Post-coronary Artery Bypass Grafting – Degenerated Saphenous Vein Graft Intervention, or Native Vessel Coronary Chronic Total Occlusion Recanalisation?

Abstract

Coronary artery bypass grafting (CABG) has dramatically changed the management of patients with ischaemic heart disease. Saphenous vein grafts (SVGs) are the most common type of grafts used in CABG, but have a progressive occlusion rate reaching 50 % at 10 years post-surgery. Treatment of SVG stenosis with percutaneous coronary intervention (PCI) is limited by the substantial risk of major adverse cardiac events. Moreover, conflicting data exist regarding the efficacy of bare metal and drug-eluting stents in SVG lesions. Success rates for the recanalisation of coronary chronic total occlusions with PCI using modern techniques and materials can be in excess of 90 % if performed by experienced operators. We report on the case of a patient who had previously undergone CABG and presented with multivessel disease and a degenerating SVG in a chronically occluded dominant left circumflex coronary artery. We address the dilemma of whether to revascularise the degenerating SVG graft, or to recanalise the chronically occluded native vessel.