Artery Saphenous Vein Bypass Graft Research Articles

AORTOCORONARY SAPHENOUS VEIN GRAFT ANEURYSM: A SILENT COMPLICATION

AORTOCORONARY SAPHENOUS VEIN GRAFT ANEURYSM: A SILENT COMPLICATION

Percutaneous occlusion of large aneurysmal right coronary artery saphenous vein bypass graft.

Percutaneous occlusion of large aneurysmal right coronary artery saphenous vein bypass graft.

Endovascular stenting of an extracranial-intracranial saphenous vein high-flow bypass graft: Technical case report.

Background:The authors describe a case of endovascular stenting of an extracranial–intracranial saphenous vein high-flow bypass graft in the management of a complex bilateral carotid aneurysm case.Case Description:A 43-year-old woman was admitted with progressive visual field restriction and headache. Imaging studies revealed bilateral supraclinoid carotid aneurysms. The right carotid aneurysm was clipped and the left one was treated by an endovascular procedure, after performing an internal carotid artery–middle cerebral artery (ICA-MCA) saphenous vein bypass graft. A few months following the bypass procedure, a 70–80% stenosis of the graft was discovered and treated endovascularly with a stenting procedure. Follow-up at 36 months after the first operation showed the patency of the venous graft and no neurological deficits.Conclusions:Endovascular stenting of the extracranial–intracranial saphenous vein high-flow bypass graft is technically feasible when postoperative graft occlusion is discovered.

Surgical Treatment of Bilateral Aneurysmal Coronary to Pulmonary Artery Fistulas Associated With Severe Atherosclerosis

A 39-year-old diabetic patient with an old inferior wall infarction presented with disabling angina pectoris, despite medical treatment. Coronary angiography showed severe triple-vessel coronary artery disease, and bilateral coronary to pulmonary fistulas originating from the right coronary artery and the left anterior descending coronary artery. Both coronary artery saphenous vein bypass grafting and ligation of the fistulas was performed.

Anomalous Left Main Coronary Artery From the Main Pulmonary Artery in an Elderly Patient

Anomalous origin of the left main coronary from the pulmonary trunk in an elderly patient is extremely rare. We report a 73-year-old woman who presented with new onset of angina and atrial fibrillation. Evaluation revealed anomalous origin of the left main coronary artery from the main pulmonary artery and tight proximal left anterior descending coronary artery stenosis. The patient underwent primary closure of the anomalous left main coronary artery orifice within the pulmonary artery, aorta-to-left anterior descending coronary artery saphenous vein bypass grafting and Maze procedure. Six months postoperatively the patient was asymptomatic and a Thallium stress test was negative for ischemia.

A large coronary artery saphenous vein bypass graft aneurysm with a fistula: Case report and review of the literature

A large coronary artery saphenous vein bypass graft aneurysm with a fistula: Case report and review of the literature

Involvement of Dendritic Cells in Long-Term Aortocoronary Saphenous Vein Bypass Graft Failure

Antigen-presenting dendritic cells are present in atherosclerotic lesions in human arterial intima, but have not been investigated in atherosclerotic and hyperplastic stenotic lesions that affect vein grafts used as arterial conduits. This study was undertaken to examine whether dendritic cells are present in aortocoronary artery saphenous vein bypass grafts affected by high-grade atheromatous stenosis. Stenotic saphenous vein coronary artery bypass grafts (angiographic luminal stenosis > 75%) were harvested from 10 patients (nine male, one female), aged 42–71 years (mean 56.5) at re-do operation. The mean time interval from bypass surgery to the excision of stenotic grafts was 11.5 years (range 2–21). The specimens were fixed in 10% buffered formalin, embedded in paraffin blocks and the sections stained with antibodies to S-100 (to identify dendritic cells). CD3 (T cells). CD68 (macrophages), von Willebrand factor (endothelial cells) and α-smooth muscle actin (smooth muscle cells) using avidin-biotin complex immunoperoxidase technique. Normal veins were obtained during saphenous vein femora-popliteal grafting. The stenotic venous grafts showed histological features typical of extensive arterialization, intimal hyperplasia, atherosclerotic plaque-like lesions, calcification and thrombosis. In areas of intimal hyperplasia, S-100-positive cells were distributed irregularly among smooth muscle cells. S-100-positive dendritic cells were seen most frequently within atherosclerotic plaque-like lesions where they co-localized with CD3+ cells and CD68+ cells. S-100-positive dendritic cells were also seen accumulating within calcific foci. No S-100-positive ceils were found in normal, ungrafted saphenous veins. We conclude that dendritic cells are present in aortocoronary saphenous vein bypass grafts affected by high grade stenosis. Dendritic cells are probably involved in immune mechanisms of atherogenesis through their interactions with T cells and macrophages. The accumulation of dendritic cells within calcific foci suggests their contribution to the calcification of stenotic venous grafts.

