Aortocoronary Saphenous Vein Graft Research Articles

Aneurysm of a saphenous vein coronary graft mimicking a cardiac mass

British Journal of Hospital MedicineEarly view Images in MedicineAneurysm of a saphenous vein coronary graft mimicking a cardiac massAyşe Füsun Bekirçavuşoğlu, Süleyman BekirçavuşoğluAyşe Füsun BekirçavuşoğluCorrespondence to: Ayşe Füsun Bekirçavuşoğlu; E-mail Address: [email protected]Department of Radiology, Bursa City Hospital, Nilüfer, TurkeySearch for more papers by this author, Süleyman BekirçavuşoğluDepartment of Radiology, Bursa City Hospital, Nilüfer, TurkeySearch for more papers by this authorAyşe Füsun Bekirçavuşoğlu; Süleyman BekirçavuşoğluPublished Online:22 May 2023https://doi.org/10.12968/hmed.2022.0550AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Ramirez FD, Hibbert B, Simard T et al.. Natural history and management of aortocoronary saphenous vein graft aneurysms: a systematic review of published cases. Circulation. 2012;126(18):2248–2256. https://doi.org/10.1161/CIRCULATIONAHA.112.101592 Crossref, Medline, Google ScholarTávora FR, Jeudy J, Burke AP. Multiple aneurysms of aortocoronary saphenous vein grafts with fatal rupture. Arq Bras Cardiol. 2007;88(5):e107–e110. https://doi.org/10.1590/S0066-782X2007000500022 Medline, Google Scholar FiguresReferencesRelatedDetails Ahead of PrintISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 22 May 2023 Information© MA Healthcare LimitedPDF download

AORTOCORONARY SAPHENOUS VEIN GRAFT ANEURYSM: A SILENT COMPLICATION

AORTOCORONARY SAPHENOUS VEIN GRAFT ANEURYSM: A SILENT COMPLICATION

Early Stage of Atherosclerosis in Aortocoronary Saphenous Vein Grafts: Intravascular Ultrasound Study.

IntroductionAngiographically visible plaques in patent vein grafts are usually detected years after surgery. Our aim was to examine early plaque formation in vein grafts.MethodsBypass angiography and intravascular ultrasonography (IVUS) examination were performed on 77 aortocoronary saphenous vein grafts (SVGs) implanted in 36 patients during the first 2 years after CABG. In each graft, a good quality 25 mm ultrasound image was analyzed. We measured: plaque area, lumen area, external elastic membrane (EEM) area, graft area and wall area. For the comparative assessment of SVGs, the index plaque area/EEM area was calculated. Data were analyzed for the following 4 time periods: I – 0-4 months (22 grafts), II – 5-8 months (23 grafts), III – 9-12 months (19 grafts) and IV – 13-16 months (13 grafts) after CABG. Student’s t and Fisher-Snedecor tests were used for the purpose of statistical analysis in this retrospective study.ResultsIn period I, plaque formation (neointimal) was observed in 10 grafts (45%), with a mean plaque area of 1.59 mm., in 6 grafts (26%) in period II, with a mean plaque area of 1.03 mm. and in 15 grafts (71%) in period III, with a mean plaque area of 1.41 mm., and in all (100%) grafts in period IV, with mean plaque area of 2,3 mm.. Average index plaque area/EEM area in periods I, II, III and IV were 0.12, 0.08, 0.13 and 0.22. We have showed a significant plaque increase between periods II and IV(P=0.038).ConclusionIVUS showed plaque in about 40% of venous grafts during the first year after CABG. Between 13-16 months plaque was visible in all studied grafts.

Saphenous vein graft near-infrared spectroscopy imaging insights from the lipid core plaque association with clinical events near-infrared spectroscopy (ORACLE-NIRS) registry.

