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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
09:04

Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg

Published on: November 19, 2019

Percutaneous intervention of acutely occluded saphenous vein grafts: contemporary techniques and outcomes

Abdul-Rahman R Abdel-Karim1, Subhash Banerjee, Emmanouil S Brilakis

  • 1Veterans Affairs North Texas Healthcare System, Dallas, Texas 75216, USA.

The Journal of Invasive Cardiology
|June 3, 2010
PubMed

Insights

Percutaneous coronary intervention (PCI) for acutely occluded saphenous vein grafts (SVGs) had an 81% success rate but high rates of stent thrombosis and recurrent events. Outcomes remain challenging despite contemporary PCI techniques for these critical interventions.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology

Background:

  • Percutaneous coronary intervention (PCI) for acutely thrombosed saphenous vein grafts (SVGs) historically has low success rates.
  • The impact of contemporary PCI techniques on outcomes for thrombosed SVGs is not well-established.

Purpose of the Study:

  • To evaluate the acute and long-term results of contemporary percutaneous coronary interventions (PCI) in patients with acutely occluded saphenous vein grafts (SVGs).

Main Methods:

  • A review of 34 patients undergoing PCI for 36 acutely occluded SVGs between 2003 and 2009.
  • Assessment of procedural success, adjunctive techniques used (thrombectomy, embolic protection, laser), stent implantation, and clinical outcomes including mortality, acute coronary syndrome, and repeat revascularization.

Main Results:

  • The procedural success rate for SVG PCI was 81%, with an additional 5% success after native coronary artery chronic total occlusion (CTO) PCI.
  • Adjunctive techniques included mechanical thrombectomy (69%), rheolytic thrombectomy (39%), and embolic protection devices (25%).
  • At 1 and 3 years, mortality was 8% and 42%, respectively; acute coronary syndrome occurred in 15% and 41%; and repeat revascularization was needed in 28% and 38%.

Conclusions:

  • Percutaneous coronary intervention (PCI) for thrombosed saphenous vein grafts (SVGs) demonstrated an 81% procedural success rate but was associated with a high incidence of stent thrombosis.
  • Patients with thrombosed SVGs remain at high risk for adverse cardiovascular events, including mortality and recurrent ischemia, even with contemporary techniques.
  • Successful revascularization of the target myocardial territory was achieved in 86% of cases, including successful native coronary artery CTO PCI after SVG PCI failure.
Abstract

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