Management of Aortic Dissection That Involves the Right Coronary Artery

A report on the follow-up of 11 patients who suffered from aortic dissection involving the right coronary artery and who underwent surgical treatment is reported. In two patients, the left coronary ostia was also affected. In seven patients, the dissection was acute and in four, chronic. The ascending aorta was substituted by a Dacron graft in all patients, and right coronary artery saphenous vein bypass or Gore-Tex graft to the coronary ostia or right coronary artery was performed in nine, and reimplantation of both dissected coronary in two. There were three early postoperative deaths (27.3%) caused by low-output syndrome and myocardial infarction. There were two late deaths. The six surviving patients were followed-up from 78 to 96 months (mean 83 months). This experience suggests that although carrying a high risk, the involvement of the coronary ostia in aortic dissection can be successfully managed if made before irreversible complications arise.

Review of the Fifth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy: outpatient management for adults.

The recommendations of the Fifth American College of Chest Physicians (ACCP) Consensus Conference on Antithrombotic Therapy are reviewed, with a focus on outpatient anticoagulation management in adults. Numerous therapeutic recommendations have changed since the Fourth ACCP Consensus Conference on Antithrombotic Therapy. The system of grading recommendations has been modified to emphasize clinically important differences and to take into account the benefit-risk ratio of each treatment option. The International Normalized Ratio (INR) goal is now expressed as a specific target value within a range rather than simply an INR range. The recommendations of the fifth conference cover initiation of warfarin therapy, hemorrhagic complications, management of excessive anticoagulation, interruption of warfarin therapy for patients requiring surgery, nonvalvular atrial fibrillation, cardioversion in patients with atrial fibrillation, valvular heart disease, mechanical and biological prosthetic heart valves, coronary artery disease, saphenous vein and internal mammary artery bypass grafts, peripheral arterial occlusive disease, prevention of venous thromboembolism, treatment of venous thromboembolism, stroke prevention in patients with cerebrovascular disease, and pregnancy. Since the fourth consensus conference, new anticoagulation therapies and indications have emerged; the recommendations of the Fifth ACCP Consensus Conference on Antithrombotic Therapy have provided practitioners with a resource of immense value.

Involvement of dendritic cells in long-term aortocoronary saphenous vein bypass graft failure

Antigen-presenting dendritic cells are present in atherosclerotic lesions in human arterial intima, but have not been investigated in atherosclerotic and hyperplastic stenotic lesions that affect vein grafts used as arterial conduits. This study was undertaken to examine whether dendritic cells are present in aortocoronary artery saphenous vein bypass grafts affected by high-grade atheromatous stenosis. Stenotic saphenous vein coronary artery bypass grafts (angiographic luminal stenosis >75%) were harvested from 10 patients (nine male, one female), aged 42–71 years (mean 56.5) at re-do operation. The mean time interval from bypass surgery to the excision of stenotic grafts was 11.5 years (range 2–21). The specimens were fixed in 10% buffered formalin, embedded in paraffin blocks and the sections stained with antibodies to S-100 (to identify dendritic cells), CD3 (T cells), CD68 (macrophages), von Willebrand factor (endothelial cells) and α-smooth muscle actin (smooth muscle cells) using avidin–biotin complex immunoperoxidase technique. Normal veins were obtained during saphenous vein femoro-popliteal grafting. The stenotic venous grafts showed histological features typical of extensive arterialization, intimal hyperplasia, atherosclerotic plaque-like lesions, calcification and thrombosis. In areas of intimal hyperplasia, S-100-positive cells were distributed irregularly among smooth muscle cells. S-100-positive dendritic cells were seen most frequently within atherosclerotic plaque-like lesions where they co-localized with CD3 + cells and CD68 + cells. S-100-positive dendritic cells were also seen accumulating within calcific foci. No S-100-positive cells were found in normal, ungrafted saphenous veins. We conclude that dendritic cells are present in aortocoronary saphenous vein bypass grafts affected by high grade stenosis. Dendritic cells are probably involved in immune mechanisms of atherogenesis through their interactions with T cells and macrophages. The accumulation of dendritic cells within calcific foci suggests their contribution to the calcification of stenotic venous grafts.

