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[Reopening of long-segment occluded aortocoronary venous bypasses. Short- and long-term results]
H Sievert1, K P Köhler, M Kaltenbach
1Abteilung für Kardiologie, Klinikum der Universität Frankfurt/Main.
Insights
This study shows successful recanalization of occluded aortocoronary vein bypasses using a modified catheter and urokinase infusion. Repeat angiography confirmed vessel patency in most patients, suggesting this procedure is viable for recent occlusions.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Occluded aortocoronary vein bypasses can lead to graft failure.
- Limited options exist for managing these occluded bypasses.
Purpose of the Study:
- To evaluate the efficacy of recanalization for occluded aortocoronary vein bypasses.
- To determine the long-term patency rates after recanalization.
Main Methods:
- Recanalization of occluded bypasses using a modified catheter with urokinase infusion and balloon dilatation.
- Post-procedure medical management with nitrates, calcium antagonists, aspirin, and heparin.
- Follow-up coronary angiography to assess vessel patency.
Main Results:
- Successful recanalization in 6 out of 7 patients (85.7%).
- Vessel patency confirmed in 4 out of 6 bypasses (66.7%) at 3-6 months follow-up.
- One severely stenosed bypass was successfully re-dilated.
Conclusions:
- Bypass recanalization is a feasible option for recent occlusions (< few weeks).
- Successful recanalization requires identifiable bypass stumps and favorable distal coronary artery outflow.
- Long-term patency may require further intervention or optimized medical management.
Abstract:
Recanalization of an occluded aortocoronary vein bypass was achieved in six out of seven patients (aged 57 +/- 4 years) 3-40 months after operation and 2-16 weeks after occlusion. The recanalization was done with a specially modified catheter introduced into the stump of the occluded vessel: urokinase was infused followed by balloon dilatation. Subsequent treatment included administration of nitrates, calcium antagonists, aspirin and heparin for at least three months. Repeat coronary angiography after 3-6 months (mean 4.3 +/- 1.0 months) demonstrated vessel patency in four of the six bypasses. One of them, severely stenosed, was again successfully dilated. It is concluded that bypass recanalization can be attempted if the occlusion occurred only a few weeks previously, angiography demonstrates a bypass stump and the state of the peripheral coronary artery makes good outflow likely.