Saphenous Vein Graft Research Articles

Candida associated infra-inguinal prosthetic vascular graft infection: A case report

Prosthetic vascular grafts (PVG) are artificial vascular materials used for revascularization in the treatment of vascular diseases. Due to increase in life expectancy, the number of individuals requiring PVGs is increasing and encountering the PVGI is also more frequent. We presented an interesting case operated because of infected graft in which Candida albicans grew. The patient had been operated twice for peripheral artery disease in another hospital before. We performed femoro-popliteal bypass by using great saphenous vein after removal of infected graft. In peripheric bypass surgery performed with PTFE (polytetrafluoroethylene) graft, growth of Candida albicans in graft material is a rare condition and this situation has a high mortality rate. In the patients with comorbidities and who will undergo redo-surgery, excessive care should be given in terms of graft infections.

Long-term outcomes of radiofrequency ablation and cyanoacrylate closure for treatment of small saphenous veins

Aim: Superficial venous insufficiency is less prevalent in the lesser saphenous vein compared to the great saphenous vein. Treating the lesser saphenous vein often presents greater challenges due to its proximity to the sural nerve and anatomical variations. This study evaluates the long-term efficacy of radiofrequency ablation (RFA) and cyanoacrylate closure (CAC) for managing small saphenous veins and discusses our treatment approach. Material and Methods: We performed a retrospective analysis involving 137 patients (64 treated with CAC and 73 with RFA) who received treatment for small saphenous vein insufficiency at our clinic between 2014 and 2019. We assessed quality of life and clinical outcomes at 6 months, and at 1, 3, and 5 years post-treatment. Results: Our findings indicated that radiofrequency ablation showed greater improvements compared to cyanoacrylate embolization in terms of VCSS. However, over the 5-year follow-up period, recurrence rates were observed in 11 (17.1%) patients in the CAC group and 5 (6.8%) patients in the RFA group, with this difference being statistically significant (p=0.045). Conclusion: Radiofrequency ablation for treating venous insufficiency offers superior long-term quality of life benefits compared to cyanoacrylate closure, particularly after three years.

Outcomes of Left Main Chronic Total Occlusion Percutaneous Coronary Interventions.

Percutaneous coronary intervention (PCI) of left main (LM) chronic total occlusions (CTO) has received limited study. We compared the clinical and procedural characteristics and outcomes of patients who underwent LM versus non-LM CTO PCI at 41 US and non-US centers between 2012 and 2024. During the study period 85 of 15,254 CTO PCIs (0.6%) performed in 14,969 patients were LM CTO PCIs. LM CTO PCI patients were older, had higher rates of dyslipidemia and heart failure and most (88.8%) had prior coronary artery bypass graft surgery (CABG). They were more likely to have moderately or severely calcified lesions (80.7% vs. 45.7%, p < 0.001) and had higher J-CTO (2.76 ± 1.17 vs. 2.37 ± 1.26, p = 0.008), PROGRESS-CTO MACE (3.56 vs. 2.57, p < 0.001), Mortality (2.45 vs. 1.68, p < 0.001), Pericardiocentesis (2.74 vs. 1.87, p < 0.001), Acute MI (1.72 vs. 0.89, p < 0.001) and Perforation (3.21 vs. 2.19, p < 0.001) scores. There was no difference in technical success (80.5% vs. 87.2%, p = 0.086) or major cardiovascular adverse events (MACE) (2.4% vs. 2.0%, p = 0.700). LM CTO PCI patients with and without prior CABG surgery had similar technical success and MACE. The retrograde approach in prior CABG patients was more likely to be performed through saphenous vein grafts. LM CTO PCI is infrequently performed, is associated with high comorbidity burden and angiographic complexity but can be performed with high success and acceptable complication rates.

Increased Nitric Oxide Availability: The Explanation for Recent Improvements in Saphenous Vein Graft Patency?

