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Transcatheter therapy of thrombotic-occlusive lesions in saphenous vein grafts
1"Charles A. Barrow" Heart Lung Center, St. Luke's Medical Center, Phoenix, Arizona, 85018, USA.
Insights
Treating saphenous vein graft (SVG) disease with urokinase-verapamil infusion and biliary stents shows high success. This combined therapy effectively manages thrombotic SVG occlusions and improves patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Saphenous vein graft (SVG) disease, a type of accelerated atherosclerosis, presents a significant therapeutic challenge.
- While stenting is effective for non-thrombotic SVG lesions, treatment for thrombotic occlusions remains complex.
Purpose of the Study:
- To evaluate the efficacy of a combined intragraft urokinase-verapamil infusion and biliary stent placement for severely symptomatic patients with thrombotic SVG occlusions.
- To assess the safety and clinical outcomes of this novel therapeutic approach.
Main Methods:
- Sixty patients with multiple subtotal and total thrombotic SVG occlusions underwent treatment.
- Therapy involved intragraft infusion of urokinase and verapamil, followed by deployment of multiple biliary stents.
- Outcomes included stent success rate, incidence of subacute thrombosis, major complications, and 12-month event-free survival.
Main Results:
- Stent deployment achieved a 100% success rate.
- No clinical subacute thrombosis was observed, and major in-hospital complications were rare (<1%).
- The 12-month event-free survival rate was 87% in 57 evaluable patients.
Conclusions:
- Combined intragraft urokinase-verapamil infusion and biliary stenting is highly effective for treating thrombus-containing occlusive SVG disease.
- This approach successfully prevents the "no-reflow" phenomenon and reduces periprocedural non-Q-wave myocardial infarction.
- The therapy offers encouraging clinical outcomes for patients with complex SVG disease.
Abstract:
Saphenous vein graft (SVG) disease, a form of accelerated atherosclerosis, remains a therapeutic conundrum. The use of stents after excluding the presence of thrombus has proved highly successful at short- and long-term follow-up. We report on 60 severely symptomatic patients with multiple subtotal and total thrombotic SVG occlusions who were treated with a combination of intragraft urokinase-verapamil infusion and insertion of multiple biliary stents. Stent deployment had a 100% success rate. No case of clinical subacute thrombosis was registered, and major in-hospital complications were uncommon (<1%). The clinical outcome was encouraging, with a 12-month event-free survival rate of 87% in the 57 evaluable patients. This method of therapy appears to be highly successful in the treatment of thrombus-containing occlusive SVG disease, in preventing the "no-reflow" phenomenon, and in lessening the incidence of periprocedural non-Q-wave myocardial infarction.