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Published on: November 19, 2019
A Case of Using No-Touch Saphenous Vein Graft in Redo CABG after Multiple Failed Percutaneous Coronary Interventions
Victor Edin1, Håkan Geijer2, Piotr Jakuszewski3
1Department of Vascular and Cardiothoracic Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Insights
Repeat revascularization for graft failure is debated. Redo coronary artery bypass grafting (CABG) with no-touch saphenous vein grafts offered an alternative to percutaneous coronary intervention (PCI) in a complex patient case.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Late graft failure after coronary artery bypass grafting (CABG) necessitates revascularization strategies.
- European guidelines suggest redo CABG for specific graft and native vessel conditions.
- Percutaneous coronary intervention (PCI) is a common revascularization method, but may not always be successful.
Observation:
- A patient with recurrent unstable angina pectoris experienced persistent symptoms despite multiple unsuccessful PCI attempts.
- The patient had a history of previous coronary revascularization procedures.
Findings:
- Redo CABG using no-touch saphenous vein grafts effectively relieved the patient's recurrent unstable angina.
- This approach provided a successful alternative to further PCI in a patient with complex coronary anatomy and prior interventions.
Implications:
- No-touch saphenous vein grafts may be a viable option for redo CABG in select patients with complex coronary disease.
- Multidisciplinary collaboration between cardiologists and cardiac surgeons is crucial for optimizing treatment decisions in repeat revascularization cases.
- This case highlights a potential alternative strategy for patients unsuitable for or refractory to repeat PCI.
Abstract:
The modality of repeat revascularization due to late graft failure is a debated topic. The latest available European guidelines recommend redo coronary artery bypass graft (CABG) for cases of extensively diseased and/or occluded grafts and those with diffuse native vessel disease. We present the case of a patient being relieved of recurrent unstable angina pectoris with redo CABG using no-touch saphenous vein grafts after repeated and unsuccessful attempts with percutaneous coronary intervention (PCI). This could be an alternative to PCI in patients with a complex medical history. Teamwork between cardiologists and surgeons is pivotal in deciding the best treatment modality.
