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(Circulation. 2003;107:2284.)
© 2003 American Heart Association, Inc.

Editorial

Percutaneous Treatment of Saphenous Vein Bypass Graft Obstructions

A Continuing Obstinate Problem

P.J. de Feyter, MD

From Erasmus Medical Centre, Rotterdam, the Netherlands.

Correspondence to Prof Dr P.J. de Feyter, Thoraxcenter, Room Bd 410, Erasmus Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. E-mail defeyter@card.azr.nl

Key Words: Editorials • veins • bypass • occlusion

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Percutaneous coronary intervention has made great strides since its inception and is nowadays the most frequently used modality for revascularization of coronary obstructions. Remaining problems are the treatment of chronic total occlusions, the occurrence of in-stent restenosis (although this may now be resolved, albeit not completely, by drug-eluting stents), and lastly the treatment of saphenous vein bypass graft (SVBG) obstructions.

See p 2331

Percutaneous treatment of SVBG obstructions is notoriously difficult because it often results in inadequate dilatation, a high likelihood of distal embolization associated with mortality and significant morbidity, and a high restenosis rate.¹ The difficulties in the percutaneous treatment of SVBG lesions are largely related to the extent and severity of vein graft atherosclerotic disease, which progresses unrelentingly over time, such that 10 years after bypass operation almost 50% of the vein grafts are occluded.

Atherosclerosis of the vein graft is associated with large, soft, and friable plaques containing necrotic debris, cholesterol crystals, foam cells, and blood elements, and there is often overlying thrombotic material, particularly in older degenerated grafts. Occlusive obstructions are often extended over a long segment of the graft, while the remainder of the graft is diffusely diseased.² Instrumentation of these friable lesions carries a high risk of distal embolization with subsequent myocardial necrosis. Distal embolization is of great concern because there appears to be no adequate treatment, and it must therefore be prevented.

Percutaneous Treatment of Nonocclusive SVBG Obstructions

Percutaneous treatment of SVBG lesions was attempted in the early days of balloon angioplasty. In selected patients with focal lesions, the . . . [Full Text of this Article]

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