We sought to examine near-infrared spectroscopy (NIRS) imaging findings of aortocoronary saphenous vein grafts (SVGs). SVGs are prone to develop atherosclerosis similar to native coronary arteries. They have received little study using NIRS. We examined the clinical characteristics and imaging findings from 43 patients who underwent NIRS imaging of 45 SVGs at our institution between 2009 and 2016. The mean patient age was 67 ± 7 years and 98% were men, with high prevalence of diabetes mellitus (56%), hypertension (95%), and dyslipidemia (95%). Mean SVG age was 7 ± 7 years, mean SVG lipid core burden index (LCBI) was 53 ± 60 and mean maxLCBI4 mm was 194 ± 234. Twelve SVGs (27%) had lipid core plaques (2 yellow blocks on the block chemogram), with a higher prevalence in SVGs older than 5 years (46% vs. 5%, P = 0.002). Older SVG age was associated with higher LCBI (r = 0.480, P < 0.001) and higher maxLCBI4 mm (r = 0.567, P < 0.001). On univariate analysis, greater annual total cholesterol exposure was associated with higher SVG LCBI (r = 0.30, P = 0.042) and annual LDL-cholesterol and triglyceride exposure were associated with higher SVG maxLCBI4 mm (LDL-C: r = 0.41, P = 0.020; triglycerides: r = 0.36, P = 0.043). On multivariate analysis, the only independent predictor of SVG LCBI and maxLCBI4mm was SVG age. SVG percutaneous coronary intervention was performed in 63% of the patients. An embolic protection device was used in 96% of SVG PCIs. Periprocedural myocardial infarction occurred in one patient. Older SVG age and greater lipid exposure are associated with higher SVG lipid burden. © 2016 Wiley Periodicals, Inc.

Aspirate from human stented saphenous vein grafts induces epicardial coronary vasoconstriction and impairs perfusion and left ventricular function in rat bioassay hearts with pharmacologically induced endothelial dysfunction.

Stent implantation into aortocoronary saphenous vein grafts (SVG) releases particulate debris and soluble vasoactive mediators, for example, serotonin. We now analyzed effects of the soluble mediators released into the coronary arterial blood during stent implantation on vasomotion of isolated rat epicardial coronary artery segments and on coronary flow and left ventricular developed pressure in isolated perfused rat hearts. Coronary blood was retrieved during percutaneous SVG intervention using a distal occlusion/aspiration protection device in nine symptomatic patients with stable angina pectoris and a flow‐limiting SVG stenosis. The blood was separated into particulate debris and plasma. Responses to coronary plasma were determined in isolated rat epicardial coronary arteries and in isolated, constant pressure‐perfused rat hearts (±nitric oxide synthase [NOS] inhibition and ±serotonin receptor blockade, respectively). Coronary aspirate plasma taken after stent implantation induced a stronger vasoconstriction of rat epicardial coronary arteries (52 ± 8% of maximal potassium chloride induced vasoconstriction [% KClmax = 100%]) than plasma taken before stent implantation (12 ± 8% of KClmax); NOS inhibition augmented this vasoconstrictor response (to 110 ± 15% and 24 ± 9% of KClmax). Coronary aspirate plasma taken after stent implantation reduced in isolated perfused rat hearts only under NOS inhibition coronary flow by 17 ± 3% and left ventricular developed pressure by 25 ± 4%. Blockade of serotonin receptors abrogated these effects. Coronary aspirate plasma taken after stent implantation induces vasoconstriction in isolated rat epicardial coronary arteries and reduces coronary flow and left ventricular developed pressure in isolated perfused rat hearts with pharmacologically induced endothelial dysfunction.

Neointima development in externally stented saphenous vein grafts.

