Current percutaneous treatment strategies for saphenous vein graft disease.
Coronary artery bypass graft surgery remains one of the most widely performed surgical procedures in North America and aortocoronary saphenous vein grafts (SVG) are the most frequently used surgical conduits. SVG disease (SVGD) remains the leading cause of symptomatic coronary artery disease postcoronary artery bypass graft. When optimal medical therapy is ineffective, repeat surgery is associated with higher mortality combined with less favorable clinical and angiographic results, thus percutaneous revascularization on SVG is currently the standard of care for the revascularization of SVGD. Balloon angioplasty, bare metal stents, polytetrafluoroethylene-covered stents, and drug-eluting stents have been extensively investigated for SVG interventions. Multiple recent randomized trials and meta-analyses have confirmed the pathophysiologic and clinical differences between SVGD and coronary artery disease. Decisions such as patient selection, premedication, stent, and protection device characteristics should be carefully considered to achieve optimal procedural and clinical results. Acute coronary syndromes due to SVG involvement, chronic total occlusions, retrograde approaches, and SVG perforation management are newer fields requesting additional research.
William Beaumont Hospital, Royal Oak, Michigan; Montreal Heart Institute, Montreal, Quebec, Canada.
Kostantinos
K
Marmagkiolis
Cindy
C
Grines
Luc
L
Bilodeau
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D057505:Embolic Protection Devices; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D018579:Patient Selection; D011474:Prosthesis Design; D012086:Reoperation; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D015607:Stents; D016896:Treatment Outcome
D002317:Cardiovascular Agents