Increased Nitric Oxide Availability: The Explanation for Recent Improvements in Saphenous Vein Graft Patency?

Factors affecting the evolution of type III shunts of the greater saphenous vein after the first step of the CHIVA 2 strategy

The CHIVA 2 strategy is a two-step surgical procedure for treating type III venous-venous shunts in the territory of the Greater Saphenous Vein (GSV). The first step consists of disconnecting the incompetent GSV tributary, either N3 or N4. Once a new N2 re-entry perforator vein has developed, or the GSV incompetence has reached the pre-existing N2 re-entry perforator vein, both documented by the re-appearance of GSV reflux during the follow-up, the second step of the CHIVA 2 strategy, i.e. the closure of the saphenous-femoral junction, can be performed. In this paper we addressed the intriguing question of whether it was possible to identify the pre-operative factors able to favourably affect the hemodynamic stability of type III shunts of the GSVs treated by the only first step of the CHIVA 2 strategy. Our data show that the pre-operative GSV anterograde flow, detectable all along the GSV course even soon after the first step of the procedure, plays a pivotal role in ensuring the hemodynamic stability of the treated GSV, which may not need the second step up to 45% of cases.

Case report of varicose veins treatment in patient with a prosthetic mitral valve

This clinical case may be of interest in situations where a patient with varicose veins of the lower limbs and concomitant heart disease, who is on long-term anticoagulant therapy and is scheduled to undergo minor surgery, may present the possibility of endovenous laser ablation (EVLA) against the background of warfarin use. Patient, G., 68 years old, with rheumatic combined mitral valve disease (mitral valve replacement in 2019, permanent atrial fibrillation), also had varicose vein disease of the lower limbs. History included acute cerebrovascular accident (19.01.2023). Duplex Ultrasonography Screening (DUS) showed failure of the left great saphenous vein valve. Hypocoagulation was also observed in coagulogram and the risk of bleeding on HAS-BLED score was average. On Caprini score, the risk was very high. Endovenous laser ablation of the large saphenous vein on the left side was performed. During follow-up examinations, there were no signs of bleeding from puncture sites. The target trunk was obliterated in dynamics at DUS. Therefore, it is possible to carry out EVLA of a large subcutaneous vein while taking therapeutic doses of warfarin without switching to bridge therapy. Endovascular laser ablation allowed it to be done with less risk of bleeding and, against the background of taking warfarin, reduced the risk of thrombosis.

Ballooning and Bursting of Barrels and Pipes: A Rare Case of Suspected Vascular Ehlers–Danlos Disease

Vascular Ehler–Danlos disease (vEDS), a rare subtype of a rare disease, is a life-threatening disease, with an increased risk for spontaneous vascular or visceral rupture. These patients have fatal complications ranging from vascular aneurysms, dissection, and rupture of systemic vessels to frequent thromboembolic events, the common causes of death in these individuals with a shortened life span. In the present case, a 28-year-old male with history of shoulder dislocations and spontaneous colon perforation presented to the primary care clinic with right lower extremity swelling and pain. His history includes presentation to the emergency department with left lower leg swelling with compartment syndrome one year prior. A CT angiogram of lower extremities and abdomen revealed acute arterial extravasation of the left posterior tibial artery, indicating a ruptured aneurysm along with aneurysms of the splenic artery and left common iliac artery. He was treated with a saphenous vein graft, but was associated with post-operative complications that necessitated below-knee amputation. CT angiogram of his right leg revealed occlusion of the anterior tibial and peroneal arteries with aneurysms, and, ultimately, he was referred to a tertiary care center for aneurysm embolization. This case report emphasizes the frequent vascular complications encountered in vascular EDS patients, and thus advocates for close and regular monitoring for early referral and surgical management of their vascular anomalies. Finally, genetic counseling and screening of asymptomatic family members should be routinely implemented in these patients.

Comparative Study on the Effectiveness and Safety of Simultaneous and Staged Bilateral Saphenous Vein Radiofrequency Ablation

Chronic Venous Insufficiency (CVI) is a common condition affecting more than half of the general population, with approximately 20% of cases being bilateral. The high prevalence, diagnosis, and treatment costs, along with the negative impact on patients' quality of life, underscore its significance. This study evaluates the clinical outcomes, quality of life effects, and postoperative complications of simultaneous and staged bilateral radiofrequency ablation (RFA) in patients with bilateral CVI in the great saphenous vein (GSV) at CEAP stages 2-4. This retrospective study included 433 patients with bilateral CVI in the great saphenous vein (GSV) at CEAP stages 2-4, treated with RFA between January 2018 and December 2022. Patients were classified into two groups: Group 1 (n=257) underwent simultaneous bilateral RFA, and Group 2 (n=176) underwent staged bilateral RFA. Clinical outcomes and quality of life effects were evaluated using Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ), and Visual Analog Scale (VAS) scores. Demographic data, type of anesthesia, surgery durations and postoperative complications were analyzed. Both groups showed significant improvements in AVVQ and VCSS scores at 12 months postoperatively, with no significant differences between the groups in preoperative and postoperative scores. No significant difference was found in postoperative VAS scores. Postoperative complication rates were low and comparable. No pulmonary embolism was observed. Symptomatic DVT was detected in one patient from each group and treated successfully. Simultaneous bilateral RFA is as effective and safe as staged bilateral RFA for treating CVI, providing similar clinical outcomes and low complication rates. The simultaneous approach offers the advantage of a single treatment session, potentially improving patient satisfaction and operational efficiency. This study supports simultaneous bilateral RFA as a viable and effective option for treating bilateral CVI.

Effects of light compression on chronic venous disease, edema and comfort in women during pregnancy and postpartum period: a prospective randomized study.

Lower limb edema associated with venous disorders is an increasingly common problem in pregnant women. The study aimed to assess the use of compression class 1 (ccl1=18-21 mmHg) in lower limb edema and CVD prevention in pregnant and postpartum women. 51 pregnant women (second trimester) were randomly recruited into either a study group CG with compression ccl1 or a control group NCG, both with physical activity (PA) recommendation. The assessment concerned venous system condition, limb size, and compression comfort. Edema was diagnosed as ≥10% measurement increase. Venous reflux (8/22 CG, 1/16 NCG) and an onset of CVD (6/22 CG, 1/16 NCG) were diagnosed in the first measurement. After postpartum, a significant reduction of the great saphenous vein (GSV) diameter in the proximal part of the left lower limb in CG (P=0.014) and expansion of the small saphenous vein (SSV) in the proximal part of the left lower limb in NCG (P=0.028) were observed. An analysis of the limb sizes in the second measurement revealed a significant increase of all circumferences and volumes in the NCG, and of lower leg volumes in the CG. Edema was diagnosed in five women in the NCG in the second measurement. Consequently, compression was recommended for the new group (NCG+C), and a significant edema reduction (P=0.026) occurred in the third measurement. Compression ccl1 reduces the risk of edema, venous insufficiency, and improves women's quality of life during pregnancy and postpartum.

Clincal outcomes of two endovenous radiofrequency ablation systems in the treatment of great saphenous vein insufficiency

Clincal outcomes of two endovenous radiofrequency ablation systems in the treatment of great saphenous vein insufficiency

034. Arterials Re-Repair with Saphenous Vein Graft for Acute Limb Ischemia in Previously Repaired Patient: A Complicated Case Report

