title: Clinical significance of distal embolization after transluminal extraction atherectomy in diffusely diseased saphenous vein grafts.
abstract: Standard balloon angioplasty of degenerated saphenous vein graft lesions may be complicated by distal embolization, particularly in the presence of intragraft thrombus. Transluminal extraction atherectomy may be useful in this setting because of its ability to remove particulate debris. This study was designed to identify the incidence and prognostic significance of distal embolization after transluminal extraction atherectomy in high-risk saphenous vein graft lesions. To address these issues the clinical course of 65 consecutive patients (86 high-risk saphenous vein graft lesions) was reviewed after extraction atherectomy. Distal embolization occurred in 11 (12.8%) of 86 high-risk lesions. The majority (63.6%) of these episodes occurred after adjunct balloon dilatation following uncomplicated use of the extraction atherectomy catheter. Correlates of distal embolization included patient age and the presence of intragraft thrombus. Major in-hospital complications developed more often in patients with distal embolization (46% vs 2% in those without distal embolization, p < 0.001), resulting in a reduced procedural success rate in this group (55% vs 91%, p = 0.01). We conclude that the risk of distal embolization after saphenous vein graft angioplasty, although potentially reduced, is not eliminated with transluminal extraction atherectomy, particularly in lesions with superimposed thrombus.
authors.affiliation: Department of Internal Medicine (Cardiology Division), Washington Hospital Center, Washington, DC 20010.
authors.forename: M K
authors.initials: MK
authors.lastname: Hong
authors.forename: J J
authors.initials: JJ
authors.lastname: Popma
authors.forename: A D
authors.initials: AD
authors.lastname: Pichard
authors.forename: K M
authors.initials: KM
authors.lastname: Kent
authors.forename: L F
authors.initials: LF
authors.lastname: Satler
authors.forename: Y C
authors.initials: YC
authors.lastname: Chuang
authors.forename: G S
authors.initials: GS
authors.lastname: Mintz
authors.forename: M B
authors.initials: MB
authors.lastname: Keller
authors.forename: M B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000706:statistics & numerical data; D017225:Atherectomy, Coronary / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D002932:Cineangiography; D017023:Coronary Angiography; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D013223:Statistics as Topic; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome