Skip to main content

Guidelines Regarding the Revascularization in Patients with Prior CABG

  • Chapter
  • First Online:
Coronary Graft Failure

Abstract

Currently, more than 300,000 patients undergo coronary artery bypass grafting (CABG) in the United States each year. Although the short-term outcomes of CABG are generally excellent, patients remain at risk for future cardiac events. Mortality rates ranged from 2 to 5 % among patients who undergo redo CABG, a two- to four-fold increase as compared to initial bypass surgery. In this chapter we review and summarize the guidelines regarding revascularization in patients with prior CABG.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Epstein AJ, Polsky D, Yang F, Yang L, Groeneveld PW. Coronary revascularization trends in the United States, 2001–2008. JAMA. 2011;305:1769–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Loop FD, Lytle BW, Cosgrove DM, Woods EL, Stewart RW, Golding LA, Goormastic M, Taylor PC. Reoperation for coronary atherosclerosis. Changing practice in 2509 consecutive patients. Ann Surg. 1990;212(3):378–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Authors/Task Forcemembers: StephanWindecker* (ESC Chairperson) (Switzerland),Philippe Kolh* (EACTS Chairperson) (Belgium), Fernando Alfonso (Spain), Jean-Philippe Collet (France), Jochen Cremer (Germany), Volkmar Falk (Switzerland), Gerasimos Filippatos (Greece), Christian Hamm(Germany), Stuart J. Head (The Netherlands), Peter Ju¨ni (Switzerland), A. Pieter Kappetein (The Netherlands), Adnan Kastrati (Germany), Juhani Knuuti (Finland), Ulf Landmesser (Switzerland), Gu¨nther Laufer (Austria), Franz-Josef Neumann (Germany), Dimitrios J. Richter (Greece), Patrick Schauerte (Germany),Miguel Sousa Uva (Portugal), Giulio G. Stefanini (Switzerland), David Paul Taggart (UK), Lucia Torracca (Italy), Marco Valgimigli (Italy),WilliamWijns (Belgium), and AdamWitkowski (Poland). ESC/EACTS Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. doi:10.1093/eurheartj/ehu278.

  4. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter Jr AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. Circulation. 2011;124:e652–735.

    Article  PubMed  Google Scholar 

  5. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Writing Group on the Joint ESCAAHAWHFTFftUDoMI, Thygesen K, Alpert JS, White HD, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA, Chaitman BA, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasche P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S, Guidelines ESCCfP. Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551–67.

    Google Scholar 

  6. Beijk MA, Harskamp RE. Treatment of coronary artery bypass graft failure, artery bypass. Aronow WS, editor. InTech; 2013. ISBN: 978-953-51-1025-5. doi:10.5772/54928. Available from: http://www.intechopen.com/books/artery-bypass/treatment-of-coronary-artery-bypass-graft-failure.

    Google Scholar 

  7. Barboriak JJ, Pintar K, Van Horn DL, Batayias GE, Korns ME. Pathologic findings in the aortocoronary vein grafts. A scanning electron microscope study. Atherosclerosis. 1978;29:69–80.

    Article  CAS  PubMed  Google Scholar 

  8. Vlodaver Z, Edwards JE. Pathologic changes in aortic-coronary arterial saphenous vein grafts. Circulation. 1971;44:719–28.

    Article  CAS  PubMed  Google Scholar 

  9. Waller BF, Roberts WC. Remnant saphenous veins after aortocoronary bypass grafting: analysis of 3,394 centimeters of unused vein from 402 patients. Am J Cardiol. 1985;55:65–71.

    Article  CAS  PubMed  Google Scholar 

  10. Zhao DX, Leacche M, Balaguer JM, Boudoulas KD, Damp JA, Greelish JP, Byrne JG, WritingGroup of the Cardiac Surgery CA, Interventional Cardiology Groups at the Vanderbilt H, Vascular I, Ahmad RM, Ball SK, Cleator JH, Deegan RJ, Eagle SS, Fong PP, Fredi JL, Hoff SJ, Jennings HS 3rd, McPherson JA, Piana RN, Pretorius M, Robbins MA, Slosky DA, Thompson A. Routine intraoperative completion angiography after coronary artery bypass grafting and 1-stop hybrid revascularization results from a fully integrated hybrid catheterization laboratory/operating room. J Am Coll Cardiol. 2009;53(3):232–41.

