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Percutaneous Saphenous Vein Graft and Arterial Graft Intervention

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Catheter-Based Cardiovascular Interventions

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Abstract

Despite major advances in the management of these lesions over the past decade, bypass-graft intervention remains a significant challenge. Saphenous vein graft (SVG) intervention in particular has a high complication rate, a consequence of frequent distal embolization, resulting in no-reflow and periprocedural myocardial infarction. Proximal and distal embolic protection devices have been shown to substantially reduce the risk of no-reflow and adverse cardiac events in patients undergoing SVG PCI. In addition, drug-eluting stents (DES), in comparison to bare-metal stents (BMS) in this patient population, attenuate the high rates of target lesion revascularization at least in the short term.

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References

  1. Epstein AJ et al (2011) Coronary revascularization trends in the United States, 2001–2008. JAMA 305(17):1769–1776

    Article  PubMed  CAS  Google Scholar 

  2. Brilakis ES, Wang TY, Rao SV et al (2010) Frequency and predictors of drug-eluting stent use in saphenous vein bypass graft percutaneous coronary interventions: a report from the American College of Cardiology – National Cardiovascular Data Registry (abstract). Presented at American College of Cardiology ACC scientific meetings, Atlanta, Georgia, 14 Mar 2010

    Google Scholar 

  3. Bourassa MG, Enjalbert M, Campeau L et al (1984) Progression of atherosclerosis in coronary arteries and bypass grafts. Ten years later. Am J Cardiol 53:102C–107C

    Article  PubMed  CAS  Google Scholar 

  4. Fitzgibbon GM, Kafka HP, Leach AJ et al (1996) Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol 28:616–626

    Article  PubMed  CAS  Google Scholar 

  5. Sharma S (2004) Current management of saphenous vein graft disease. Int J Cardiol 2:2

    Google Scholar 

  6. Hiscock M, Oqueli E, Dick R (2007) Percutaneous saphenous vein graft intervention - a review. Heart Lung Circ 16:S51–S55

    Article  PubMed  Google Scholar 

  7. Cameron A, Kemp HG Jr, Green GE (1998) Reoperation for coronary artery disease: 10 years of clinical follow-up. Circulation 78:1158–1162

    Google Scholar 

  8. Baim DS (2003) Percutaneous treatment of saphenous vein graft disease: the ongoing challenge. J Am Coll Cardiol 42:1370–1372

    Article  PubMed  Google Scholar 

  9. Baim DS, Wahr D, George B et al (2002) Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts. Circulation 105:1285–1290

    Article  PubMed  Google Scholar 

  10. Piana RN, Paik GY, Moscucci M et al (1994) Incidence and treatment of “no-reflow” after percutaneous coronary intervention. Circulation 89:2514–2518

    Article  PubMed  CAS  Google Scholar 

  11. Fasseas P, Orford JL, Denktas AE et al (2001) Distal protection devices during percutaneous coronary and carotid interventions. Curr Control Trials Cardiovasc Med 2:286–291

    Article  PubMed  Google Scholar 

  12. Hong MK, Mehran R, Dangas G et al (1999) Creatinine kinase-MB enzyme elevation following successful saphenous vein graft intervention is associated with late mortality. Circulation 100:2400–2405

    Article  PubMed  CAS  Google Scholar 

  13. Resnik FS, Wainstein M, Lee MK et al (2003) No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention. Am Heart J 145(1):43–46

    Google Scholar 

  14. Baim DS, Carrozza JP Jr, Kuntz RE et al (1999) Managing the embolization problem during saphenous vein graft intervention. Catheter Cardiovasc Interv 47:155–156

    Article  PubMed  CAS  Google Scholar 

  15. Movahed RM (2008) Post coronary bypass surgery angiography and interventions. CTSNet. http://www.ctsnet.org/portals/endovascular/procedures101/exp_tech4.html. Accessed 28 Mar 2011

  16. Hanekamp C, Koolen J, den Heijer P et al for VENESTENT Study Group (2003) A randomised comparison between balloon angioplasty and elective stent implantation in venous bypass grafts; the VENESTENT study. Catheter Cardiovasc Interv 60:452–457

    Google Scholar 

  17. Savage MP, Douglas Jr JS, Fischman DL et al for the Saphenous Vein De Novo Trial Investigators (1997) Stent placement compared with balloon angioplasty for obstructed coronary bypass grafts. N Engl J Med 337:740–747

