Angioplasty of Saphenous Vein Grafts After Coronary Artery Bypass Surgery: A Single-Center Retrospective Study with Literature Review
DOI:
https://doi.org/10.5281/zenodo.19136330Keywords:
CABG, CORONARY ARTERY DISEASE, coronary artery bypass grafting, saphenous vein graft, percutaneous coronary intervention, angioplasty, distal embolization, embolic protection devices, drug-eluting stents, acute coronary syndromeAbstract
In many patients undergoing coronary artery bypass graft surgery (CABG), venous saphenous grafts (SVG) are used in addition to arterial grafts. Treatment of degenerated and occluded venous grafts is complex and challenging. Angioplasty on occluded venous bypass grafts involves a high rate of complications (such as massive distal embolization).
Objectives:
To review the demographic data, risk factors, outcomes, and complications of SVG use in CABG surgery, and on this basis to build an algorithm for optimal treatment.
Methods:
A retrospective study of patients who underwent angioplasty of saphenous vein grafts (SVGs) between 2005 and 2015 in a tertiary care hospital. Patients were divided into two groups: 2005–2009 (group A) and 2010–2015 (group B), and the comparison was performed according to demographic data, risk factors, time from CABG, as well as angiographic features.
Results:
Among the 238 patients, 226 (95%) were male, with a mean age of 68±22 years.
74.4% suffered from hypertension, 56.3% from diabetes mellitus, 17.2% from chronic kidney disease, and 99% had a history of previous myocardial infarction.
62% of patients were admitted due to ACS.
Distal protection devices were used in only 31 (22%) patients.
Intervention was performed mainly on the right and circumflex coronary arteries.
A lower amount of contrast was used in group B (186 vs 137 mL, p=0.0018).
There was more frequent use of covered stents in group B (18.8% vs 2.1%, p=0.003), as well as increased use of protection devices (36.4% vs 9.5%, p=0.0002).
Conclusions:
The progression of technologies, mainly the use of protection devices, lowered the rate of complications during intervention on SVGs. This was also reflected in the reduced amount of contrast material used and lower incidence of kidney injury. Over the years, there has been a tendency to treat more severely ill patients with longer time since surgery (“older” grafts).
Keywords: coronary artery bypass grafting; saphenous vein graft; angioplasty; complications; distal embolization; protection devices; stents; acute coronary syndrome
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