    Google Scholar 

  11. Thielmann M, Massoudy P, Jaeger BR, Neuhauser M, Marggraf G, Sack S, Erbel R, Jakob H. Emergency re-revascularization with percutaneous coronary intervention, reoperation, or conservative treatment in patients with acute perioperative graft failure following coronary artery bypass surgery. Eur J Cardiothorac Surg. 2006;30(1):117–25.

    Article  PubMed  Google Scholar 

  12. De Bruyne B, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, Jagic N, Mobius-Winkler S, Rioufol G, Witt N, Kala P, MacCarthy P, Engstrom T, Oldroyd KG, Mavromatis K, Manoharan G, Verlee P, Frobert O, Curzen N, Johnson JB, Juni P, Fearon WF, Investigators FT. Fractional flow reserve-guided PCI vs. medical therapy in stable coronary disease. N Engl J Med. 2012;367(11):991–1001.

    Article  PubMed  Google Scholar 

  13. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003;107(23):2900–7.

    Article  PubMed  Google Scholar 

  14. Szavits-Nossan J, Stipić H, Sesto I, Kapov-Svilicić K, Sipić T, Bernat R. Angiographic control and percutaneous treatment of myocardial ischemia immediately after CABG. Coll Antropol. 2012;36(4):1391–4.

    PubMed  Google Scholar 

  15. Alexander JH, Hafley G, Harrington RA, Peterson ED, Ferguson Jr TB, Lorenz TJ, Goyal A, Gibson M, Mack MJ, Gennevois D, Califf RM, Kouchoukos NT. Efficacy and safety of edifoligide, an E2F transcription factor decoy, for prevention of vein graft failure following coronary artery bypass graft surgery: PREVENT IV: a randomized controlled trial. JAMA. 2005;294(19):2446–54.

    Article  PubMed  Google Scholar 

  16. Tatoulis J, Buxton BF, Fuller JA. The right internal thoracic artery: the forgotten conduit: 5,766 patients and 991 angiograms. Ann Thorac Surg. 2011;92(1):9–15; discussion 15–7.

    Article  PubMed  Google Scholar 

  17. Barner HB, Bailey M, Guthrie TJ, Pasque MK, Moon MR, Damiano Jr RJ, Lawton JS. Radial artery free and T graft patency as coronary artery bypass conduit over a 15-year period. Circulation. 2012;126(11 Suppl 1):S140–4.

    Article  PubMed  Google Scholar 

  18. Achouh P, Boutekadjirt R, Toledano D, Hammoudi N, Pagny JY, Goube P, Isselmou KO, Lancelin B, Fouquet R, Acar C. Long-term (5- to 20-year) patency of the radial artery for coronary bypass grafting. J Thorac Cardiovasc Surg. 2010;140(1):73–9, 79 e1–e2.

    Article  PubMed  Google Scholar 

  19. Davierwala PM, Verevkin A, Leontyev S, Misfeld M, Borger MA, Mohr FW. Impact of expeditious management of perioperative myocardial ischemia in patients undergoing isolated coronary artery bypass surgery. Circulation. 2013;128(11 Suppl 1):S226–34.

    Article  PubMed  Google Scholar 

  20. Laflamme M, DeMey N, Bouchard D, Carrier M, Demers P, Pellerin M, Couture P, Perrault LP. Management of early postoperative coronary artery bypass graft failure. Interact Cardiovasc Thorac Surg. 2012;14(4):452–6.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sabik 3rd JF, Blackstone EH, Houghtaling PL, Walts PA, Lytle BW. Is reoperation still a risk factor in coronary artery bypass surgery? Ann Thorac Surg. 2005;80(5):1719–27.

    Article  PubMed  Google Scholar 

  22. Subramanian S, Sabik 3rd JF, Houghtaling PL, Nowicki ER, Blackstone EH, Lytle BW. Decision-making for patients with patent left internal thoracic artery grafts to left anterior descending. Ann Thorac Surg. 2009;87(5):1392–8; discussion 1400.

