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Percutaneous transluminal angioplasty of coronary saphenous vein bypass grafts
Insights
Percutaneous transluminal angioplasty of saphenous vein grafts is effective for graft stenosis, but restenosis remains a significant issue. This procedure offers a safe alternative to bypass surgery for recurrent angina.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Saphenous vein grafts (SVGs) are commonly used for coronary artery bypass grafting (CABG).
- Graft stenosis can lead to recurrent anginal symptoms and graft failure.
- Percutaneous transluminal angioplasty (PTA) is a less invasive option for treating graft stenosis.
Purpose of the Study:
- To evaluate the efficacy and safety of PTA for stenotic saphenous vein grafts.
- To assess the rate of restenosis and long-term outcomes after PTA of SVGs.
Main Methods:
- A cohort of 18 patients (14 men, 4 women) with recurrent angina and SVG stenosis underwent PTA.
- The study analyzed 24 lesions in SVGs, noting their location (proximal, distal, middle anastomosis).
- Success rates, procedural complications, and clinical/angiographic outcomes were recorded.
Main Results:
- Primary technical success rate for PTA was 79%, with significant stenosis reduction (82% to 26%).
- No emergency CABG was required; two patients underwent elective CABG after failed PTA.
- Overall restenosis rate was 58% at follow-up, with repeat PTA successful in 3 of 5 attempted cases.
Conclusions:
- PTA of localized SVG stenosis is effective and safe, improving symptoms in most patients.
- High rates of restenosis suggest intimal fibrous proliferation as a likely cause.
- Further research may be needed to address the high restenosis rates in SVG angioplasty.
Abstract:
Between December 1981 and August 1983, percutaneous transluminal angioplasty of saphenous vein grafts was performed in 14 men and 4 women, selected because of recurrent anginal symptoms and graft stenosis. The interval from bypass to angioplasty was 41 +/- 36 months. Of 24 lesions, 9 were at the proximal anastomosis, 13 in the distal segment and 2 in the middle segment of the vein graft. The primary success rate was 79%. Failure to cross the stenosis occurred in three patients and failure to dilate in one. The stenosis was reduced from a mean of 82% +/- 13% to 26% +/- 15%. No patient required emergency coronary artery bypass grafting but two underwent elective grafting after the angioplasty had failed. No patient sustained a Q-wave myocardial infarction and all who had a successful angioplasty were asymptomatic or much improved after the procedure. Angiographic follow-up was available in 12 of 14 patients (86%). Six patients had significant symptoms (Canadian Cardiovascular Society class II to III) and five of these had evidence of restenosis. Among the six patients who were asymptomatic, two had angiographic evidence of restenosis. The overall rate of restenosis was 58% (7 of 12). Repeat angioplasty was successful in three of the five patients in whom it was attempted. The authors conclude that percutaneous transluminal angioplasty of a saphenous vein graft for a localized area of stenosis is effective and safe, but there is a high rate of restenosis that possibly is due to intimal fibrous proliferation in saphenous vein grafts.