RT Book, Section
A1 Douglas, Jr., John S.
A2 Samady, Habib
A2 Fearon, William F.
A2 Yeung, Alan C.
A2 King III, Spencer B.
SR Print(0)
ID 1146599364
T1 Intervention in Venous and Arterial Grafts
T2 Interventional Cardiology, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071820363
LK accesscardiology.mhmedical.com/content.aspx?aid=1146599364
RD 2024/04/19
AB The  surgeon’s  use  of  saphenous  veins  and  a  variety  of  arterial  conduits  to  bypass  obstructive  coronary  atherosclerotic  disease  preceded  percutaneous  revascularization  by  about  a  decade.  In  that  relatively  short  period  of  time,  the  inferiority  of  venous  compared  to  arterial  grafts  and  the  potential  for  atheroembolization  with  vein  graft  manipulation  at  surgery  had  become  apparent.  When  Andreas  Gruentzig  reported  the  first  50  patients  treated  with  percutaneous  coronary  angioplasty  in  1979,  5  had  undergone  saphenous  vein  graft  (SVG)  dilatation,  and  3  (60%)  had  developed  restenosis,  leading  him  to  surmise  “the  different  kind  of  disease  may  explain  the  high  incidence  of  recurrence  in  graft  stenosis”  and  to  question  the  wisdom  of  percutaneous  SVG  intervention.1  In  the  more  than  35  years  since  that  observation,  interventional  cardiologists  have  struggled  with  the  indications  for  SVG  intervention  because  of  higher  acute  complications,  more  restenosis  than  was  observed  in  native  coronary  arteries  and  arterial  grafts,  rapid  disease  progression  in  nontarget  sites,  and  high  late  cardiac  event  rates.  By  1983,  outcomes  of  SVG  intervention  had  been  more  completely  characterized,  and  the  first  left  internal  mammary  artery  intervention  had  been  reported.2  In  a  subsequent  summary  of  several  thousand  reported  cases  of  balloon  angioplasty  in  SVGs,  procedural  mortality  was  less  than  1%,  Q-wave  infarction  occurred  in  less  than  2%  of  cases,  and  emergency  surgery  was  required  in  0.3%  to  4%  of  cases.3  A  gradient  was  observed  in  SVG  restenosis  rates,  with  very  high  rates  approaching  70%  at  proximal  anastomoses  and  progressively  lower  rates  in  more  distal  locations  (see  discussion  mid-SVG  and  distal  anastomosis).  Subsequent  maturation  of  graft  percutaneous  coronary  intervention  (PCI)  occurred  with  improved  understanding  of  patient  and  lesion  selection,  application  of  stents  and  embolic  protection  strategies,  prediction  and  prevention  of  complications,  and  use  of  intravascular  imaging  as  discussed  below.  Unfortunately,  the  goal  of  procedural  and  long-term  safety  and  optimal  durability  of  graft  PCI  has  been  illusive  following  treatment  with  SVGs.