PERI-PROCEDURAL OUTCOME OF SAPHENOUS VEIN GRAFT INTERVENTION

Authors

  • Tariq Shakoor
  • Nadeem Hayat Mallick
  • Ahmad Noeman

Abstract

Background: Patients who develop recurrent myocardial ischemia after coronary artery bypass graft(CABG) surgery are often referred for percutaneous coronary intervention. The objective of thisstudy was to evaluate the clinical characteristics and peri-procedural outcomes in patients with priorCABG referred for percutaneous coronary intervention (PCI) over a 3 year period. Methods: Datawere collected on patients who underwent coronary interventional procedures following CABGsurgery. We evaluated angiographic procedural success and immediate outcome among patients whohad undergone such procedures from Nov 2006 to Oct 2009 (n=113). Results: Patients in the 2006–2009 cohort had mean age 58.2 years, more patients were male (109 vs 4) and were more likely tohave hypertension (57.5%), hyperlipidaemia (72.6%) and family history of ischemic heart disease(IHD) (65.5%), but less likely to have smoking (42.5%). Acute closure of stent leading to proceduralfailure was seen in 1 (0.9%) patient, sub-acute thrombosis of stent was seen in 1 (0.9%) patient,dissection or perforation of target vessel was seen in 3 (2.7%) and 1 (0.9%) patients respectively.Slow flow phenomenon was seen in 13 (11.5%) and post-procedural cardiac enzymes were raised in6 (5.3%) patients. Conclusion: Success rates of saphenous vein graft (SVG) intervention andsurvival rate have improved with time as a result of improvements in technique and greater use ofstents, filter devices and adjunctive medications.Keywords: Percutaneous coronary intervention, saphenous vein graft, Ischemic heart disease, IHD

References

Bourassa MG, Enjalbert M, Campeau L, Lesperance J.

Progression of atherosclerosis in coronary arteries and bypass

grafts. Ten years later. Am J Cardiol 1984;53:102C–107C.

Johnson WD, Kayser KL, Pednaza PM: Angina pectoris and

coronary bypass surgery: Patterns of prevalence and recurrence

in 3105 consecutive patients followed upto 11 years. Am Heart J

;108:1190–7.

Savage MP, Douglas JS Jr, Fischman DL, Pepine CJ, King SB

rd, Werner JA, et al. Stent placement compared with balloon

angioplasty for obstructed coronary bypass grafts. N Engl J Med

;337:740 –7.

J Ayub Med Coll Abbottabad 2012;24(3-4)

http://www.ayubmed.edu.pk/JAMC/24-3/Tariq.pdf

Verghese M, Berger PB, Lennon RJ, Gersh BJ, Holmes DR, Jr.

Comparison of percutaneous interventions for unstable angina

pectoris with and without previous coronary artery bypass

grafting. Am J Cardiol 2000;86:931–7.

Laird-Meeter K, ten Katen HJ, Brower RW, van den Brand

MJ, Serruys PW, Haalebos MM, et al. Angina pectoris, 1 to 10

years after aortocoronary bypass surgery. Eur Heart J

;5:35–42.

Brower R, Laird-Meeter K, Serruys P, Meester G, Hugenholtz

PG. Long-term follow-up after coronary artery bypass graft

surgery: progression and regression of disease in native coronary

circulation and bypass grafts. Br Heart J 1983;50:42–7.

Campeau L, Lesperance J, Hermann J, Corbara F, Grondin CM,

Bourassa MG. Loss of improvement of angina between 1 and 7

years after aortocoronary bypass surgery: correlations with

changes in vein grafts and in coronary arteries. Circulation

;60:11–5.

Dorros G, Johnson WD, Tector AJ, Schmahl TM, Kalush SL,

Janke L. Percutaneous transluminal coronary angioplasty in

patients with prior coronary artery bypass grafting. J Thorac

Cardiovasc Surg 1984;87:17–26.

de Feyter PJ, van Suylen RJ, de Jaegere PP, Topol EJ, Serruys

PW. et al. Balloon angioplasty for the treatment of lesions in

saphenous vein bypass grafts. J Am Coll Cardiol

;21:1539–49.

Reul GJ, Cooley DA, Ott DA, Coelho A, Chapa L, Eterovic I.

Reoperation for recurrent coronary artery disease. Arch Surg

;14:1269–75.

Vouhe P, Grondin CM. Reoperation for coronary graft failure:

clinical and angiographic results in 43 patients. Ann Thorac Surg

;328–34.

Loop RD, Cosgrove DM, Kramer JR, Lytle BW, Taylor

PC, Golding LA, et al. Late and arteriographic results in 500

coronary artery reoperations. J Thorac Cardiovasc Surg

;675–85.

Krause AH, Page US, Bigelow JC, Okies JE, Dunlap SF.

Reoperation in symptomatic patients after direct coronary artery

revascularization. J Thorac Cardiovasc Surg 1978;75:499–504.

Lytle BW, Loop FD, Cosgrove DM, Taylor PC, Goormastic

M, Peper W, et al. Fifteen hundred coronary reoperation: results

and determinants of early and late survival. J Thorac Cardiovasc

Surg. 1987 Jun;93:847-59.

