Related Experiment Videos
Percutaneous revascularization of ostial saphenous vein graft stenoses
A E Abdel-Meguid1, P L Whitlow, C Simpfendorfer
1Department of Cardiology, Cleveland Clinic Foundation, Ohio, USA.
Insights
Percutaneous revascularization of ostial saphenous vein graft stenoses shows similar short-term and long-term outcomes compared to nonostial lesions. This contrasts with native coronary artery disease, suggesting vein grafts may have a more favorable prognosis.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Surgery
Background:
- Percutaneous angioplasty for native coronary ostial stenoses yields poorer results than nonostial lesions.
- The prognosis for interventions in ostial saphenous vein graft stenoses remains controversial.
Purpose of the Study:
- To evaluate the short-term results and long-term outcomes of percutaneous revascularization for ostial saphenous vein graft stenoses.
- To compare these outcomes with those of proximal, nonostial saphenous vein graft stenoses.
Main Methods:
- A retrospective analysis of 68 patients with ostial (group I) and 72 patients with proximal, nonostial (group II) saphenous vein graft stenoses.
- Patients underwent percutaneous angioplasty or directional atherectomy between 1986 and 1992.
Main Results:
- Procedural success rates were similar (89.7% in group I vs. 88.9% in group II).
- Major procedural complications did not differ significantly between groups.
- At a mean follow-up of 23 months, adverse event rates (death, infarction, repeat revascularization, hospital admission) were comparable (64% in group I vs. 58% in group II).
- Angina-free rates were also similar (50% in group I vs. 56% in group II).
Conclusions:
- Percutaneous revascularization of ostial saphenous vein graft stenoses has a clinical, procedural, and follow-up profile comparable to proximal nonostial saphenous vein graft disease.
- This contrasts with native coronary arteries, where ostial lesions have worse outcomes.
- This may be due to the generally suboptimal results of percutaneous revascularization in vein grafts or intrinsic differences between ostial vein grafts and ostial native coronary arteries.
Objectives:
This study sought to evaluate the short-term results and long-term outcome of percutaneous revascularization of ostial saphenous vein graft stenoses in a large patient series.
Background:
Previous studies have demonstrated that the results of balloon angioplasty for native coronary ostial stenoses are significantly worse than those for nonostial lesions. However, it is controversial whether interventions in patients with ostial saphenous vein grafts carry a similar prognosis.
Methods:
We identified 68 consecutive patients with ostial (group I) and 72 consecutive patients with proximal, nonostial (group II) saphenous vein graft stenoses who underwent percutaneous angioplasty or directional atherectomy for a single new stenosis at the Cleveland Clinic between 1986 and 1992.
Results:
Success was achieved in 61 patients (89.7%) in group I and 64 (88.9%) in group II (p = 0.88). There were no differences in major procedural complications (death, Q wave infarction and bypass surgery) between the two groups. At a mean (+/- SD) follow-up of 23 +/- 17 months, 36 patients (64%) in group I had one or more adverse events (death, infarction, repeat coronary revascularization or cardiac-related hospital admission) compared with 34 patients (58%) in group II (p = 0.87). Twenty-eight patients (50%) were angina free in group I compared with 33 (56%) in group II (p = 0.65). During the follow-up period in group I, 7 patients died (13%), 10 had a myocardial infarction (18%), 11 had repeat bypass surgery (20%), 8 had repeat percutaneous interventions (14%), and 30 had one or more cardiac-related hospital admissions (54%). The incidence of these events was similar in group II except for a slightly higher incidence of myocardial infarction: 6 patients died (10%), 3 had a myocardial infarction (5%), 12 had repeat bypass surgery (20%), 12 had repeat percutaneous interventions (20%), and 26 had one or more cardiac-related hospital admissions (44%).
Conclusions:
Unlike ostial native coronary disease, the clinical, procedural and follow-up profile of ostial saphenous vein graft revascularization is not significantly worse than proximal nonostial disease. This finding may be related to the overall suboptimal results of percutaneous revascularization in saphenous vein grafts compared with native coronary arteries or to the unfavorable intrinsic properties of ostial native coronary arteries compared with ostial vein grafts.