A retrospective review of the population of patients after angioplasty on venous grafts

Background:

In patients with ischemic heart disease requiring coronary artery bypass graft surgery (CABG), saphenous vein graft (SVG) is used in addition to the arterial grafts bypass. Treatment of SVG is complex and challenging. Previous studies did not show advantage for any type of stents implantation over the other.

Objectives:

To review the demographic data, risk factors, outcome and complications of SVG’s use in CABG surgery and on this basis to build an algorithm for optimal treatment.

Methods:

A retrospective study of patients who underwent angioplasty for SVG’s during 2005-2015 in a tertiary care hospital. Two hundred thirty eight patients were reviewed. Thereafter they were divided into two groups: 2005-2009 (group A) and 2010-2015 (group B) and the comparison was performed according to the demographic data, risk factors, time from CABG, as well as angiographic features.

Results:

Among the 238 patients, 226 (95%) were male, mean age 68±22y, 177 (74.4%) suffered from hypertension, 134 (56.3%) suffered from diabetes mellitus. Mean period from CABG was 12y. Severity of the stenosis was at least 50% in 83% of the population. Distal protection devices were used in only 31 (22%) patients.

TIMI III flow was achieved in both groups in a high rate (95%). Contrast mean amount used was 174.8 ml per procedure and larger amount of contrast was used in group A (186 vs 137 ml, p=0.0018, respectively). There was more frequent use of covered stents in group B as compared with group A (18.8% vs 2.1%, p=0.003, respectively), as was the use of protection devices (36.4% vs 9.5%, p=0.0002).

Conclusions:

Progression of the technologies and mainly the use of protection devices lowered the rate of complications while intervention on SVGs. Over the years there has been a tendency to treat more criticaly ill patients with longer time since surgery.