Background: Acute upper extremity ischemia following trauma is a potentially limb-threatening condition that requires prompt diagnosis and intervention. We presented a complicated case of a patient who had previously undergone repair for his left arm but developed post-operative acute limb ischemia. Case: A 51-year-old male presented to the emergency room (ER) with acute numbness in his left hand. He previously underwent a muscle, artery, and nerve repair for his left arm due to a wooden impaled wound. Other comorbidities were denied, and the patient’s hemodynamics were stable. Physical examination showed left antebrachial covered with Backslab, tenderness upon palpation, and limited range of motion. The left fingers’ oxygen saturation were lower (90-93%). Left antebrachial imaging revealed no fracture. Vascular exploration, thrombectomy, and left radial and ulnar arteries repair using the saphenous vein graft were performed. The post-surgical outcome was great, and the numbness began to fade away. Left fingers’ oxygen saturation rose dramatically (94-95%). The patient was satisfied with the outcomes, followed by discharge from the hospital. Conclusion: Prompt recognition and surgical intervention of vascular trauma complications effectively restore function and alleviate symptoms.

Action of high intensity focused ultrasound (HIFU) ablation on the venous wall: Histopathological analysis, insights, and perspectives.

In the medical field, ultrasound is commonly used for diagnostic imaging due to its ability to provide real-time images. However, High-Intensity Focused Ultrasound (HIFU) is also used for other clinical purposes, such as thermal tissue ablation. In the case of varicose veins, the potential role and benefits of HIFU have been known for a long time despite in-vivo results have mostly been preliminary and experimental, particularly regarding its effect on venous wall. The aim of this brief report is to describe how HIFU acts on venous wall in human incompetent great saphenous veins.

The impact of hydrostatic pressure on fractional flow reserve in saphenous vein grafts

Abstract Background Intracoronary physiological measurements can be subject to the influence of hydrostatic pressure. Saphenous vein grafts (SVGs) diverge in origin and trajectory from native coronary arteries, which may increase the susceptibility of fractional flow reserve (FFR) measurements to be impacted by the hydrostatic pressures. The precise impact of SVG anatomy on physiological pressure indices remains unknown at present. Purpose We sought to study the impact of SVG anatomy on FFR. Methods Included were symptomatic patients with prior coronary artery bypass grafting and at least one non-occluded SVG, who underwent coronary computed tomography angiography (CCTA) preceding invasive coronary angiography. SVG course and height excursion were reconstructed based on the CCTA images. Similarly to native coronary arteries, the impact of hydrostatic pressure on FFR was calculated by adding 0.077 mmHg to the distal coronary pressure for every millimeter height difference in a supine position between the SVG ostium and the position of the pressure wire tip. Results In total, 74 patients (mean age 71 ± 7 years; 85% male) with 87 SVGs were included. A total of 76 SVGs underwent interrogation by FFR. The height difference between SVG ostium and pressure wire tip position was largest for single SVGs to the circumflex artery (Cx; - 55.1 ± 17.0 mm), followed by sequential SVGs to the Cx (- 53.1 ± 17.7 mm) and to the right coronary artery (RCA; - 36.7 ± 21.6 mm). Corrected FFR was significantly lower as compared to uncorrected FFR in single SVGs to the Cx (0.85 ± 0.17 vs. 0.90 ± 0.18), and sequential SVGs to the Cx (0.92 ± 0.14 vs. 0.96 ± 0.15) and the RCA (0.82 ± 0.20 vs. 0.85 ± 0.21) (P&amp;lt;0.001 for all). Conclusions Hydrostatic pressure related to the course anatomy of SVGs notably affects FFR values, resulting in an overestimation of FFR in SVGs to the Cx and sequential SVGs to the RCA. In these SVGs, FFR values near the cutoff value should be interpreted cautiously.

