Late changes in saphenous vein coronary artery bypass grafts and their implications in clinical practice.
Late changes are frequent in saphenous vein grafts. About 10 to 12 years after bypass, about one-third are occluded, one-third have wall irregularities and narrowings attributed to atherosclerosis and one-third are seemingly intact. These changes are associated with recurrence of angina and other deleterious clinical events such as unstable angina, acute myocardial infarction, heart failure and death. Intimal fibrous hyperplasia may be a precursor of these changes, which could be minimized by appropriate surgical technologies and perhaps antiplatelet therapy. These late changes appear related to serum hyperlipidemia and smoking. Optimal control of these risk factors may retard their development and subsequent clinical deterioration. Although internal mammary artery (IMA) graft is the conduit of choice because of its apparent immunity to premature atherosclerosis, and hence its longer durability, saphenous vein grafts are still placed in many old patients and others, when a short operation time is a priority, and above all in combination with IMA grafts in order to obtain complete revascularization.
D000328:Adult; D000368:Aged; D000792:Angiography; D001161:Arteriosclerosis / Q000000981:diagnostic imaging; D002318:Cardiovascular Diseases / Q000209:etiology; D001026:Coronary Artery Bypass; D005260:Female; D006083:Graft Occlusion, Vascular / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000637:transplantation; D008875:Middle Aged; D011183:Postoperative Complications; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D013997:Time Factors; D014654:Vascular Patency