    Article  PubMed  Google Scholar 

  23. Escaned J. Secondary revascularization after CABG surgery. Nat Rev Cardiol. 2012;9(9):540–9.

    Article  PubMed  Google Scholar 

  24. Frobert O, Schersten F, James SK, Carlsson J, Lagerqvist B. Long-term safety and efficacy of drug-eluting and bare metal stents in saphenous vein grafts. Am Heart J. 2012;164(1):87–93.

    Article  PubMed  Google Scholar 

  25. Alam M, Bandeali SJ, Virani SS, Jneid HM, Shahzad SA, Ramanathan KB, Kar B, Kleiman NS, Lakkis N. Clinical outcomes of percutaneous interventions in saphenous vein grafts using drug-eluting stents compared to bare-metal stents: a comprehensive meta-analysis of all randomized clinical trials. Clin Cardiol. 2012;35(5):291–6.

    Article  PubMed  Google Scholar 

  26. Ko DT, Guo H, Wijeysundera HC, Zia MI, Dzavik V, Chu MW, Fremes SE, Cohen EA, Tu JV. Long-term safety and effectiveness of drug-eluting stents for the treatment of saphenous vein grafts disease: a population-based study. JACC Cardiovasc Interv. 2011;4(9):965–73.

    Article  PubMed  Google Scholar 

  27. Mehilli J, Pache J, Abdel-Wahab M, Schulz S, Byrne RA, Tiroch K, Hausleiter J, Seyfarth M, Ott I, Ibrahim T, Fusaro M, Laugwitz KL, Massberg S, Neumann FJ, Richardt G, Schomig A, Kastrati A. Drug-eluting vs. bare-metal stents in saphenous vein graft lesions (ISAR-CABG): a randomised controlled superiority trial. Lancet. 2011;378(9796):1071–8.

    Article  CAS  PubMed  Google Scholar 

  28. Nauta ST, Van Mieghem NM, Magro M, Deckers JW, Simsek C, Van Geuns RJ, Van Der Giessen WJ, De Jaegere P, Regar E, Van Domburg RT, Serruys PW. Seven-year safety and efficacy of the unrestricted use of drug-eluting stents in saphenous vein bypass grafts. Catheter Cardiovasc Interv. 2012;79(6):912–8.

    Article  PubMed  Google Scholar 

  29. Brilakis ES, Lasala JM, Cox DA, Berger PB, Bowman TS, Starzyk RM, Dawkins KD. Outcomes after implantation of the TAXUS paclitaxel-eluting stent in saphenous vein graft lesions: results from the ARRIVE (TAXUS Peri-Approval Registry: A Multicenter Safety Surveillance) program. JACC Cardiovasc Interv. 2010;3(7):742–50.

    Article  PubMed  Google Scholar 

  30. Baim DS, Wahr D, George B, Leon MB, Greenberg J, Cutlip DE, Kaya U, Popma JJ, Ho KK, Kuntz RE. Saphenous vein graft Angioplasty Free of Emboli Randomized Trial I. Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts. Circulation. 2002;105(11):1285–90.

    PubMed  Google Scholar 

  31. Stone GW, Rogers C, Hermiller J, Feldman R, Hall P, Haber R, Masud A, Cambier P, Caputo RP, Turco M, Kovach R, Brodie B, Herrmann HC, Kuntz RE, Popma JJ, Ramee S, Cox DA, FilterWire EXREI. Randomized comparison of distal protection with a filter-based catheter and a balloon occlusion and aspiration system during percutaneous intervention of diseased saphenous vein aorto-coronary bypass grafts. Circulation. 2003;108(5):548–53.

    Article  PubMed  Google Scholar 

  32. Mauri L, Cox D, Hermiller J, Massaro J, Wahr J, Tay SW, Jonas M, Popma JJ, Pavliska J, Wahr D, Rogers C. The PROXIMAL trial: proximal protection during saphenous vein graft intervention using the Proxis Embolic Protection System: a randomized, prospective, multicenter clinical trial. J Am Coll Cardiol. 2007;50(15):1442–9.

    Article  PubMed  Google Scholar 

  33. Naidu SS, Turco MA, Mauri L, Coolong A, Popma JJ, Kereiakes DJ. Contemporary incidence and predictors of major adverse cardiac events after saphenous vein graft intervention with embolic protection (an AMEthyst trial substudy). Am J Cardiol. 2010;105(8):1060–4.