IntroductionThe main limitation of coronary artery bypass grafting (CABG) is rapid neointimal hyperplasia leading to graft failure.AimTo assess plaque formation in saphenous vein grafts (SVG) covered by an external Dacron stent in comparison with the classical technique.Material and methodsIn the study group vein grafts covered by external stent mesh made of Dacron were implanted. An intravascular ultrasonography (IVUS) study was performed in 35 aorto-coronary SVG covered by an external Dacron stent and in 64 normal SVG during the first year after CABG. In each SVG 25 mm of good quality IVUS image, volumes of lumen, plaque (neointima), outer border of the vein graft (external SVG) and adventitia were calculated in three time periods: 0–130 days, 130–260 days and 260–390 days.ResultsBetween the first and second time period, lumen volume (mm3) was reduced from 10.33 ±4.4, to 6.80 ±2.23 in the second period and 5.69 ±1.26 in the third one. This effect was much less marked in normal grafts. The corresponding lumen volume (mm3) was: 10.90 ±3.9, 9.15 ±2.94 and 8.92 ±2.93 in consecutive time periods. Plaque volume (mm3) did not change in control grafts during the course of the study, but it increased very significantly in stented grafts from 0.86 ±1.24 in the first period to 2.70 ±1.58 in the second and 3.29 ±2.66 in the third one.ConclusionsThe experimental technique of implanting SVG covered with an external elastic Dacron stent seems to be inferior to traditional ones. This is probably due to the more complicated process of vein implantation and higher micro-injury occurrence during the surgery.

GRAFT PATENCY OF AN ALTERNATIVE CORONARY BYPASS GRAFTING TECHNIQUE: THE SAPHENOUS VEIN BRIDGE - COHORT STUDY

GRAFT PATENCY OF AN ALTERNATIVE CORONARY BYPASS GRAFTING TECHNIQUE: THE SAPHENOUS VEIN BRIDGE - COHORT STUDY

Bilateral Saphenous Vein Graft Aneurysms

SESSION TITLE: Procedures Case Report Posters SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: More than 50 years have passed since CABG was first successfully performed in humans. Despite many improvements in surgical technique, complications of CABG continue to occur. Here, we present a rare case of bilateral saphenous vein graft aneurysm as a late complication of CABG. CASE PRESENTATION: 77 yo man with CAD status post CABG 12 years ago, presented for evaluation of chest pain and dyspnea. On examination, his vitals were stable and his exam was unremarkable. Basic labs, including cardiac enzymes, were unrevealing. A chest x-ray demonstrated fullness in the right hilum worrisome for a mass (1). CT of the chest with contrast confirmed two large anterior mediastinal masses as well as mediastinal lymphadenopathy. Percutaneous CT guided biopsy showed only blood and was complicated by a hemothorax. Further work up with bronchoscopy and biopsy was non diagnostic. Coronary CT angiography revealed aneurysms of two coronary bypass vein grafts (2). The right graft was patent to the RCA, but the left was occluded. Patient was offered surgical treatment, but he declined, opting for conservative management. He is doing well 1 year after initial diagnosis. DISCUSSION: Saphenous Vein Graft Aneurysm (SVGA) is a rare complication of CABG. The overall incidence is likely less than 0.5% of grafts. Proposed etiologies include exposure to arterial pressures, atherosclerotic changes, infection, and technical factors during harvest and transplant. Typical presentation is with chest pain, dyspnea, and MI, but a large number of patients are asymptomatic. Multiple studies have documented aneurysmal enlargement, however the rate of growth is variable. Large aneurysms have higher rates of mechanical complications, but increasing size has not been demonstrated to increase the risk of rupture or death. Treatment data is limited, with some case series advocating conservative management 1, and others suggesting surgical treatment 2. Recently, increasing percutaneous options are becoming available. CONCLUSIONS: Anterior mediastinal mass with a history of CABG should raise suspicion for SVGA. More data is needed to determine optimal treatment. Reference #1: Dieter, R. S., et al. (2003). “Conservative vs. invasive treatment of aortocoronary saphenous vein graft aneurysms: Treatment algorithm based upon a large series.” Cardiovasc Surg 11(6): 507-513. Reference #2: Sareyyupoglu, B., et al. (2009). “Surgical treatment of saphenous vein graft aneurysms after coronary artery revascularization.” Ann Thorac Surg 88(6): 1801-1805. DISCLOSURE: The following authors have nothing to disclose: Michael Tatusov No Product/Research Disclosure Information

Long-term outcomes with first- vs. second-generation drug-eluting stents in saphenous vein graft lesions.