    Google Scholar 

  18. Vermeersch P, Agostini P, Verheye S et al (2006) Randomised double-blind comparison of sirolimus-eluting stent versus bare-metal stent implantation in diseased saphenous vein grafts: six month angiographic, intravascular ultrasound and clinical follow-up of the RRISC trial. J Am Coll Cardiol 48(12):2423–2431

    Article  PubMed  CAS  Google Scholar 

  19. Vermeersch P, Agostoni P, Verheye S et al (2007) Increased late mortality after sirolimus eluting stents versus bare-metal stents in diseased saphenous vein grafts. J Am Coll Cardiol 50:261–267

    Article  PubMed  CAS  Google Scholar 

  20. Brodie BR, Wilson H, Stuckey T et al (2009) Outcomes with drug-eluting versus bare-metal stents in saphenous vein graft intervention results from the STENT (strategic transcatheter evaluation of new therapies) group. JACC Cardiovasc Interv 2(11):1105–1112

    Article  PubMed  Google Scholar 

  21. Mehilli J (2011) ISAR-CABG: randomized, superiority trial of drug-eluting stent and bare-metal stent in saphenous vein graft lesions. Presented at: American College of Cardiology Scientific Session/i2 Summit, New Orleans, 4 Apr 2011

    Google Scholar 

  22. Schachinger V, Hamm CW, Munzel C et al for the STING (Stents IN Grafts) Investigators (2003) A randomized trial of polytetrafluoroethylene-membrane-covered stents compared with conventional stents in aortocoronary saphenous vein grafts. J Am Coll Cardiol 42:1360–1369

    Google Scholar 

  23. Stankovic G, Colombo A, Presbitero P et al (2003) Randomized evaluation of polytetrafluro-ethylene covered stent in saphenous vein grafts: the randomized evaluation of polytetrafluroethylene covered stent in saphenous vein grafts (RECOVERS) trial. Circulation 108:37–42

    Article  PubMed  CAS  Google Scholar 

  24. Stone GW, Goldberg S, Mehran R et al (2005) A prospective, randomized U.S. trial of the PTFE covered JOSTENT for the treatment of diseased saphenous vein grafts: the BARRICADE trial(abstr). J Am Coll Cardiol 45(Suppl A):27A

    Google Scholar 

  25. Turco MA, Buchbinder M, Popma JJ et al (2006) Pivotal, randomized U.S. study of the Symbiottrade mark covered stent system in patients with saphenous vein graft disease: eight-month angiographic and clinical results from the Symbiot III trial. Catheter Cardiovasc Interv 68(3):379–388

    Article  PubMed  Google Scholar 

  26. Banerjee S, Brilakis E (2009) Embolic protection during saphenous vein graft interventions. J Invasive Cardiol 21:415–417

    PubMed  Google Scholar 

  27. Carrozza J, Mumma M, Breall J et al for PRIDE Study Investigators (2005) Randomized evaluation of the TriActiv balloon-protection flush and extraction system for the treatment of saphenous vein graft disease. J Am Coll Cardiol 46:1677–1683

    Google Scholar 

  28. Stone GW, Rogers C, Hermiller J et al (2003) 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 108:548–553

    Article  PubMed  Google Scholar 

  29. http://www.bostonscientific.com/Device.bsci?page=HCP_Overview&navRelId=1000.1003&method=DevDetailHCP&id=10004801&pageDisclaimer=Disclaimer.ProductPage

  30. Gorog DA, Foale RA, Malik I (2005) Distal myocardial protection during percutaneous coronary intervention—when and where? J Am Coll Cardiol 46(8):1434–1435

    Article  PubMed  Google Scholar 

  31. Waknine Y (2004) FDA approvals: Parcopa, Saizen, FilterWire EZ, and Others. Medscape Medical News. www.medscape.com/viewarticle/488455 Accessed 15 May 2011

  32. von Korn H, Yu J, Huegle B et al (2005) Safety and efficacy of a new filter-based protection system for aorto-coronary bypass graft interventions: the ev3 Spider™ device. J Invasive Cardiol 17(7):352–355

    Google Scholar 

  33. Dixon SR (2005) Saphenous vein graft protection in a distal embolic protection randomized trial. Presented at Transcatheter Cardiovascular Therapeutics, Washington, DC, Oct 2005

    Google Scholar 

  34. Subbarao M, Bacharach JM, Ansel G et al (2010) Carotid artery stenting in high surgical risk patients using the FiberNet® embolic protection system: the EPIC trial results. Catheter Cardiovasc Interv 75(6):817–822