Fractional flow reserve in saphenous vein grafts for the detection of myocardial ischemia determined by perfusion imaging

Abstract Background Fractional flow reserve (FFR) is recommended to guide revascularization of native coronary arteries. Revascularization decision-making for saphenous vein grafts (SVGs), however, is based on angiographic estimation of lesion severity, as studies exploring the value of FFR to detect perfusion imaging defined myocardial ischemia in SVGs are scarce. Purpose We aimed to define an optimal FFR threshold and compare its diagnostic performance with the traditional FFR cutoff and with percentage diameter stenosis (%DS) in patients evaluated for SVG disease using myocardial perfusion imaging (MPI) as the reference standard. Methods Symptomatic patients with prior coronary artery bypass grafting (CABG) who underwent single-photon emission computed tomography, positron emission tomography or stress perfusion cardiac magnetic resonance imaging, and had FFR measurements of one or more SVGs were included. Angiographic lesion severity of the SVG was measured using 2D quantitative invasive coronary angiography. We allocated and matched the myocardial territory subtended by the SVG to compare the values of FFR and %DS with ischemia determined by MPI. Results Included were 77 patients (mean age 72 ± 7 years; 86% male) with 91 SVGs. A total of 38 SVGs (42%) supplied an ischemic coronary territory. FFR and %DS correlated moderately (r= -0.51, P&amp;lt;0.001). The optimal cutoff value of FFR was ≤0.94, resulting in a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 63%, 75%, 65%, 74% and 70%, respectively (Figure 1). Corresponding values of FFR≤0.80 and DS%≥50 are shown in Figure 1 as well. Sensitivity, NPV and accuracy of FFR ≤0.94 outperformed that of FFR≤0.80, whereas specificity was lower. FFR≤0.94 outperformed %DS≥50 only in terms of sensitivity. Conclusions The optimal cutoff value of FFR for the detection of MPI-defined disease in SVGs is higher than the traditional FFR cutoff used to guide native coronary artery revascularization. Importantly, the increased sensitivity led to a higher diagnostic performance of the adjusted cutoff. However, the high prevalence of ischemia in post-CABG patients questions whether the optimal cutoff reflects ischemia caused by SVG obstruction.Diagnostic performance of FFR and %DS

Patient and procedural characteristics of successful endovascular procedures in the BEST-CLI Trial and their relationship to major adverse limb events

Abstract Background The Best Endovascular versus Best Surgical Therapy in Patients with Chronic Limb Threatening Ischemia (CLTI) (BEST-CLI) trial randomized 1830 subjects with chronic limb threatening ischemia (CLTI) to endovascular or surgical bypass revascularization. Major adverse limb events (MALE) were higher after endovascular revascularization compared to bypass in the cohort with bypass using adequate single segment great saphenous vein. However, 15% of endovascular procedures had a major endpoint due to lack of technical success of the index procedure. Purpose To assess the factors related to a MALE in subjects in the BEST-CLI trial with an initial endovascular procedure that was technically successful. Methods All patients with a technically successful endovascular procedure (defined as a residual stenosis &amp;lt; 50% in the superficial femoral, popliteal, and/ or tibial arteries with in-line flow to the foot) were included. MALE was defined as above ankle amputation of the index limb or a major index-limb reintervention (new bypass, interposition graft revision, thrombectomy, or thrombolysis). Patient, procedure, and limb characteristics at the time of the index procedure were compared to the risk of MALE over an average 2.7 years follow-up. Characteristics were compared with the Kruskal-Wallis or Chi-square tests as appropriate. Results Of 923 patients having endovascular therapy as the index revascularization, 773 (84%) had a technically successful procedure. The cause of failure in 122 (82%) of unsuccessful procedures was the inability to cross the lesion with a wire. Significant patient factors associated with MALE included younger age (64 vs 68 years, p&amp;lt;0.0001), current smoking (44% vs 33%, p=0.004), and end-stage renal disease (17% vs 10%, p=0.013). Diabetes mellitus was not associated with MALE (74% vs 68%, p=0.08). Significant limb characteristics associated with MALE included lesions treated in the superficial femoral (SFA) or above knee popliteal artery (87% vs 81%, p=0.042), length of lesion in the SFA or above knee popliteal artery (201 cm vs 172 cm, p=0.02), use of atherectomy and bare-metal stent (10% vs 5%, p=0.01), and total procedure time (172 vs 155 min, p=0.002). Lesions treated in the below-knee popliteal artery or tibial arteries (62% vs 62%, p=0.93) or lesion length in this region (134 vs 144 cm, p=0.70) were not related to the risk of MALE. Conclusions The risk of MALE after successful endovascular revascularization for CLTI was increased with younger age, current smoking, end-stage renal disease, longer lesion length, treatment of the SFA to above knee popliteal arteries, and treatment with atherectomy with bare-metal stenting. Treatment of below knee lesions were not associated with MALE. These results indicate the importance of both modifiable and non-modifiable patient factors as well as the anatomic location of disease in determining limb outcomes in CLTI.