As compared with bare metal stents, first-generation drug-eluting stents (DES) improved post-procedural outcomes in aortocoronary saphenous vein graft (SVG) lesions, but there is limited information on outcomes after use of second-generation DES in SVGs. We compared the outcomes of patients who received first- (n = 81) with those who received second-generation (n = 166) DES in SVG lesions at our institution between 2006 and 2013. Major adverse cardiac events (MACE) were defined as the composite of all-cause death, myocardial infarction, and target vessel revascularization. Mean age was 66.0 ± 8.1 years and 97.6% of the patients were men. Mean SVG age was 11.1 ± 0.4 years. First-generation DES were sirolimus-eluting (n = 17) and paclitaxel-eluting (n = 64) stents. Second-generation DES were everolimus-eluting (n = 115) and zotarolimus-eluting (n = 51) stents. Median follow-up was 41 months. At 2-years post-procedure, patients with first- and second-generation DES had similar rates of death (20.91% vs. 20.27%, P = 0.916), target lesion revascularization (16.39% vs. 20.00%, P = 0.572), target vessel revascularization (20.97% vs. 23.16%, P = 0.747), myocardial infarction (26.15% vs. 23.00%, P = 0.644), and MACE (43.5% vs. 40.87%, P = 0.707), respectively. Outcomes with first- and second-generation DES in SVGs are similar. Novel stent designs are needed to further improve the clinical outcomes in this challenging patient and lesion subgroup. © 2015 Wiley Periodicals, Inc.

Complete Revascularization of the Three-Vessel Territories Using a Left Internal Thoracic Artery Composite Graft

We evaluated whether revascularization using a Y-composite graft based on the left internal thoracic artery (ITA) is sufficient for patients with 3-vessel disease. Of 542 patients who underwent complete revascularization for 3-vessel disease, patients who received either single inflow from a left ITA-based Y-composite graft (group S, n = 297) or who received multiple inflows (including bilateral in situ ITAs, in situ right gastroepiploic artery, or aortocoronary grafts) (group M, n = 245) were compared. Clinical outcomes and myocardial perfusion improvement during the first postoperative year were studied. Baseline differences between groups were adjusted by inverse probability of treatment weighting (IPTW). Median follow-up duration was 94 (2 to 176) months. There were no differences in early mortality (4 of 297 vs 4 of 245; p > 0.999) and morbidity rates between the 2 groups, except atrial fibrillation (which was higher in group S than in group M; p < 0.001). There were no differences between the 2 groups in IPTW-adjusted overall survival, freedom from cardiac death, and freedom from major adverse cardiac and cerebrovascular events at 5 and 10 years (group S, 85.2% and 76.2% vs group M, 88.6% and 74.1%, p = 0.990). The IPTW-adjusted Cox proportional hazard model demonstrated that age (p = 0.030) and aortocoronary saphenous vein grafting (p = 0.002) were risk factors for major adverse cardiac and cerebrovascular events. Myocardial single photon emission computed tomography performed preoperatively, and 3 months and 1 year postoperatively demonstrated similar patterns of myocardial perfusion improvement between the 2 groups (p = 0.483). Revascularization using a Y-composite graft based on the left ITA for single inflow was sufficient for patients with 3-vessel disease in terms of early and long-term clinical outcomes and myocardial perfusion improvement.

