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Percutaneous saphenous vein angioplasty to avoid reoperative bypass surgery
Insights
Percutaneous transluminal vein graft angioplasty offers a less invasive option for treating vein graft stenosis after coronary artery bypass. This procedure showed initial success and reduced costs compared to repeat bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Vein graft stenosis is a common complication following coronary artery bypass surgery.
- Disabling angina pectoris often necessitates intervention for significant vein graft stenosis.
Purpose of the Study:
- To evaluate the efficacy and outcomes of percutaneous transluminal vein graft angioplasty (PTVA) in patients with coronary artery bypass vein graft stenosis.
- To compare the restenosis rates and clinical outcomes of PTVA based on the location of stenosis (aortic anastomosis, vein body, distal anastomosis).
Main Methods:
- Thirty-seven patients with symptomatic vein graft stenosis underwent PTVA.
- Stenosis location, procedural success, complications, and restenosis rates were recorded.
- Clinical outcomes and hospital costs were compared to repeat coronary artery bypass surgery.
Main Results:
- Initial success, defined as >20% reduction in stenosis, was achieved in 35 out of 37 patients.
- Significant reduction in stenosis (84% to 24%) and pressure gradient (58 to 15 mm Hg) was observed.
- Restenosis was more common in lesions at the aortic anastomosis or vein body (7/15) compared to the distal anastomosis (3/22).
- Patients with distal anastomosis stenosis had better long-term asymptomatic outcomes (12/22) compared to other locations (2/7).
- Complications included emergency bypass (2), myocardial infarction (2), and ventricular fibrillation (1); no deaths occurred.
- PTVA was significantly more cost-effective than repeat coronary artery bypass surgery.
Conclusions:
- PTVA is an effective initial treatment for vein graft stenosis, particularly for lesions at the distal anastomosis.
- While restenosis can occur, PTVA offers a less invasive and more cost-effective alternative to repeat coronary artery bypass surgery.
- Further investigation may be warranted for optimizing PTVA outcomes in patients with proximal vein graft stenosis.
Abstract:
Thirty-seven patients with vein graft stenosis following coronary artery bypass underwent percutaneous transluminal vein graft angioplasty to avoid another operation. Location of the stenoses was at the aortic anastomosis in 3 patients, in the vein body in 12, and at the distal anastomosis in 22. All patients had disabling angina pectoris. Initial success (greater than 20% reduction of stenosis) was achieved in 35 patients. Vein graft angioplasty was performed within a year after bypass in 28 patients. The percent of stenosis and the pressure gradient across the obstruction were reduced from 84 to 24% and from 58 to 15 mm Hg, respectively. Complications of the procedure included emergency coronary artery bypass in 2 patients, myocardial infarction in 2, and ventricular fibrillation in 1. There were no deaths. Of 15 patients with stenosis at the aortic anastomosis or vein body, the dilation was initially successful in 14 but restenosis occurred in 7 within the first year after angioplasty. Only 2 of the remaining 7 were asymptomatic after vein graft angioplasty. However, for patients having vein graft angioplasty of the distal anastomosis, restenosis occurred in only 3, while 12 were asymptomatic at the end of the first year. The average hospital cost of a repeat coronary artery bypass operation was 2.8 times the cost of vein graft angioplasty.