    Google Scholar 

  35. Mauri L, Rogers C, Baim DS (2006) Devices for distal protection during percutaneous coronary revascularization. Circulation 113:2651–2656

    Article  PubMed  Google Scholar 

  36. Mauri L, Cox D, Hermiller J et al (2007) The PROXIMAL Trial: proximal protection during saphenous vein graft intervention using the Proxis Embolic Protection System. J Am Coll Cardiol 50:1442–1449

    Article  PubMed  Google Scholar 

  37. Smith SC et al (2006) ACC/AHA/SCAI 2005 guideline update for PCI (update of the 2001 PCI guidelines). J Am Coll Cardiol 47:216–235

    Article  PubMed  Google Scholar 

  38. Ashby D, Dangas G, Aymong E et al (2003) Effect of percutaneous coronary interventions for in-stent restenosis in degenerated saphenous vein grafts without distal embolic protection. J Am Coll Cardiol 41:740–752

    Google Scholar 

  39. Cohen DJ, Murphy SA, Baim DS et al (2004) Cost-effectiveness of distal embolic protection for patients undergoing percutaneous intervention of saphenous vein bypass grafts: results from the SAFER trial. J Am Coll Cardiol 44(9):1801–1808

    PubMed  Google Scholar 

  40. Sdringola S, Assali A, Ghani M et al (2001) Risk assessment of slow or no re-flow phenomenon in aortocoronary vein graft percutaneous intervention. Catheter Cardiovasc Interv 54(3):318–324

    Article  PubMed  CAS  Google Scholar 

  41. Kaeng WL, Norell MS (2008) Management of ‘no-reflow’ complicating reperfusion therapy. Acute Card Care 10:5–14

    Google Scholar 

  42. Kirtane AJ, Heyman ER, Metzger C et al (2008) Correlates of adverse events during saphenous vein graft intervention with distal embolic protection a PRIDE substudy. J Am Coll Cardiol Interv 1:186–191

    Google Scholar 

  43. Lee CH, Wong HB, Tan HC et al (2005) Impact of reversibility of no reflow phenomenon on 30-day mortality following percutaneous revascularization for acute myocardial infarction-insights from a 1328 patient registry. J Interv Cardiol 18:261–266

    Article  PubMed  Google Scholar 

  44. Hong YJ, Pichard AD, Mintz GS et al (2010) Outcome of undersized drug-eluting stents for percutaneous coronary intervention of saphenous vein graft lesions. Am J Cardiol 105(2):179–185

    Article  PubMed  CAS  Google Scholar 

  45. Michaels AD, Appleby M, Otten MH et al (2002) Pretreatment with intragraft verapamil prior to percutaneous coronary intervention of saphenous vein graft lesions: results of the randomized, controlled vasodilator prevention on no-reflow (VAPOR) trial. J Invasive Cardiol 14:299–302

    PubMed  Google Scholar 

  46. Micari A, Belcik TA, Balcells EA et al (2005) Improvement in microvascular reflow and reduction of infarct size with adenosine in patients undergoing primary coronary stenting. Am J Cardiol 96:1410–1415

    Article  PubMed  CAS  Google Scholar 

  47. Sdringola S, Assali A, Ghani M et al (2000) Adenosine use during aortocoronary vein graft interventions reverses but does not prevent the slow-no reflow phenomenon. Catheter Cardiovasc Interv 51:394–399

    Article  PubMed  CAS  Google Scholar 

  48. Hillegrass WB, Dean NA, Liao L et al (2001) Treatment of no-reflow and impaired flow with the nitric oxide donor nitroprusside following percutaneous coronary interventions: initial human clinical experience. J Am Coll Cardiol 37:1335–1343

    Article  Google Scholar 

  49. Roffi M, Mukherjee D, Chew DP et al (2002) Lack of benefit from intravenous platelet glycoprotein IIb/IIIa receptor inhibition as adjunctive treatment for percutaneous interventios of aortocoronary bypass grafts. A pooled analysis of five randomized clinical trials. Circulation 106:3063–3067

    Article  PubMed  Google Scholar 

  50. Mishra S, Chu W, Torguson R et al (2006) Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention. Am J Cardiol 98:608–612

