Balloon angioplasty of aortocoronary saphenous vein bypass grafts: a histopathologic study of six grafts from five patients, with emphasis on restenosis and embolic complications

Division of Pathology, Mayo Clinic, Rochester, Minnesota 55905.

Among 103 patients undergoing percutaneous transluminal balloon angioplasty of obstructed aortocoronary saphenous vein bypass grafts at the Mayo Clinic, six grafts from 5 patients were available for histopathologic examination. The interval from graft insertion to angioplasty ranged from 5 to 105 months and that from angioplasty to graft excision ranged from 6 h to 24 months. Angioplasty produced intimal fissures in three grafts initially obstructed by intimal fibromuscular proliferation. Healing and restenosis resulted from filling of lacerations with fibrocellular tissue and apparently also from restitution of muscular tone. In two of three grafts initially narrowed by atherosclerosis, balloon angioplasty cause extensive plaque rupture and restenosis resulted from extrusion of plaque debris and secondary luminal thrombosis. In the third graft, angioplasty produced no distinct lesions and late restenosis was due to progressive atherosclerosis of the vein graft. Atheroembolization was observed in both patients with plaque rupture and was associated with reoperation in one and death in the other. In conclusion, the results derived from six saphenous vein bypass grafts subjected to balloon angioplasty indicate that restenosis may result from intimal fibrocellular proliferation, thrombosis, restitution of muscular tone and progressive atherosclerosis. Symptomatic atheroembolization may occur in grafts greater than 1 year old.

This article has been cited by other articles:

				F. J. Schoen and R. F. Padera Jr. Cardiac Surgical Pathology Card. Surg. Adult, January 1, 2003; 2(2003): 119 - 185. [Full Text]

				B.-W. Hochleitner, E.-O. Hochleitner, P. Obrist, T. Eberl, A. Amberger, Q. Xu, R. Margreiter, and G. Wick Fluid Shear Stress Induces Heat Shock Protein 60 Expression in Endothelial Cells In Vitro and In Vivo Arterioscler. Thromb. Vasc. Biol., March 1, 2000; 20(3): 617 - 623. [Abstract] [Full Text] [PDF]

				D. R. Holmes Jr and P. B. Berger Percutaneous Revascularization of Occluded Vein Grafts : Is It Still a Temptation to Be Resisted? Circulation, January 12, 1999; 99(1): 8 - 11. [Full Text] [PDF]

				B. H. Strauss, M. K. Natarajan, W. B. Batchelor, D. E. Yardley, J. A. Bittl, T. A. Sanborn, J. A. Power, L. E. Watson, R. Moothart, J. E. Tcheng, et al. Early and Late Quantitative Angiographic Results of Vein Graft Lesions Treated by Excimer Laser With Adjunctive Balloon Angioplasty Circulation, August 1, 1995; 92(3): 348 - 356. [Abstract] [Full Text]

				D. R. Holmes Jr, E. J. Topol, R. M. Califf, L. G. Berdan, F. Leya, P. B. Berger, P. L. Whitlow, R. D. Safian, A. G. Adelman, M. A. Kellett Jr, et al. A Multicenter, Randomized Trial of Coronary Angioplasty Versus Directional Atherectomy for Patients With Saphenous Vein Bypass Graft Lesions Circulation, April 1, 1995; 91(7): 1966 - 1974. [Abstract] [Full Text]

				S. C. Wong, J. J. Popma, A. D. Pichard, K. M. Kent, L. F. Satler, G. S. Mintz, Y. C. Chuang, M. K. Hong, C. J. Ditrano, and M. B. Leon Comparison of Clinical and Angiographic Outcomes After Saphenous Vein Graft Angioplasty Using Coronary Versus `Biliary' Tubular Slotted Stents Circulation, January 15, 1995; 91(2): 339 - 350. [Abstract] [Full Text]