Laird-Meeter K, van Domburg R, van den Brand M, Lubsen J,

Bos E, Hugenholtz PG. Incidence, risk and outcome of

reintervention after aortocoronary bypass surgery. Br Heart J

;57:427–35.

Kalan JM, Roberts WC. Morphologic changes in saphenous

veins used as coronary arterial bypass conduits for longer than

one year: necropsy analysis of 53 patients, 123 saphenous veins

and 1865 five millimeter segments of veins. Am Heart J

;119:1164–84.

Bourassa MG. The national history of saphenous vein bypass

graft disease. In: Bates ER, Holmes DR, Eds. Saphenous Vein

Bypass Graft Disease. New York, NY: Marcel Dekker; 1998.p.

–76.

Nwasokwa ON. SsCoronary artery bypass graft disease. Ann

Intern Med 1995;123:528–45.

Lawrie GM, Lie JT, Movis GC, Beagley HC. Vein graft patency

and intimal proliferative after aortocoronary bypass: early and

long-term angiopathologic correlations. Am J Cardiol

;38:856–62.

White CJ, Ramee SR, Collins TJ, Mesa JE, Jain A. Percutaneous

angioscopy of saphenous vein coronary bypass grafts. J Am Coll

Cardiol 1993;21:1181–5.

Meester B J, Samson M, Suryapranata et al. Long-term followup after attemted angioplasty of saphenous vein grafts: the

Thoraxcenter experience 1981–88. Eur Heart J 1991;12:648–53.

Stone GW; Reifart NJ; Moussa I, Hoye A, Cox DA, Colombo

A, et al Percutaneous recanalization of chronically occluded

coronary arteries: a consensus document: part II. Circulation

;112:2530–7.

Roffi M; Mukherjee D; Chew DP, Bhatt DL, Cho L, Robbins

MA, et al. Lack of benefit from intravenous platelet glycoprotein

IIb/IIIa receptor inhibition as adjunctive treatment for

percutaneous interventions of aortocoronary bypass grafts: a

pooled analysis of five randomized clinical trials. Circulation

;106:3063–7.

Sharma S. Current Management Of Saphenous Vein Graft

Disease. Internet J Cardiol 2004;2:2 (internet edition)

Chen L; Theroux P; Lesperance J, Shabani F, Thibault B, De

Guise P. Angiographic features of vein grafts versus ungrafted

coronary arteries in patients with unstable angina and previous

bypass surgery. J Am Coll Cardiol 1996;28(6):1493–9.

Pinkerton CA, Slack JD, Orr CM, Vantassel JW, Smith ML.

Percutaneous transluminal angioplasty in patients with prior

myocardial revascularization surgery. Am J Cardiol

;61:15G–22.

Block PC, Cowley MJ, Kaltenbac h M, Kent KM, Simpson J.

Percutaneous angioplasty of stenoses of bypass grafts or of

bypass graft anastomotic sites. Am J Cardiol 1984;53:666–8.

Dorros G, Johnson WD, Tector AJ, Schmahl TM, Kalush SL,

Janke L. Percutaneous transluminal coronary angioplasty in

patients with prior coronary artery bypass grafting. J Thorac

Cardiovasc Surg 1984;87:17–26.

Douglas JS, Gruentzig AR, King SB, Hollman J, Ischinger

T, Meier B, et al. Percutaneous transluminal angioplasty in

patients with prior coronary artery bypass surgery. J Am Coll

Cardiol 1983;745–54.

El Gamal M, Bonnier H, Michels R, Heijman J, Stassen E.

Percutaneous transluminal angioplasty of stenosed aortocoronary

bypass grafts. Br Heart J 1984;52:617–20.

Cote G, Myler RK, Stertzer SH, Clark DA, Fishman-Rosen

J, Murphy M, et al. Percutaneous transluminal angioplasty of

stenotic coronary artery bypass grafts: 5 year’s experience. J Am

Coll Cardiol 1987;9:8–17.

Corbelli J, Franco I, Hollman J, Simpfendorfer C, Galan K.

Percutaneous transluminal angioplastyafter previous coronary

artery bypass surgery. Am J Cardiol 1985;56:398–403.

Ernst SM, Vander Feltz TA, Ascoop CA, Bal ET, Vermeulen

FE, Knaepen PJ, et al. Percutaneous transluminal coronary

angioplasty in patients with prior coronary artery bypass grafting:

long-term results. J Thorac Cardiovasc Surg 1987;93:268–75.

Reeder GS, Bresnahan JF, Holmes DR, Mock MB, Orszulak

TA, Smith HC, et al. Angioplasty for aortocoronary bypass graft

stenosis Mayo Clin Proc 1986;61:14–9.

Cooper I, Ineson N, Demirtas E, Coltart J, Jenkins S, WebbPeploe M. Role of angioplasty in patients with previous coronary

artery bypass surgery. Cathet Cardiovasc Diagn 1989;16:81–6.

Published

2012-12-01

Most read articles by the same author(s)