Aspirate from stented aortocoronary saphenous vein grafts reduces coronary flow and left ventricular pressure in an isolated perfused rat hearts

BackgroundStent implantation into aortocoronary saphenous vein grafts (SVG) releases not only particular debris but also soluble factors which compromise coronary blood flow: using rat mesenteric arteries as bioassay, we have identified serotonin as the main vasoconstrictor. We now addressed the effects of aspirate on the coronary microcirculation and left ventricular function.MethodsIn 16 patients with significant SVG stenoses, arterial plasma was withdrawn before stent implantation and aspirate was retrieved after stent implantation under protection with a distal occlusion/aspiration device. Isolated rat hearts were perfused at constant pressure with Krebs‐Henseleit buffer containing 4% bovine albumin. Plasma was infused (2ml/min) into rat hearts (± NOS‐inhibition: L‐NAME 100µM; ± serotonin receptor blockade: ketanserin (10‐6 M) and pindolol (10‐7 M)). Changes of coronary flow (CF) and left ventricular pressure (LVP) are expressed relative to baseline before plasma application.ResultsAspirate plasma reduced CF and LVP more than arterial plasma, however, only during NOS‐inhibition (arterial vs. aspirate plasma; CF [Δml/min]: ‐1.2±0.3 vs. ‐1.6±0.6, LVP [ΔmmHg]:‐11±2 vs.‐15±‐3). Effects of aspirate on CF and LVP were largely attenuated by serotonin receptor blockade.ConclusionIn isolated rat hearts with impaired endothelial function, soluble factors within coronary aspirate, notably serotonin, compromise coronary microcirculation and left ventricular function.

Impacts of Intraoperative Flow on Graft Patency of Sequential and Individual Saphenous Vein Grafts

ObjectiveWe sought to delineate the predictor of saphenous vein graft (SVG) failure and to evaluate the impact of sequential grafting of SVG on graft flow as the significant predictor of patency.MethodsAngiograms and clinical records of 439 patients who underwent coronary artery bypass grafting with aortocoronary SVG were reviewed. Of these, 708 distal anastomoses were created by 480 SVGs. Of 349 patients who underwent isolated coronary artery bypass grafting, operation was performed with an off-pump technique in 347 patients (99%). For 90 patients, a combined procedure on cardiopulmonary bypass was performed. A postoperative angiography was performed in 230 SVGs for clinical reasons. Insufficient flow (IF) was defined as a graft flow of 20 mL/min or less, measured by transit-time Doppler flowmetry during operation.ResultsIn 480 SVGs, 44 (9.2%) presented IF, and 24 SVGs presented partial or total occlusion. Six of the nine failed individual SVG had IF, whereas none of the failed sequential SVG was associated with IF. Univariate and multivariate logistic regression analyses demonstrated that IF (P = 0.002; odds ratio, 6.63) and sequential grafting (P = 0.004; odds ratio, 2.51) were significantly correlated with a failure of the SVG. The patency rate of sequential SVG to the most distal target was 78/93 (83.9%), which was significantly lower than 9/139 (93.5%) of the individual SVG (P = 0.02) and 7/113 (93.8%) of the sequential SVG to proximal targets (P = 0.02).ConclusionsWhen both targets seem to have sufficient demand, avoidance of sequential grafting would be reasonable. Moreover, the important target should be grafted by individual grafting or sequential proximal anastomosis.

Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial

BackgroundIn severe coronary artery disease, coronary artery bypass grafting (CABG) surgery is indicated to re-establish an adequate blood supply to the ischemic myocardium. Effectiveness of CABG surgery for symptom relief and mortality decrease should therefore depend on bypass graft patency. As bypass using a left internal mammary artery (LIMA)-to-left anterior descending coronary artery (LAD) anastomosis allows the best results in terms of graft patency, we designed a new surgical technique using a saphenous vein graft as a venous bridge to distribute the LIMA flow to the cardiac anterolateral territory. This novel strategy could extend the patency benefits associated to the LIMA. Other potential benefits of this technique include easier surgical technique, possibility to use saphenous vein grafts as vein patch angioplasty, shorter saphenous vein grafts requirement and reduced or eliminated manipulations of the ascendant aorta (and associated stroke risk).Methods/DesignBetween July 2012 and 2016, 200 patients undergoing a primary isolated CABG surgery using cardiopulmonary bypass with a LAD bypass graft and at least another target on the anterolateral territory will be randomized (1:1) according to 1) the new composite strategy and 2) the conventional strategy with a LIMA-to-LAD anastomosis and revascularization of the other anterolateral target(s) with a separated aorto-coronary saphenous vein graft. The primary objective of the trial is to assess whether the composite strategy allows non-inferior anterolateral graft patency index (proportion of non-occluded CABGs out of the total number of CABGs) compared to the conventional technique. The primary outcome is the anterolateral graft patency index, evaluated at one year by 256-slice computed tomography angiography. Ten years of clinical follow-up is planned to assess clinical outcomes including death, myocardial infarction and need for revascularization.DiscussionThis non-inferiority trial has the potential to advance the adult cardiac surgery field, given the potential benefits associated with the composite grafting strategy.Trial registrationClinicalTrials.gov: NCT01585285.

Current percutaneous treatment strategies for saphenous vein graft disease

Coronary artery bypass graft surgery remains one of the most widely performed surgical procedures in North America and aortocoronary saphenous vein grafts (SVG) are the most frequently used surgical conduits. SVG disease (SVGD) remains the leading cause of symptomatic coronary artery disease postcoronary artery bypass graft. When optimal medical therapy is ineffective, repeat surgery is associated with higher mortality combined with less favorable clinical and angiographic results, thus percutaneous revascularization on SVG is currently the standard of care for the revascularization of SVGD. Balloon angioplasty, bare metal stents, polytetrafluoroethylene-covered stents, and drug-eluting stents have been extensively investigated for SVG interventions. Multiple recent randomized trials and meta-analyses have confirmed the pathophysiologic and clinical differences between SVGD and coronary artery disease. Decisions such as patient selection, premedication, stent, and protection device characteristics should be carefully considered to achieve optimal procedural and clinical results. Acute coronary syndromes due to SVG involvement, chronic total occlusions, retrograde approaches, and SVG perforation management are newer fields requesting additional research.

Aortocoronary saphenous vein graft rupture during diagnostic angiography

Coronary saphenous vein graft (SVG) rupture during diagnostic angiography is a very rare but known complication of the procedure. It has typically been reported to occur at the site of pseudoaneurysms or secondary to an interventional procedure involving the graft. We present a case of SVG mid-body rupture during diagnostic angiography that occurred without evidence of pseudoaneurysmal changes.

Invited Commentary

The greater saphenous vein continues to be the most commonly used conduit for coronary artery bypass grafting (CABG). Despite the convenience of saphenous vein grafts (SVGs), the long-term durability remains inferior to arterial grafts, particularly the left internal mammary artery when grafted to the left anterior descending coronary artery. Up to 15% of aortocoronary SVGs are occluded by 1 year after CABG, and approximately 40% of SVGs are occluded at 10 years. In addition, only 50% of patent SVGs at this time point are free of significant stenosis.

