title: Outcomes of percutaneous coronary intervention of chronic total saphenous vein graft occlusions in the contemporary era.
abstract: BACKGROUND
  Percutaneous coronary intervention of a chronic total occlusion to a saphenous vein graft is currently not recommended because the benefit/risk ratio is considered unfavorable. However, there is a patient subset with clinical ischemia, and PCI of the native chronic total occlusion (CTO) is unfavorable. In this setting, PCI to the saphenous vein graft (SVG) may have utility. We reviewed our experience to determine its value in the modern era.
  
  
  RESULTS
  This was a single-center retrospective study of all patients undergoing PCI to SVG CTO. Of 161 patients undergoing SVG PCI during the study period, 27 patients underwent 28 SVG CTO PCI, which was technically successful in 79% (22/28). There were 2 intra-procedural Q wave myocardial infarctions. At 30 days there were no adverse events after hospital discharge. Angina relief was significantly better at 30 days in successful (n = 21) vs. unsuccessful (n = 6) PCI(90% vs. 33% P < 0.01). At the last available follow-up (591 ± 407 days), angina improvement persisted (80.1% vs. 33%, P < 0.01). Long-term adverse events were not significantly different between the two groups.
  
  
  CONCLUSIONS
  PCI to SVG CTO is feasible with a reasonable success rate, safety profile, and improvement in angina in contemporary practice. This approach may be considered in highly selected patients where revascularization to the ischemic territory is appropriate and the native CTO is technically difficult to recanalize.
authors.affiliation: Department of Medicine, University of Arkansas for Medical Sciences, Central Arkansas Veterans Health System, Little Rock, Arkansas.
authors.forename: Nadish
authors.initials: N
authors.lastname: Garg
authors.forename: Abdul
authors.initials: A
authors.lastname: Hakeem
authors.forename: Freij
authors.initials: F
authors.lastname: Gobal
authors.forename: Barry F
authors.initials: BF
authors.lastname: Uretsky
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D016896:Treatment Outcome
keywords: angioplasty; chronic total occlusion; guidelines; percutaneous coronary intervention; saphenous venous graft