Application of Endovenous Laser Treatment Combined with Foam Sclerotherapy for the Minimally Invasive Treatment of Great Saphenous Vein Varicosity

Objective: To evaluate the efficacy of endovenous laser treatment (EVLT) combined with foam sclerotherapy (FS) in the treatment of great saphenous vein varicosity (GSVV). Methods: A total of 50 patients with GSVV, treated between March 2021 and March 2024, were selected and randomly divided into two groups using a random number table. The combination group (25 cases) underwent EVLT combined with FS, while the conventional group (25 cases) underwent EVLT alone. The total effective rate, complication rate, disease severity score, and serological indicators were compared between the two groups. Results: The total effective rate in the combination group was higher, and the complication rate was lower compared to the conventional group (P &lt; 0.05). One week after surgery, the disease severity score in the combination group was lower, coagulation function indicators were better, and inflammatory factor levels were lower compared to the conventional group (P &lt; 0.05). Conclusion: EVLT combined with FS can improve the clinical efficacy in GSVV patients, prevent postoperative complications, reduce disease severity, protect patients’ coagulation function, and alleviate postoperative inflammatory responses, showing significant advantages in combined surgery.

Percutaneous transcatheter closure of a large saphenous vein graft aneurysm with Amplatzer vascular plug

A saphenous vein graft (SVG) aneurysm is a rare complication seen in coronary artery bypass grafts (CABG). While the sternotomy for surgical correction is used in most of these patients, depending on the patient’s condition, an alternative method may be required. This case is a 64-year-old man who developed SVG aneurysm more than 10 years after CABG and underwent a successful percutaneous transcatheter exclusion of SVG aneurysm using 10 mm Amplatzer Vascular Plug 2, resulting in prevention of blood flow into the aneurysm and future rupturing. This case illustrates the potential of noninvasive treatment with flexible procedures based on the patient’s anatomy and risk for complicated surgery. Keywords: Amplatzer vascular plug, saphenous vein graft, saphenous vein graft aneurysm, coronary artery bypass graft

The Predictive Value of Pan-Immune-Inflammation Value for Saphenous Vein Graft Disease in Post-Coronary Artery Bypass Grafting Patients

Background: Coronary artery bypass grafting (CABG) remains the gold standard treatment for patients with significant coronary artery disease (CAD) and high-risk profiles for percutaneous coronary intervention. Despite the frequent use of saphenous vein grafts (SVGs) in CABG, their patency rates are lower than those of arterial grafts. Identifying noninvasive methods to determine SVG patency is crucial. Aims: This study investigates the relationship between a novel inflammation marker, pan-immune-inflammation value (PIV), and SVG patency in post-CABG patients. Methods: The study included 507 patients who underwent coronary angiography (CAG) due to clinical indications between 2016 and 2023. Patients who had undergone CABG at least one year prior with at least one SGV used were divided into two groups based on the presence or absence of SVG stenosis (SGVS). Results: Among the 507 patients, 244 had SVGS. Patients with SVGS exhibited higher levels of diabetes mellitus and inflammatory markers such as NLR, SII, CAR, and PIV. Multivariate analysis identified PIV as an independent predictor of SVGS. ROC analysis showed that a PIV cut-off value &gt; 315.5 predicted SVGS with 75.8% sensitivity and 68.6% specificity. Conclusions: PIV, a simple and easily measurable marker, demonstrated strong predictive value for SVGS in post-CABG patients.