    Article  PubMed  Google Scholar 

  51. Dave RM (2008) Complex SVG PCI in acute coronary syndrome: case 3 of a 5 part series. Cath Lab Digest; November. http://www.cathlabdigest.com/articles/Complex-SVG-PCI-Acute-Coronary-Syndrome-Case-3-a-5-part-series

  52. Sarkar K, Kini AS (2010) Percutaneous left ventricular support devices. Cardiol Clin 28:169–184

    Article  PubMed  Google Scholar 

  53. Ferreiro JL, Gomez-Hospital JA, Cequier AR et al (2010) Use of Impella Recover LP 2.5 in elective high risk percutaneous coronary intervention. Int J Cardiol 145(2):235–237

    Article  PubMed  Google Scholar 

  54. McCulloch B (2011) Use of the Impella 2.5 in high-risk percutaneous coronary intervention. Crit Care Nurse 31(1):e1–e16

    Article  PubMed  Google Scholar 

  55. Dixon SR, Henriques JPS, Mauri L et al (2009) A prospective feasibility trial investigating the use of the Impella 2.5 system in patients undergoing high-risk percutaneous coronary intervention (the PROTECT I trial): initial U.S. experience. J Am Coll Cardiol 2:91–96

    Google Scholar 

  56. Lee MS, Makkar RR (2006) Percutaneous left ventricular support devices. Cardiol Clin 24:265–275

    Article  PubMed  Google Scholar 

  57. Vranckx P, Meliga E, de Jaegere P et al (2008) The TandemHeart®, percutaneous transseptal left ventricular assist device: a safeguard in high-risk percutaneous coronary interventions. The six-year Rotterdam experience. EuroIntervention 4:331–337

    Article  PubMed  Google Scholar 

  58. Bagai J, Webb D, Kasasbeh E et al (2011) Efficacy and safety of percutaneous life support during high-risk percutaneous coronary intervention, refractory cardiogenic shock and in-laboratory cardiopulmonary arrest. J Invasive Cardiol 23(4):141–147

    PubMed  Google Scholar 

  59. Berger PB, Alderman EL, Nadel A et al (1999) Frequency of early occlusion and stenosis in a left internal mammary artery to left anterior descending artery bypass graft after surgery through a median sternotomy on conventional bypass: benchmark for minimally invasive direct coronary artery bypass. Circulation 100:2353–2358

    Article  PubMed  CAS  Google Scholar 

  60. Sharma A, Ajani A, Garg N et al (2003) Percutaneous interventions in radial artery grafts: clinical and angiographic outcomes. Cathet Cardiovasc Diagn 59:172–175

    Google Scholar 

  61. Beloscar A, Guarinos J, Gutierrez L et al (2005) Percutaneous intervention to a radial coronary artery graft. Initial results and follow-up. Rev Esp Cardiol 58:306–309

    Article  PubMed  Google Scholar 

  62. Hung WC, Wu CJ, Yip HK et al (2007) Percutaneous transluminal angioplasty to left internal mammary artery grafts: immediate and long-term clinical outcomes. Chang Gung Med J 30:235–241

    PubMed  Google Scholar 

  63. Mann T, Cubeddu G, Schneider J et al (2000) Left internal mammary artery intervention: the left radial approach with a new guide catheter. J Invasive Cardiol 12:298–302

    PubMed  CAS  Google Scholar 

  64. Sharma S, Makkar RM (2003) Percutaneous intervention on the LIMA: tackling the tortuosity. J Invasive Cardiol 15:359–362

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, St Vincent Medical Group, St Vincent Heart Center of Indiana, 10590 Meridian Street, Indianapolis, IN, 46290, USA

    Matthew Cantrell M.D., Edward Fry M.D., FACC, FSCAI & James Hermiller M.D., FACC, FSCAI

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  1. Matthew Cantrell M.D.
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  2. Edward Fry M.D., FACC, FSCAI
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  3. James Hermiller M.D., FACC, FSCAI
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Correspondence to Matthew Cantrell M.D. .

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  1. , Dept. of Internal Medicine, Gesundheitszentrum Bitterfeld-Wolfen, Friedrich-Ludwig-Jahn-Straße 2, Bitterfeld-Wolfen, 06749, Germany

    Peter Lanzer

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Cantrell, M., Fry, E., Hermiller, J. (2013). Percutaneous Saphenous Vein Graft and Arterial Graft Intervention. In: Lanzer, P. (eds) Catheter-Based Cardiovascular Interventions. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27676-7_32

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  • DOI: https://doi.org/10.1007/978-3-642-27676-7_32

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