Natural History and Management of Aortocoronary Saphenous Vein Graft Aneurysms

Despite ongoing advances in percutaneous revascularization, coronary artery bypass grafting (CABG) continues to be performed in a large number of patients, with >400 000 operations reported in 2007 in the United States alone.1 Although arterial conduits are generally preferred, saphenous vein grafts (SVGs) continue to be used regularly. First described by Riahi and colleagues2 in 1975, aneurysmal dilatation of aortocoronary SVGs remains a rare yet widely reported phenomenon. Indeed, subsequent literature on the topic consists almost exclusively of case reports and small case series. Thus, the precise incidence of aortocoronary SVG aneurysms (SVGAs) remains difficult to ascertain, although in 1 case series, an incidence of 0.07% was estimated from a review of >5500 grafts at a single institution.3 However, this likely underestimates the true number because SVGAs often remain clinically silent and no guidelines exist to screen for their development. Given the infrequent identification of SVGAs, our current understanding of the epidemiology and pathogenesis of these aneurysms remains limited. Aneurysms are generally defined as a focal dilatation of vessels >1.5 times the proximal reference diameter; however, aneurysmal dilatation of aortocoronary SVGs has led to “giant” aneurysm formation, with reports of cases exceeding 10 cm.4–6 SVGAs are often incidentally identified on imaging, but cases of rupture,7 fistula formation with neighboring anatomy,8 and hemodynamic compromise resulting from compression of adjacent cardiac and vascular structures have been reported.9 To date, 2 reviews have been published that briefly summarize 108 cases of SVGAs.10,11 Traditionally, their management has been surgical—generally resection of the aneurysm with or without bypass of the affected territory. However, with refinement of percutaneous techniques, including the use of Amplatzer devices, covered stents, and arterial coiling, the management options …

Saphenous vein aorto-coronary graft atherosclerosis in patients with chronic kidney disease: more plaque calcification and necrosis, but less vasoconstrictor potential

Atherosclerotic coronary arteries are more calcified in patients with than without chronic kidney disease (CKD). We addressed the potential for coronary microvascular obstruction in patients with and without CKD during stenting for saphenous vein aorto-coronary graft (SVG) stenosis under protection with a distal occlusion/aspiration device. In patients with and without CKD (n = 20/20), SVG plaque composition was analyzed from virtual histology using intravascular ultrasound analysis before stent implantation. There was more dense calcium and more necrotic core in patients with than without CKD (14 ± 3 vs. 3 ± 1 % and 21 ± 3 vs. 12 ± 2 % of plaque volume, respectively). Coronary aspirate was retrieved during stent implantation and divided into particulate debris and plasma. Patients with CKD had more particulate debris and calcium release than patients without CKD. In contrast, the release of serotonin was less in patients with than without CKD (0.4 ± 0.1 vs. 1.2 ± 0.3 μmol/L), whereas that of catecholamines, endothelin, tissue factor, thromboxane, tumor necrosis factor α, and C reactive protein was not significantly different. Confirming the biochemical results, aspirate plasma from patients with CKD induced less vasoconstriction of rat mesenteric arteries than that from patients without CKD (with endothelium (+E), 26 ± 7 %; without endothelium (-E): 28 ± 7 % vs. +E, 68 ± 12 %; -E: 95 ± 16 % of maximum KCl-induced vasoconstriction). Graft atherosclerosis of patients with CKD is more degenerated and releases more particulate debris and calcium, but the aspirate has surprisingly less serotonin and vasoconstrictor potential.

012 Natural History and Management of Aortocoronary Saphenous Vein Graft Aneurysms: A Systematic Review of Published Cases

Saphenous vein graft aneurysms (SVGAs) are a very rare complication of coronary artery bypass grafting (CABG). Our objective was to determine the clinical features and management options for aortocoronary SVGAs in an effort to develop an approach to identifying and managing patients with this complication.

A completely fractured zotarolimus-eluting stent in an aortocoronary saphenous vein bypass graft

Drug-eluting stents (DES) have significantly improved the rate of target vessel revascularization in comparison with bare metal stents. DES fracture was not reported in multicenter randomized clinical trials, but several case reports of DES fracture have been published, mostly with sirolimus-eluting stents. DES fracture is associated with stent restenosis and thrombosis. We report a zotarolimus-eluting stent fracture in an aortocoronary saphenous vein graft (SVG) bypass. The patient presented with chest pain and a non-ST-elevation myocardial infarction. He underwent cardiac catheterization that showed a complete fracture of a zotarolimus-eluting stent in the ostium of a sequential SVG to the diagonal and obtuse coronary arteries. His management included coronary angioplasty and retrieval of the proximal fractured segment. We discuss the potential causes for this stent fracture and suggest caution when using a DES in an ostial location of a SVG bypass, especially in a highly mobile vessel.