[Limits of revascularization: interventional treatment possibilities in occlusion and restenosis after bypass...

Coronary artery bypass graft (CABG) surgery may be limited by incomplete revascularization, graft failure and progression of narrowing in the native coronary arteries. Ischemia in the first year after CABG, associated with anastomotic problems, can be safely and effectively treated with angioplasty. The rate of saphenous vein graft failure increases rapidly 8 years after CABG. Interventional strategy depends largely on lesion morphology. Focal stenoses can be treated with stents, with primary success rates > 90% and complication rates < 5%. Diffusely degenerated vein grafts and chronic total occlusions remain problematic for all catheter-based interventions. No randomized trial exists comparing reoperative CABG with angioplasty. In non-randomized data, neither therapy was clearly superior to the other. The underlying extent of disease primarily determines long-term survival. This suggests that control of risk factors may well be beneficial. In patients with recurrent symptoms unresponsive to medical therapy, referral for revascularization is reasonable. The choice of additional treatment may be made on the basis of clinical criteria and angiographic suitability, as well as patient preference.