Percutaneous treatment of diseased saphenous vein grafts: current state-of-the-art and future directions.
The percutaneous treatment of patients with obstructive atherosclerotic disease in diseased coronary saphenous vein bypass grafts still remains a challenge in interventional cardiology. We discuss the actual evidence-based knowledge for the percutaneous management of this lesion subset, focusing on the devices that are actually considered the gold standard for this treatment: bare-metal stents and distal protection devices. We also comment the negative results of the trials regarding the promising covered stent-grafts. We finally offer insights into the currently available evidence for the use of drug-eluting stents in saphenous vein grafts. These devices are potentially a promise for the successful sealing of vein graft disease, however, available long-term safety and effectiveness data are conflicting and give reason for caution.
Vermeersch
P
P
Antwerp Cardiovascular Institute Middelheim, AZ Middelheim, Antwerp, Belgium. paul.vermeersch@zna.be
Agostoni
P
P
D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control; D054855:Drug-Eluting Stents; D019317:Evidence-Based Medicine; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D012501:Saphenous Vein / Q000473:pathology / Q000637:transplantation*; D016896:Treatment Outcome