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CLINICAL STUDIES

Long-term clinical outcome after endoluminal reconstruction of diffusely degenerated saphenous vein grafts with less-shortening wallstents

Remi Choussat, MD^*, Alexander J. R. Black, MB, BS, Irene Bossi, MD^*, Thierry Joseph, MD^*, Jean Fajadet, MD^* and Jean Marco, MD^*

^* Unité de Cardiologie Interventionelle, Clinique Pasteur, Toulouse, France
Department of Cardiology, The Geelong Hospital, Geelong, Australia

Manuscript received June 4, 1999; revised manuscript received January 20, 2000, accepted March 29, 2000.

Reprint requests and correspondence: Dr. Jean Fajadet, Unité de Cardiologie Interventionelle, Clinique Pasteur, 45 avenue de Lombez, Toulouse 31076, France
fajadet{at}interv-cardio-toul.com

OBJECTIVES

This study was designed to evaluate the immediate and long-term clinical results of patients undergoing endoluminal reconstruction in diffusely degenerated saphenous vein grafts (SVGs) with elective implantation of one or more less-shortening Wallstents.

BACKGROUND

The optimal treatment strategy for patients with diffusely degenerated SVGs is controversial. Endoluminal reconstruction by stent implantation is one proposed strategy; however, there are few data regarding long-term clinical outcome.

METHODS

Between May 1995 and September 1998, 6,534 consecutive patients underwent angioplasty in our institution, including 440 who were treated for SVG lesions. Of these, 126 (115 men, 11 women, median age 69.5 years, range: 33–86 years) with old SVGs (mean age: 13 ± 5 years) diffusely degenerated stenosed or occluded (mean lesion length: 27 ± 12 mm) were treated electively with implantation of one or multiple (total 197) less-shortening Wallstents.

RESULTS

Before discharge, 13 patients (10.3%) sustained at least one major cardiovascular event, including 4 deaths (3.2%), 11 myocardial infarctions (MI) (8.7%), and 3 repeat revascularizations (target vessel = 1, nontarget vessel = 2, 2.4%). Surviving patients were followed for 22 ± 11 months: 13 patients (11.1%) died, 11 (9.4%) sustained an MI, 37 underwent angioplasty (31.6%), and 4 (3.4%) underwent bypass surgery. The estimated three-year event-free survival rates (freedom from death, and freedom from death/MI/target vessel revascularization) were (mean ± SE) 81.1 ± 7.8% and 43.2 ± 18.5%, respectively.

CONCLUSIONS

The long-term clinical outcome of patients undergoing endoluminal reconstruction in diffusely degenerated SVG is relatively poor, mainly because of a high incidence of death or MI and the frequent need for repeat angioplasty. It is unlikely that percutaneous intervention alone will provide a satisfactory or definitive solution for these patients.

Abbreviations and Acronyms   CABG = coronary artery bypass graft   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   SVG = saphenous vein graft   TIMI = Thrombolysis in Myocardial Infarction

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