Improvement of the outcome of the saphenous vein graft when connected to the internal thoracic artery.

Since 2000, we have been grafting the right coronary artery system (RCAs) using the proximal portion of the right internal thoracic artery (RITA) as the inflow of the saphenous vein graft (SVG) to increase the number of patients undergoing beating heart complete myocardial revascularization. From 2000 to 2022, 928 consecutive patients underwent SVG on the RCAs. In 546 patients (58.8%), the inflow was the RITA (I-graft group), and in 382 patients (41.2%), the inflow was the aorta (Ao-graft group). The inclusion criteria were age ≤75 years, ejection fraction >35%, only one SVG per patient, bilateral internal thoracic arteries as a Y-graft on the left system (three-vessel disease, n = 817, 88.0%) or left internal thoracic artery on the left anterior descending artery and RITA + SVG on the RCAs (two-vessel disease, n = 111, 12.0%). Propensity matching identified 306 patients per group. After a median follow-up of 8 (5-10) years, graft patency was assessed by coronary computed tomographic angiography in 132 patients (64 in the I-graft group and 68 in the Ao-graft group). Early results were similar in both groups. The I-graft group had higher 10-year survival and freedom from main adverse cardiac events (90.0 ± 2.0 vs. 80.6 ± 3.8, p = 0.0162, and 81.3 ± 2.7 vs. 64.7 ± 5.6, p = 0.0206, respectively). When RITA was the inflow, SVG had a higher estimated 10-year patency rate (82.8% ± 6.5 vs. 58.8% ± 7.4, p = 0.0026) and a smaller inner lumen diameter (2.7 ± 0.4 vs. 3.4 ± 0.6 mm, p < 0.0001). When the inflow is the RITA, SVG grafted to the RCAs (I-graft) may result in a higher patency rate and better outcome than when the inflow is the ascending aorta (Ao-graft). The continuous supply of nitric oxide by RITA may be the cause of the higher patency rate of the I-graft, which can behave like an arterial conduit.

Correlation and Agreement of Quantitative Flow Ratio With Fractional Flow Reserve in Saphenous Vein Grafts.

The applicability of quantitative flow ratio (QFR), a nonhyperemic, invasive coronary angiography-derived computation of fractional flow reserve (FFR), has not been studied in coronary artery bypass grafts. We sought to explore the correlation and diagnostic agreement between QFR and FFR in saphenous vein grafts (SVGs). A total of 129 prospectively included patients (mean age 73±8 years, 84% male) with prior coronary artery bypass grafting underwent invasive coronary angiography and pressure-derived functional assessment in 150 nonoccluded SVGs. QFR dedicated angiography images of the SVGs were acquired and used for offline QFR computation. The diagnostic performance of QFR was compared with 2-dimensional quantitative coronary angiography, using FFR as a reference. A threshold of ≤0.80 was used to define functional significance. QFR was successfully computed in 140 (93%) SVGs. We found a significant correlation between QFR and FFR (r=0.72, P<0.001). FFR indicated significant disease in 43 (31%) SVGs, whereas QFR analysis showed significant lesions in 53 (38%) bypass grafts. QFR exhibited a higher sensitivity and diagnostic accuracy compared with angiographic lesion assessment (84% versus 63%, P=0.030 and 83% versus 74%, P=0.036, respectively), whereas specificity did not differ (82% versus 79%, P=0.466). Lastly, QFR demonstrated a higher area under the receiver operating curve than quantitative coronary angiography (0.90 versus 0.82, P=0.008) for the detection of FFR-defined significant vein graft disease. This study shows the potential applicability of contemporary QFR computation in venous bypass grafts with a moderate correlation and good diagnostic accuracy compared with functional assessment using FFR.