.1 mm. Routine anti-coagulation protocol was used. There were 2 major initial adverse events and no further in-hospital complications. Mean follow-up was 18.8 months. A total of 3 major late clinical events were identified. We conclude that coronary or peripheral Wallstents should be considered for the management of these patients.