    Article  PubMed  Google Scholar 

  34. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). EuroIntervention. 2014. pii: 20140826e. doi:10.4244/EIJY14M09_01.

    Google Scholar 

  35. Kolh P, Windecker S, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A; ESC Committee for Practice Guidelines, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol Ç, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S; EACTS Clinical Guidelines Committee, Sousa Uva M, Achenbach S, Pepper J, Anyanwu A, Badimon L, Bauersachs J, Baumbach A, Beygui F, Bonaros N, De Carlo M, Deaton C, Dobrev D, Dunning J, Eeckhout E, Gielen S, Hasdai D, Kirchhof P, Luckraz H, Mahrholdt H, Montalescot G, Paparella D, Rastan AJ, Sanmartin M, Sergeant P, Silber S, Tamargo J, ten Berg J, Thiele H, van Geuns RJ, Wagner HO, Wassmann S, Wendler O, Zamorano JL. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg. 2014;46(4):517–92. doi:10.1093/ejcts/ezu366.

    Google Scholar 

  36. Coolong A, Baim DS, Kuntz RE, O’Malley AJ, Marulkar S, Cutlip DE, Popma JJ, Mauri L. Saphenous vein graft stenting and major adverse cardiac events: a predictive model derived from a pooled analysis of 3958 patients. Circulation. 2008;117(6):790–7.

    Article  PubMed  Google Scholar 

  37. Roffi M, Mukherjee D, Chew DP, Bhatt DL, Cho L, Robbins MA, Ziada KM, Brennan DM, Ellis SG, Topol EJ. Lack of benefit from intravenous platelet glycoprotein IIb/IIIa receptor inhibition as adjunctive treatment for percutaneous interventions of aortocoronary bypass grafts: a pooled analysis of five randomized clinical trials. Circulation. 2002;106(24):3063–7.

    Article  PubMed  Google Scholar 

  38. Dunning J, Versteegh M, Fabbri A, et al. Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg. 2008;34:73–92.

    Article  PubMed  Google Scholar 

  39. Weaver H, Shukla N, Ellinsworth D, Jeremy JY. Oxidative stress and vein graft failure: a focus on NADH oxidase, nitric oxide and eicosanoids. Curr Opin Pharmacol. 2012;12(2):160–5.

    Article  CAS  PubMed  Google Scholar 

  40. Kulik A, Le May MR, Voisine P, Tardif JC, DeLarochelliere R, Naidoo S, Wells GA, Mesana TG, Ruel M. Aspirin plus clopidogrel versus aspirin alone after coronary artery bypass grafting: the clopidogrel after surgery for coronary artery disease (CASCADE) Trial. Circulation. 2010;122:2680–7.

    Article  CAS  PubMed  Google Scholar 

  41. Gao G, Zheng Z, Pi Y, Lu B, Lu J, Hu S. Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery: a single-center, randomized, controlled trial. J Am Coll Cardiol. 2010;56:1639–43.

    Article  CAS  PubMed  Google Scholar 

  42. Gao C, Ren C, Li D, Li L. Clopidogrel and aspirin versus clopidogrel alone on graft patency after coronary artery bypass grafting. Ann Thorac Surg. 2009;88:59–62.

    Article  PubMed  Google Scholar 

  43. Sun JCJ, Teoh KHT, Lamy A, Sheth T, Ellins ML, Jung H, Yusuf S, Anand S, Connolly S, Whitlock RP, et al. Randomized trial of aspirin and clopidogrel versus aspirin alone for the prevention of coronary artery bypass graft occlusion: the preoperative aspirin and postoperative anti-platelets in coronary artery bypass grafting study. Am Heart J. 2010;160:1178–84.

    Article  CAS  PubMed  Google Scholar 

  44. Sørensen R, Abildstrom SZ, Hansen PR, Hvelplund A, Andersson C, Charlot M, Fosbøl EL, Køber L, Madsen JK, Gislason GH, et al. Efficacy of post-operative clopidogrel treatment in patients revascularized with coronary artery bypass grafting after myocardial infarction. J Am Coll Cardiol. 2011;57:1202–9.

