title: Applicability of distal protection for aortocoronary vein graft interventions in clinical practice.
abstract: Percutaneous revascularization of diseased saphenous vein grafts is associated with increased risk of adverse events, although the use of distal protection mitigates this to a significant extent. However, anatomic characteristics may preclude the use of such devices in a proportion of vein grafts intended for percutaneous treatment. We reviewed our consecutive experience of saphenous vein graft interventions from 1 May 2001 through 30 April 2002 to determine suitability for distal protection. Relevant angiographic characteristics included lesion within 5 mm of the ostium; lesion < 20 mm from the distal anastomosis; planned distal landing site of the occlusion balloon < 3 mm or > 6 mm in diameter; total occlusion of the vein graft; or lesion in a sequential vein graft distal to the first anastomosis. One hundred twenty-seven patients (140 procedures, 147 vein grafts) were treated. One or more of the angiographic exclusion criteria for a balloon occlusion protection system existed in 57% of grafts, while 42% had exclusions for a filter device. A large number of patients with vein graft disease intended for percutaneous treatment have anatomic exclusions to available distal protection technology.
authors.affiliation: Mayo Clinic, Rochester, Minnesota 55905, USA. mathew.verghese@mayo.edu
authors.forename: Verghese
authors.initials: V
authors.lastname: Mathew
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: John F
authors.initials: JF
authors.lastname: Bresnahan
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000601:surgery* / Q000637:transplantation; D016896:Treatment Outcome