PCI of Chronic Saphenous Vein Graft Occlusion: A Potential New Paradigm
A 69-year-old male with a history of hypertension, hyperlipidemia, s/p coronary artery bypass graft in 1994 (saphenous vein graft [SVG] to the right coronary artery [RCA], SVG to the diagonal branch, SVG to the obtuse marginal artery and left internal mammary artery to the left anterior descending artery [LAD]) underwent percutaneous coronary intervention in 2000 with bare-metal stent implantation in the SVG to the RCA due to 90% stenosis at the distal anastomosis. He did well until 3 months prior to his current admission, when he experienced recurrence of exertional anginal symptoms that persisted despite optimization of the medical therapy. He underwent coronary angiography on December 16, 2005 at another hospital and was found to have proximal occlusion of the SVG-to-RCA graft with left-to-right collaterals (Figure 1). Remaining grafts were patent. He was referred to the Lenox Hill Heart and Vascular Institute of New York for revascularization. The patient's hematocrit was 42.1%; his platelets were 181,000; blood urea nitrogen/creatine was 16/1.4 mg/dl; his total cholesterol was 141 mg/dl (low-density lipoprotein: 79 mg/dl; high-density lipoprotein: 38 mg/dl; triglyceride: 122 mg/dl). Electrocardiography showed sinus rhythm, a heart rate of 58 beats per minute, LAD, left atrial enlargement and non-specific ST-T wave changes. Echocardiographic evaluation revealed normal left ventricular function and wall motion.
(Enlarge Image)
Figure 1.
Occuluded saphenous vein graft.
Case Presentation
A 69-year-old male with a history of hypertension, hyperlipidemia, s/p coronary artery bypass graft in 1994 (saphenous vein graft [SVG] to the right coronary artery [RCA], SVG to the diagonal branch, SVG to the obtuse marginal artery and left internal mammary artery to the left anterior descending artery [LAD]) underwent percutaneous coronary intervention in 2000 with bare-metal stent implantation in the SVG to the RCA due to 90% stenosis at the distal anastomosis. He did well until 3 months prior to his current admission, when he experienced recurrence of exertional anginal symptoms that persisted despite optimization of the medical therapy. He underwent coronary angiography on December 16, 2005 at another hospital and was found to have proximal occlusion of the SVG-to-RCA graft with left-to-right collaterals (Figure 1). Remaining grafts were patent. He was referred to the Lenox Hill Heart and Vascular Institute of New York for revascularization. The patient's hematocrit was 42.1%; his platelets were 181,000; blood urea nitrogen/creatine was 16/1.4 mg/dl; his total cholesterol was 141 mg/dl (low-density lipoprotein: 79 mg/dl; high-density lipoprotein: 38 mg/dl; triglyceride: 122 mg/dl). Electrocardiography showed sinus rhythm, a heart rate of 58 beats per minute, LAD, left atrial enlargement and non-specific ST-T wave changes. Echocardiographic evaluation revealed normal left ventricular function and wall motion.
(Enlarge Image)
Figure 1.
Occuluded saphenous vein graft.
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