    Article  PubMed  Google Scholar 

  45. Kim DH, Daskalakis C, Silvestry SC, Silvestry SC, Sheth MP, Lee AN, Adams S, Hohmann S, Medvedev S, Whellan DJ. Aspirin and clopidogrel use in the early postoperative period following on-pump and off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2009;138:1377–84.

    Article  CAS  PubMed  Google Scholar 

  46. Yap CH, Sposato L, Akowuah E, Theodore S, Dinh DT, Shardey GC, Skillington PD, Tatoulis J, Yii M, Smith JA, Mohajeri M, Pick A, Seevanayagam S, Reid CM. Contemporary results show repeat coronary artery bypass grafting remains a risk factor for operative mortality. Ann Thorac Surg. 2009;87(5):1386–91.

    Article  PubMed  Google Scholar 

  47. Morrison DA, Sethi G, Sacks J, Henderson W, Grover F, Sedlis S, Esposito R, Ramanathan K, Weiman D, Saucedo J, Antakli T, Paramesh V, Pett S, Vernon S, Birjiniuk V, Welt F, Krucoff M, Wolfe W, Lucke JC, Mediratta S, Booth D, Barbiere C, Lewis D, Angina With Extremely Serious Operative Mortality E. Percutaneous coronary intervention vs. coronary artery bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: a multicenter, randomized trial. Investigators of the Department of Veterans Affairs Cooperative Study #385, the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME). J Am Coll Cardiol. 2001;38(1):143–9.

    Article  CAS  PubMed  Google Scholar 

  48. Morrison DA, Sethi G, Sacks J, Henderson WG, Grover F, Sedlis S, Esposito R, Investigators of the Department of Veterans Affairs Cooperative Study AWESOME. Percutaneous coronary intervention vs. repeat bypass surgery for patients with medically refractory myocardial ischemia: AWESOME randomized trial and registry experience with post-CABG patients. J Am Coll Cardiol. 2002;40(11):1951–4.

    Article  PubMed  Google Scholar 

  49. Harskamp RE, Beijk MA, Damman P, Kuijt WJ, Woudstra P, Grundeken MJ, Kloek JJ, Tijssen JG, de Mol BA, de Winter RJ. Clinical outcome after surgical or percutaneous revascularization in coronary bypass graft failure. J Cardiovasc Med (Hagerstown). 2013;14(6):438–45.

    Article  Google Scholar 

  50. Sabik 3rd JF, Raza S, Blackstone EH, Houghtaling PL, Lytle BW. Value of internal thoracic artery grafting to the left anterior descending coronary artery at coronary reoperation. J Am Coll Cardiol. 2013;61(3):302–10.

    Article  PubMed  Google Scholar 

  51. Lytle BW, Loop FD, Taylor PC, et al. Vein graft disease: the clinical impact of stenoses in saphenous vein bypass grafts to coronary arteries. J Thorac Cardiovasc Surg. 1992;103:831–40.

    CAS  PubMed  Google Scholar 

  52. Brooks N, Honey M, Cattell M, et al. Reoperation for recurrent angina. Br Heart J. 1979;42:333–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Oglietti J, Cooley DA. Myocardial revascularization. Early and late results after reoperation. J Thorac Cardiovasc Surg. 1976;71:736–40.

    CAS  PubMed  Google Scholar 

  54. Marshall Jr WJ, Saffitz J, Kouchokos NT. Management during reoperation of aortocoronary saphenous vein grafts with minimal atherosclerosis by angiography. Ann Thorac Surg. 1986;42:163–7.

    Article  PubMed  Google Scholar 

  55. Grodin CM. The removal of still functioning albeit old grafts; not in our genes? Ann Thorac Surg. 1986;42:122–3.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sarmad Said MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Said, S., Abbas, A. (2016). Guidelines Regarding the Revascularization in Patients with Prior CABG. In: Ţintoiu, I., Underwood, M., Cook, S., Kitabata, H., Abbas, A. (eds) Coronary Graft Failure. Springer, Cham. https://doi.org/10.1007/978-3-319-26515-5_49

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-26515-5_49

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-26513-1

  • Online ISBN: 978-3-319-26515-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics