Percutaneous transluminal angioplasty of saphenous vein graft stenosis: long-term follow-up

Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195-5066.

Percutaneous transluminal angioplasty was used to treat 101 patients with saphenous vein bypass graft stenosis at a mean of 50.1 months (range 2 to 196) after coronary artery bypass surgery. The patients presented between March 1981 and April 1987. A total of 107 saphenous vein grafts were dilated at 117 sites. The primary success rate was 91.8%. The incidence of cardiac complications was 7.1%. There were no cardiac complications in 53 patients with grafts implanted less than 36 months before angioplasty (Group 1). The 48 patients with grafts implanted for greater than 36 months (Group 2) had a 12.5% incidence rate of myocardial infarction, a 4% incidence rate of emergent bypass surgery and a 4% incidence rate of death for an overall cardiac complication rate of 14.9% (p less than 0.01). Follow-up was obtained at a mean of 16.8 +/- 13.9 months (range 1 to 54) in 87 patients (97% of successful cases). Repeat coronary angiography was performed in 49 patients and revealed restenosis in 30 patients (61.2%), with no difference in recurrence rates for proximal, mid or distal graft sites. Clinical recurrence (defined as recurrence of symptoms, myocardial infarction, repeat angioplasty, surgery or death) was 33.1% for Group 1 patients and 64.1% for Group 2 patients (p less than 0.01). The complication and recurrence rates of saphenous vein graft angiography are significantly higher when performed for late (greater than 36 months) vein graft failure. All therapeutic options should be carefully examined before proceeding with angioplasty for saphenous vein graft stenosis in this type of patient.

This article has been cited by other articles:

				A. Coolong, D. S. Baim, R. E. Kuntz, A. J. O'Malley, S. Marulkar, D. E. Cutlip, J. J. Popma, and L. Mauri Saphenous Vein Graft Stenting and Major Adverse Cardiac Events: A Predictive Model Derived From a Pooled Analysis of 3958 Patients Circulation, February 12, 2008; 117(6): 790 - 797. [Abstract] [Full Text] [PDF]

				C. Held, P. Tornvall, and U. Stenestrand Effects of revascularization within 14 days of hospital admission due to acute coronary syndrome on 1-year mortality in patients with previous coronary artery bypass graft surgery Eur. Heart J., February 1, 2007; 28(3): 316 - 325. [Abstract] [Full Text] [PDF]

				L. Ge, I. Iakovou, G. M. Sangiorgi, A. Chieffo, G. Melzi, J. Cosgrave, M. Montorfano, I. Michev, F. Airoldi, M. Carlino, et al. Treatment of saphenous vein graft lesions with drug-eluting stents: Immediate and midterm outcome J. Am. Coll. Cardiol., April 5, 2005; 45(7): 989 - 994. [Abstract] [Full Text] [PDF]

				G. Stankovic, A. Colombo, P. Presbitero, F. van den Branden, L. Inglese, C. Cernigliaro, L. Niccoli, A. L. Bartorelli, P. Rubartelli, N. Reifart, et al. Randomized Evaluation of Polytetrafluoroethylene-Covered Stent in Saphenous Vein Grafts: The Randomized Evaluation of polytetrafluoroethylene COVERed stent in Saphenous vein grafts (RECOVERS) Trial Circulation, July 8, 2003; 108(1): 37 - 42. [Abstract] [Full Text] [PDF]

				T M Schiele, E Regar, S Silber, E Eeckhout, D Baumgart, W Wijns, A Colombo, W Rutsch, D Meerkin, A Gershlick, et al. Clinical and angiographic acute and follow up results of intracoronary {beta} brachytherapy in saphenous vein bypass grafts: a subgroup analysis of the multicentre European registry of intraluminal coronary {beta} brachytherapy (RENO) Heart, June 1, 2003; 89(6): 640 - 644. [Abstract] [Full Text] [PDF]

				B. W. Lytle Coronary Artery Reoperations Card. Surg. Adult, January 1, 2003; 2(2003): 659 - 679. [Full Text]

				R. Waksman, A. E. Ajani, R. L. White, R. C. Chan, L. F. Satler, K. M. Kent, A. D. Pichard, E. E. Pinnow, A. B. Bui, S. Ramee, et al. Intravascular Gamma Radiation for In-Stent Restenosis in Saphenous-Vein Bypass Grafts N. Engl. J. Med., April 18, 2002; 346(16): 1194 - 1199. [Abstract] [Full Text] [PDF]

				S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]

				U E Heidland, M P Heintzen, C J Michel, and B E Strauer Risk factors for the development of restenosis following stent implantation of venous bypass grafts Heart, March 1, 2001; 85(3): 312 - 317. [Abstract] [Full Text]

				B. Bhargava, R. Kornowski, R. Mehran, K. M. Kent, M. K. Hong, A. J. Lansky, R. Waksman, A. D. Pichard, L. F. Satler, and M. B. Leon Procedural results and intermediate clinical outcomes after multiple saphenous vein graft stenting J. Am. Coll. Cardiol., February 1, 2000; 35(2): 389 - 397. [Abstract] [Full Text] [PDF]

				K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF]

				J. G. Webb, R. G. Carere, R. Virmani, D. Baim, P. S. Teirstein, P. Whitlow, C. McQueen, F. D. Kolodgie, E. Buller, A. Dodek, et al. Retrieval and analysis of particulate debris after saphenous vein graft intervention J. Am. Coll. Cardiol., August 1, 1999; 34(2): 468 - 475. [Abstract] [Full Text] [PDF]

				A. E. Abdelmeguid and E. J. Topol The Myth of the Myocardial `Infarctlet' During Percutaneous Coronary Revascularization Procedures Circulation, December 15, 1996; 94(12): 3369 - 3375. [Full Text]

				T. Katsumata, M. Endo, K. Ihashi, S. Fujino, H. Nishida, and H. Koyanagi Post-Stenting Enlarging False Aneurysm of a Saphenous Vein Graft Ann. Thorac. Surg., October 1, 1995; 60(4): 1121 - 1123. [Abstract] [Full Text]

				J. Lefkovits, D. R. Holmes, R. M. Califf, R. D. Safian, K. Pieper, G. Keeler, E. J. Topol, and f. t. C.-I. Investigators Predictors and Sequelae of Distal Embolization During Saphenous Vein Graft Intervention From the CAVEAT-II Trial Circulation, August 15, 1995; 92(4): 734 - 740. [Abstract] [Full Text]

				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]

				A. Colombo, P. Hall, S. Nakamura, Y. Almagor, L. Maiello, G. Martini, A. Gaglione, S. L. Goldberg, and J. M. Tobis Intracoronary Stenting Without Anticoagulation Accomplished With Intravascular Ultrasound Guidance Circulation, March 15, 1995; 91(6): 1676 - 1688. [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]

				C. Landau, R. A. Lange, and L. D. Hillis Percutaneous Transluminal Coronary Angioplasty N. Engl. J. Med., April 7, 1994; 330(14): 981 - 993. [Full Text]

				J. A. Bittl Directional Coronary Atherectomy versus Balloon Angioplasty N. Engl. J. Med., July 22, 1993; 329(4): 273 - 274. [Full Text]

				C. Unterberg, A. Buchwald, V. Wiegand, and H. Kreuzer Coronary Angioplasty in Patients with Previous Coronary Artery Bypass Grafting Angiology, August 1, 1992; 43(8): 653 - 660. [Abstract] [PDF]