Management of aortic dissection that involves the right coronary artery

A report on the follow-up of 11 patients who suffered from aortic dissection involving the right coronary artery and who underwent surgical treatment is reported. In two patients, the left coronary ostia was also affected. In seven patients, the dissection was acute and in four, chronic. The ascending aorta was substituted by a Dacron graft in all patients, and right coronary artery saphenous vein bypass or Gore-Tex graft to the coronary ostia or right coronary artery was performed in nine, and reimplantation of both dissected coronary in two. There were three early postoperative deaths (27.3%) caused by low-output syndrome and myocardial infarction. There were two late deaths. The six surviving patients were followed-up from 78 to 96 months (mean 83 months). This experience suggests that although carrying a high risk, the involvement of the coronary ostia in aortic dissection can be successfully managed if made before irreversible complications arise.

Manuseio da dissecção aórtica envolvendo artéria coronária direita

E conhecido o fato de que a disseccao aortica pode envolver as arterias coronarias, Entretanto, somente alguns artigos fazem referencia ao tratamento cirurgico dessa afeccao. Apresentamos o seguimento de 11 pacientes acometidos por disseccao da aorta ascendente envolvendo a arteria coronaria direita e que se submeteram a operacao em nossa Instituicao - Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. Em 2 pacientes o ostio coronariano esquerdo tambem foi afetado. Em 7 pacientes a disseccao foi aguda e, em 4, cronica. A aorta ascendente foi substituida por enxerto tubular de Dacron em todos os pacientes; ponte de veia safena para a coronaria direita ou enxerto de gore-tex para o ostio coronariano ou arteria coronaria direita foi realizado em 9 pacientes e reimplante de ambas as coronarias dissecadas em 2. Houve 3 (27,3%) mortes no pos-operatorio recente, devido a sindrome de baixo debito e infarto do miocardio. Dois pacientes acometidos por sindrome de Marfan faleceram no 14o mes de pos-operatorio por doenca hepatica, e outro devido a rotura da aorta descendente no 39o mes. Os 6 pacientes restantes foram acompanhados por um periodo que variou de 78 a 96 meses (media de 83 meses). Tal experiencia sugere que, apesar de significar alto risco, o envolvimento do ostio coronariano direito na disseccao de aorta e um acontecimento que pode ser manejado com sucesso atraves de alguns procedimentos cirurgicos, quando realizados antes do surgimento de complicacoes irreversiveis.

Regional Remodeling of Atherosclerotic Arteries: A Major Determinant of Clinical Manifestations of Disease

In this review we present the current data on remodeling, based on in vivo ultrasound imaging or postmortem histologic analysis of native peripheral and coronary arteries from animal models and studies in patients (coronary artery saphenous vein bypass grafts, lesions of restenosis after balloon angioplasty and other catheter-based interventions). Histologic and ultrasound imaging studies of arteries with atherosclerosis and after vascular injury reveal that arterial remodeling is common and that the cross-sectional area of the vessel is not constant. Compensatory enlargement, inadequate compensatory enlargement and shrinkage at the site of atherosclerotic lesions occurs in coronary and peripheral arteries. Current studies demonstrate that arterial remodeling is a major determinant of vessel lumen size.

Asymptomatic large coronary artery saphenous vein bypass graft aneurysm: A case report and review of the literature

Am Heart J 1997;133:454-60.

Validation of coronary artery saphenous vein bypass graft diameter measurements using quantitative angiography.

The accepted value for reproducibility (true change) is two standard deviations (SD) of the differences between repeat measurements. It has been well established for coronary artery measurements using several different quantitative coronary angiography (QCA) systems, but it has not been well documented for saphenous vein grafts (SVG). The purpose of this study was to assess, using the Cardiovascular Measurement System (CMS), the measurement reproducibility of 24 vein grafts from 24 patients who had symptom-directed control angiography. Three equal graft segments were studied separately. Focal narrowings expressed in percent stenosis varied from 5 to 80% (mean 20.8 +/- 15.9%). The average minimum lumen diameter (MLD) was 3.07 +/- 0.81 mm and the average interpolated reference diameter (Ref. D) was 3.87 +/- 0.58 mm. We assessed the reproducibility of measurements obtained from two separate imagings of the graft in the same view but at least 20 minutes apart, near the beginning and at the end of the angiographic procedure (simulating baseline and end-trial examinations). The SD for differences in measurements (variability) was 0.183 mm for the MLD, 0.193 mm for the Ref.D, 0.184 mm for the mean diameter (Mean D) and 3.72% for the percent diameter stenosis (PDS). A reasonable true change cut-off for SVG measurements in our laboratory is > or = 0.4 mm for the minimum and mean lumen diameters, and > or = 10% for the PDS, when QCA is obtained with the QCA-CMS analytical software package.

