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Late changes in saphenous vein coronary artery bypass grafts and their implications in clinical practice
1Montreal Heart Institute, Quebec.
Insights
Saphenous vein grafts often change years after bypass surgery, leading to blockages and narrowing. Managing risk factors like high cholesterol and smoking may help prevent these graft complications and improve patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Clinical Cardiology
Background:
- Saphenous vein grafts (SVGs) are commonly used in coronary artery bypass grafting (CABG).
- Late graft changes, including occlusion and atherosclerosis, frequently occur 10-12 years post-CABG.
- These changes are linked to adverse clinical events like angina, myocardial infarction, heart failure, and death.
Purpose of the Study:
- To investigate the incidence and nature of late changes in saphenous vein grafts.
- To identify risk factors associated with these degenerative graft alterations.
- To explore potential strategies for mitigating graft deterioration and improving long-term CABG outcomes.
Main Methods:
- Review of clinical outcomes and graft patency in patients undergoing CABG with SVGs.
- Analysis of graft morphology and associated patient risk factors (e.g., hyperlipidemia, smoking).
- Comparison of SVG performance with internal mammary artery (IMA) grafts.
Main Results:
- Approximately one-third of SVGs are occluded, one-third show atherosclerotic changes, and one-third remain patent at 10-12 years.
- Intimal hyperplasia is a potential precursor to graft degeneration.
- Serum hyperlipidemia and smoking are identified as significant risk factors for late SVG changes.
Conclusions:
- Late degenerative changes in SVGs are common and associated with significant clinical morbidity and mortality.
- Risk factor modification (hyperlipidemia, smoking) may slow SVG deterioration.
- While IMA grafts offer superior long-term durability, SVGs remain relevant for specific patient groups and complete revascularization strategies.
Abstract:
Late changes are frequent in saphenous vein grafts. About 10 to 12 years after bypass, about one-third are occluded, one-third have wall irregularities and narrowings attributed to atherosclerosis and one-third are seemingly intact. These changes are associated with recurrence of angina and other deleterious clinical events such as unstable angina, acute myocardial infarction, heart failure and death. Intimal fibrous hyperplasia may be a precursor of these changes, which could be minimized by appropriate surgical technologies and perhaps antiplatelet therapy. These late changes appear related to serum hyperlipidemia and smoking. Optimal control of these risk factors may retard their development and subsequent clinical deterioration. Although internal mammary artery (IMA) graft is the conduit of choice because of its apparent immunity to premature atherosclerosis, and hence its longer durability, saphenous vein grafts are still placed in many old patients and others, when a short operation time is a priority, and above all in combination with IMA grafts in order to obtain complete revascularization.