Chronic total occlusion treatment in post‐CABG patients: Saphenous vein graft versus native vessel recanalization—Long‐term follow‐up in the drug‐eluting stent era

Abstract

Objective: To compare the postprocedural and long-term clinical outcomes of two groups of patients, all presenting with chronic saphenous vein graft (SVG) occlusion, who underwent either SVG or native vessel reopening. Background: Chronic total occlusions (CTO) treatment in patients who underwent previous surgical revascularization is a dilemma and the choice of performing native vessel or SVG recanalization is not always easy. Methods: Between July 2002 and October 2004, a total of 260 patients were successfully treated for a CTO. Of them, we selected all patients (n = 24) who had previous bypass surgery with graft occlusion. Of this final group, 13 patients underwent a percutaneous graft recanalization while 11 underwent native vessel reopening. Results: Primary end points were in-hospital and 3-year rates of death, myocardial infarction, target lesion revascularization, and target vessel revascularization. No events occurred in either group during the in-hospital period. Cumulative 3-year event-free survival in the native vessel and SVG group was 81.8% and 83.9% respectively (P = NS). One death and one TVR occurred in each group. Conclusion: In selected cases, SVG reopening instead of the native vessel is feasible. In such a high-risk population, drug-eluting stent implantation in both SVG and native CTO lesions is associated with good long-term outcomes. ' 2007 Wiley-Liss, Inc.

Percutaneous revascularization strategies in saphenous vein graft lesions: Long-term results

“…in mortality, MI or TVF between patients revascularized in the saphenous graft, in the native coronary artery or in both territories. These results are in agreement with other published studies 8. Angioplasty of the SVG instead of the native vessel is feasible and safe and should be considered a valid option in selected cases, despite the expected higher difficulty of interventional maneuvers inside a vein graft and the higher risk of complications such as vein wall perforation and dislodgment and distal embolization of atherosclerotic and thrombotic material.…”

“…4---7 Nonetheless, only a few small retrospective studies comparing the two strategies have been published, with inconclusive results, and the general practice is to decide on an individual basis. 8,9 The second question concerns the most suitable stent for PCI of SVG lesions. Although superior to balloon angioplasty, 10---13 results of stent implantation in SVG lesions are not as good as in native coronary arteries.…”

Clinical Presentation and Angiographic Characteristics of Saphenous Vein Graft Failure After Stenting

“…Acute SVG occlusions are usually associated with large thrombus burden, often necessitating stenting of a long length of the SVG to restore patency. Patients with chronic SVG occlusions and medically refractory symptoms might be best treated with PCI of the native coronary artery, when technically feasible (20,21); yet this might be challenging, due to the high prevalence of chronic occlusions in the native coronary arteries of prior CABG patients. In view of the poor short-and long-term outcome after PCI of occluded vein grafts (19), prevention of SVG occlusion is of paramount importance.…”

Retrograde recanalization of a chronic total occlusion of a saphenous vein graft

“…In the current era, with the use of drug-eluting stents (DES), improved equipment, particularly guidewires and distal protection devices, and better pharmacotherapy, a reappraisal of the value of recanalizing SVG CTO seems warranted. In a study of 24 patients with CTO of both native and graft vessel to a myocardial territory, 13 underwent PCI with DES implantation of the SVG CTO [4]. Patients who had the SVG (as opposed to the native vessel) stented with SVG CTO presented more frequently with acute coronary syndrome and had a mean stent length were only 22 mm.…”