Transluminal extraction catheter for the treatment of diseased saphenous vein grafts: A multicenter experience

Abstract

To evaluate the efficacy, safety, and long-term results of atherectomy using the Transluminal Extraction catheter (TEC), patients with diseased saphenous vein grafts were enrolled in a prospective nonrandomized trial. Patients were followed to hospital discharge for acute complications and underwent routine 6-mo reevaluation with repeat cardiac catheterization to assess restenosis. Atherectomy was performed on 650 graft lesions in 538 consecutive patients (male 81%; mean age 66 yr; range 37-81). Mean graft age was 8.3 yr; (range 0.3-20) with 85% of grafts > 3 yr of age. Complex lesion morphology included thrombus (28%), ulceration (13%), and eccentricity (50%). Lesion success was achieved in 606 lesions (93%) with clinical success in 479 patients (89%). Lesion success was achieved in 90% of thrombus containing lesions, 97% of ulcerated lesions, and 97% of grafts > 3 yr. Complications included nonfatal myocardial infarction in 4 (0.7%) of patients, emergency bypass surgery in 2 (0.41%), and in-hospital death in 17 patients (3.2%). Angiographic follow-up at 6 mo was obtained from 268 lesions in 227 patients. The overall lesion angiographic restenosis rate was 60%. TEC atherectomy can be performed in patients with diseased saphenous vein grafts with high primary success and low complication rates. It is suitable for use in aged grafts, particularly in the presence of thrombus and ulcerations, and may be superior to balloon angioplasty alone in this group of patients.

Percutaneous revascularization of an extensively diseased saphenous vein bypass graft with a saphenous vein-covered Palmaz stent

“…Transluminal extraction catheter treatment of diseased saphenous vein grafts has a major complication rate of 4.3% and a death rate of 3.2%, as reported in a multicenter study [11]. Distal embolization was reported in 4.3% of patients.…”

Transluminal extraction catheter for acute myocardial infarction

“…This device can be applied to symptomatic patients with ischemic coronary syndromes whose diseased saphenous vein grafts are amenable to percutaneous revascularization. The reported primary success rate is adequate and is associated with a relatively low complication rate [9,10,11]. Safian et al [12] reported procedural success in 84% of 158 saphenous vein graft lesions in 146 consecutive patients.…”

“…TEC atherectomy, which cuts and aspirates thrombus and atheromatous material, has been advocated as a unique revascularization strategy in saphenous vein grafts containing thrombotic lesions [9]. This device can be applied to symptomatic patients with ischemic coronary syndromes whose diseased saphenous vein grafts are amenable to percutaneous revascularization.…”

Angioplasty of totally occluded old vein grafts with new interventional techniques: A long-term follow-up study

“…Use of stents in SVGs versus balloon angioplasty alone has been shown to improve late clinical outcome [7]. TEC atherectomy was used in occluded vein graft because it was supposed to remove intraluminal thrombus and plaque tissue and it reduced the risk of distal embolization [4,8,9]. …”