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Saphenous vein bypass grafts: Long-term patency and effect on the native coronary circulation
Insights
Saphenous vein bypass grafts demonstrate excellent long-term patency, remaining durable for at least 2-3 years. Their presence does not accelerate coronary artery disease progression in native arteries.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Background:
- Long-term outcomes of saphenous vein bypass grafts (SVG) are not fully understood.
- The impact of SVG on the progression of intrinsic coronary artery disease (CAD) requires further investigation.
Purpose of the Study:
- To evaluate the long-term durability of SVG.
- To assess the effect of SVG on the progression of native coronary artery disease.
Main Methods:
- Sequential coronary arteriography in patients with previously documented patent SVG.
- Follow-up studies performed 15-36 months postoperatively.
Main Results:
- 27 out of 29 grafts remained unchanged, with one showing minimal irregularities and one occlusion at follow-up.
- Progression of CAD proximal to a patent graft occurred in 24% of vessels with severe lesions.
- Disease progression distal to the graft anastomosis was uncommon (20% in ungrafted vessels).
Conclusions:
- Patent SVG at 3 months demonstrate sustained patency for 2-3 years.
- SVG implantation does not accelerate the progression of native coronary artery disease.
- SVG are a durable revascularization option with a stable long-term outlook.
Abstract:
The long-term durability of saphenous vein bypass grafts and their effect on existing intrinsic coronary artery disease remain ill defined. Therefore, sequential catheterization studies were performed in patients selected for study solely on the basis of documentation of a patent graft at an earlier study performed three to nine months postoperatively; at that time 29 patent grafts were demonstrated in 20 patients. Fifteen to 36 months postoperatively (average 22 months), 27 grafts were unchanged, 1 manifested minimal luminal irregularities and 1 was occluded. In one additional patient, studied 4 months and 4 1/2 years postoperatively, the graft was widely patent and had good distal runoff at the second study. Sequential coronary arteriograms revealed that progression of disease to complete occlusion occurred in 24 percent of vessels with severe lesions proximal to a patent graft, whereas progression of disease distal to a graft anastomosis was uncommon. Of 25 vessels not receiving grafts, disease progressed in 5 (20 percent). Grafts that are patent 3 months after operation appear to remain patent for at least 2 to 3 years, and their presence does not unduly accelerate the disease process involving the native coronary arteries.