Preserved vasodilatory response to nitroglycerin in saphenous vein bypass grafts.

Uncertainty exists regarding the effects of nitroglycerin on atherosclerotic segments of coronary arteries, and information on vasoreactivity of saphenous vein bypass grafts is sparse. Intravascular ultrasound enables identification of atherosclerosis in angiographically normal segments and allows continuous determination of alterations in cross-sectional lumen areas. Patients with documented coronary atherosclerosis were studied. Vessel morphology and lumen area at baseline and after 100 to 200 micrograms nitroglycerin were assessed at 10-second intervals for 60 seconds in vessel segments without angiographically apparent lesions. Coronary artery saphenous vein bypass grafts from 11 patients were compared with native coronary arteries in 16 different patients. Atherosclerosis was present in all vessel segments studied. There was a rapid increase in lumen area compared with baseline after intravascular nitroglycerin in both native coronary arteries and saphenous vein bypass grafts. Maximum lumen area dilatation was 19.6 +/- 12.2% in saphenous vein bypass grafts and 19.7 +/- 13.1% in native coronary arteries. An earlier peak response in saphenous vein bypass grafts (34.5 +/- 6.9 seconds) compared with native coronary arteries (44.7 +/- 8.5 seconds; P = .003) was found. Vessel wall area remained constant during vasodilation, but there was a significant reduction in measured wall thickness (P = .034). In patients with documented coronary artery disease, intravascular ultrasound reveals substantial atherosclerosis in angiographically normal vessel segments. In these vessel segments, both native coronary arteries and saphenous vein bypass grafts exhibit prompt vasodilation with the intravascular administration of nitroglycerin. The vasodilatory capacity in response to nitroglycerin seems to be preserved in transposed, denervated, and devascularized saphenous veins.

High stress regions in saphenous vein bypass graft atherosclerotic lesions

Objectives. Our aim was to test the hypothesis that maximal stresses in saphenous vein atherosclerotic stenoses are greater than those in native coronary artery stenoses.Background. The patency of coronary artery saphenous vein bypass grafts decreases with time, usually because of thrombosis. Plaque rupture has been described as one mechanism of vein graft thrombosis.Methods. Twenty-six nonruptured human lesions were studied. Fourteen lesions were from native coronary arteries, and 12 were from saphenous vein bypass grafts placed a mean ± SD of 9.8 ± 3.3 years before pathologic study. The finite element method was used to determine the distribution of stress in the lesion, using estimates of material properties from previous measurements of human tissues.Results. Maximal circumferential stresses were significantly higher in the saphenous vein lesions (median 352 kPa [interquartile range 161 to 475]) than in the coronary artery lesions (median 104 kPa [interquartile range 75 to 185]) (p = 0.05). Thin-walled cylinder formulations predict that stresses are proportional to the radius of the vessel and inversely proportional to the minimal wall thickness. In this study, there was a good correlation between the maximal stress in the 26 lesions and the ratio of the square root of lumen area to minimal fibrous cap thickness (r = 0.83, p < 0.001).Conclusions. Maximal circumferential tensile stresses in saphenous vein bypass graft stenoses are higher than in native coronary artery atherosclerotic stenoses. These data suggest that strategies that decrease stresses in bypass graft atherosclerotic lesions, such as prevention of lipid accumulation, could reduce the probability of plaque rupture in bypass grafts.

Brachial approach directional coronary atherectomy of right coronary artery saphenous vein bypass grafts

We describe here a technique for performing directional coronary atherectomy to right coronary artery saphenous vein bypass grafts from the brachial approach using a long introducer sheath system. This technique has the advantages of 1) avoiding femoral artery trauma and 2) ease of access into the bypass graft, avoiding occasional problems with guide catheter kinking or non-coaxial alignment.

Percutaneous puncture of a nondeflatable coronary artery angioplasty balloon

We report a case in which a balloon catheter became permanently inflated in a coronary artery saphenous vein bypass graft. While still inflated, the balloon was forcibly withdrawn from the graft into the external iliac artery and successfully deflated via percutaneous puncture using a CHIBA needle.

Percutaneous valvuloplasty as a treatment for aortic and mitral valve disease

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