Current Management Of Saphenous Vein Graft Disease

Abstract

The percutaneous management of saphenous vein graft disease is rapidly changing and continues to be an ongoing challenge for the interventional cardiologist. As compared to percutaneous coronary intervention in native vessels, graft vessel interventions are associated with sub-optimal results, increased major adverse cardiac events and less favorable long-term results. The arrival of stents, better antithrombotic medication, distal protection and thrombectomy devices have made it possible to attempt interventions in larger number of patients and obtain favorable results. The results vary according to age of the graft, clinical presentation and thrombus load. Chronically occluded vein grafts still pose the biggest challenge. While treating a patient with saphenous vein graft disease, a choice should be made between treatment of native vessels, repeat bypass surgery and a vein graft intervention. The first choice should be an intervention of the native vessel if feasible. Repeat coronary artery bypass surgery should be seriously considered particularly if arterial grafts can be implanted. The last choice should be intervention on saphenous venous grafts and should include implantation of a stent along with use of a distal protection device. Drug coated stents may change the scenario and future data in this field is eagerly awaited. Aggressive atherosclerosis modification and intensive medication should continue in all these patients to improve the long -term survival.