Saphenous vein graft disease
Summary
Patients undergoing saphenous vein graft (SVG) intervention usually present with degenerated SVGs, are often older, and suffer significant comorbidities. SVG intervention carries a higher risk of distal embolization and poorer outcome than native coronary vessel intervention, despite advances in embolic protection and pharmacotherapy. Although, embolic protection devices have demonstrated to decrease the risk of embolization after SVG intervention, their value in contemporary practice have been questioned. However, in many cases those devices are not utilised or cannot be used. This article describes the natural history of disease involving SVGs, discusses the risk-benefit of SVG interventions, reviews prevention strategies for no-reflow, and offers a perspective on the utility of percutaneous SVG intervention in both elective and acute settings.
Introduction
The utility of aorto-coronary saphenous vein grafts (SVGs) is limited by gradual attrition, regardless of the territory bypassed: approximately 10% of SVGs occlude before hospital discharge or within 30 days, 65% to 80% are patent at 5 years, and 50% to 60% are patent at 10 years 1
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