title: Intervention in the occluded vein graft: with high risk can come great reward: review of techniques with case examples.
abstract: Total occlusion of a saphenous vein graft (SVG) can present as abrupt thrombotic occlusion in an atherosclerotic graft with resultant acute cardiac events or chronic total occlusion (CTO) with resultant angina symptoms. The risks of percutaneous coronary intervention (PCI) within an occluded graft include not only periprocedural myocardial infarction (MI), but also the risks that come part and parcel with any CTO intervention which include an increased probability of procedural failure, vessel perforation, dissection, high radiation, and contrast exposure, and the potential for worse outcomes. PCI of a chronically occluded graft remains a class III indication in current PCI guidelines because of the increased procedural risk and modest clinical data supporting improved outcomes. Acute-type occlusions, with bulky and thrombotic obstruction, while not specifically addressed in the guidelines, are also fraught with somewhat similar risks. In this review, we describe four case scenarios with occluded SVG and discuss challenges and techniques and available evidence that support these interventions.
authors.affiliation: Department of Medicine, Division of Cardiology, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, 4300 W. 7th Street, Little Rock, AR 72205 USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cook
authors.forename: Barry F
authors.initials: BF
authors.lastname: Uretsky
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sachdeva
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000209:etiology; D000792:Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D054855:Drug-Eluting Stents; D006083:Graft Occlusion, Vascular / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D013927:Thrombosis / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors