Skip to main content
SpringerLink
Log in

Laser Revascularisation in Saphenous Vein Grafts

  • Chapter
Lasers in Cardiovascular Interventions

  • 716 Accesses

Abstract

Coronary artery bypass surgery has revolutionised the treatment of symptomatic coronary atherosclerosis. However, the lack of long term patency of saphenous vein grafts has been a barrier to lasting procedural success. Recent estimates suggest that only 50 % of vein grafts will be patent and free of significant luminal stenosis at 10 years. The therapeutic options available to symptomatic patients facing further revascularisation are limited and hazardous. Re-do surgery is offered but at a higher risk of both morbidity and mortality than at initial operation, especially in the common situation of a patent internal mammary graft. The percutaneous option is, therefore, usually the preferred option by both the Heart Team and the patient.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
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. Favaloro RG. Saphenous vein graft in the surgical treatment of coronary artery disease: operative technique. J Thorac Cardiovasc Surg. 1969;58:178–85.

    CAS  PubMed  Google Scholar 

  2. Garrett HE, Dennis EW, DeBakey ME. Aortocoronary bypass with saphenous vein graft: seven-year follow-up. JAMA. 1973;223:792–4.

    Article  CAS  PubMed  Google Scholar 

  3. Motwani JG, Topol EJ. Aortocoroanry saphenous vein graft disease. Pathogenesis, predisposition and prevention. Circulation. 1998;97:916–31.

    Article  CAS  PubMed  Google Scholar 

  4. Campeau L, Enjalbert M, Lesperance J, Bourassa MG, Kwiterovich Jr P, Wacholder S, Sniderman A. The relation of risk factors to the development of atherosclerosis in saphenous vein bypass grafts and the progression of disease in the native circulation: a study 10 years after aortocoronary bypass surgery. N Engl J Med. 1984;311:1329–32.

    Article  CAS  PubMed  Google Scholar 

  5. Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper D, Burton JR. 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. 1996;28:616–26.

    Article  CAS  PubMed  Google Scholar 

  6. Weintraub WS, Jones EL, Craver JM, Guyton RA. Frequency of repeat coronary bypass or coronary angioplasty after coronary artery bypass surgery using saphenous venous grafts. Am J Cardiol. 1994;73:103–12.

    Article  CAS  PubMed  Google Scholar 

  7. Cao C, Ang SC, Wolak K, et al. A meta-analysis of randomized controlled trials on mid-term angiographic outcomes for radial artery versus saphenous vein in coronary artery bypass graft surgery. Ann Cardiothorac Surg. 2013;2(4):401–7.

    PubMed Central  PubMed  Google Scholar 

  8. Loop FD, Lytle BW, Cosgrove DM, Woods EL, Stewart RW, Golding LAR, Goormastic M, Taylor PC. Reoperation for coronary atherosclerosis: changing practice in 2509 consecutive patients. Ann Surg. 1990;212:378–86.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Lee MS, Park S-J, Kandzari DE, et al. Saphenous vein graft intervention. JACC Cardiovasc Interv. 2011;4:831–43.

    Article  PubMed  Google Scholar 

  10. Davies MG, Hagen PO. Reprinted article “pathophysiology of vein graft failure: a review”. Eur J Vasc Endoavasc Surg. 2011;42:S19–29.

    Article  Google Scholar 

  11. Quist WC, LoGerfo FW. Prevention of smooth muscle cell phenotypic modulation in vein grafts: a histomorphometric study. J Vasc Surg. 1992;16:225e31.

    Article  Google Scholar 

  12. Cherian SM, Bobryshev YV, Liang H, et al. Immunohistochemical and ultrastructural evidence that dendritic cells infiltrate stenotic aortocoronary saphenous vein bypass grafts. Cardiovasc Surg. 2001;9(2):194–200.

    Article  CAS  PubMed  Google Scholar 

  13. Shukla N, Jeremy J. Pathophysiology of saphenous vein graft failure: a brief overview of interventions. Curr Opin Pharmacol. 2012;12:114–20.

    Article  CAS  PubMed  Google Scholar 

  14. Chen SJ, Wilson JM, Muller DWM. Adenovirus-mediated gene transfer of soluble vascular cell adhesion molecule to porcine interposition vein grafts. Circulation. 1994;89:1922–8.

    Article  CAS  PubMed  Google Scholar 

  15. HarsKamp RE, Lopes RD, Baisden CE, et al. Saphenous vein graft failure after coronary artery bypass surgery. Pathophysiology, management, and future directions. Ann Surg. 2013;257:824–33.

    Article  PubMed  Google Scholar 

  16. Rodés-Cabau J, Bertrand OF, Larose E, et al. Comparison of plaque sealing with paclitaxel-eluting stents versus medical therapy for the treatment of moderate nonsignificant saphenous vein graft lesions: the moderate vein graft lesion stenting with the Taxus stent and intravascular ultrasound (VELETI) pilot trial. Circulation. 2009;2:1978–86.

    Article  Google Scholar 

  17. Rodés-Cabau J. Plaque sealing with paclitaxel-eluting stents for the treatment of moderate non-significant saphenous vein graft lesions. Three-year follow-up of the VELETI (moderate vein graft lesion stenting with the taxus stent and intravascular ultrasound) trial. Paper presented at: i2 Summit 2010, Atlanta, 14 March 2010.

    Google Scholar 

  18. Al-Lamee R, Ielasi A, Latib A, et al. Clinical and angiographic outcomes after percutaneous recanalization of chronic total saphenous vein graft occlusion using modern techniques. Am J Cardiol. 2010;106:1721–7.

    Article  PubMed  Google Scholar 

  19. Hindnavis V, Sung-Hae C, Goldberg S. Saphenous vein graft intervention: a review. J Invasive Cardiol. 2012;24(2):64–71.

    PubMed  Google Scholar 

  20. van Gaal WJ, Banning AP. Percutaneous coronary intervention and the no-reflow phenomenon. Expert Rev Cardiovasc Ther. 2007;5(4):715–31.

    Article  PubMed  Google Scholar 

  21. Baim DS, Wahr D, George B, et al. Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aortocoronary bypass grafts. Circulation. 2002;105(11):1285–90.

    PubMed  Google Scholar 

  22. Mathew V, Grill DE, Scott CG, et al. The influence of abciximab use on clinical outcome after aortocoronary vein graft interventions. J Am Coll Cardiol. 1999;34(4):1163–9.

    Article  CAS  PubMed  Google Scholar 

  23. Roffi M, Mukherjee D, Chew DP, et al. 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 

  24. Baldus S, Koster R, Elsner M, et al. Treatment of aortocoronary vein graft lesions with membrane-covered stents: a multicenter surveillance trial. Circulation. 2000;102(17):2024–7.

    Article  CAS  PubMed  Google Scholar 

  25. Schachinger V, Hamm CW, Munzel T, et al; STING (STents IN Grafts) Investigators. A randomized trial of polytetrafluoroethylene-membrane-covered stents compared with conventional stents in aortocoronary saphenous vein grafts. J Am Coll Cardiol. 2003;42(8):1360–9.

    Google Scholar 

  26. Stankovic G, Colombo A, Presbitero P, et al. Randomized Evaluation of polytetrafluoroethylene COVERed stent in Saphenous vein grafts (RECOVERS) Trial. Circulation. 2003;108(1):37–42.

    Article  CAS  PubMed  Google Scholar 

  27. Lee MS, Yang T, Kandzari DE, et al. Comparison by meta-analysis of drug-eluting stents and bare metal stents for saphenous vein graft intervention. Am J Cardiol. 2010;105:1076–82.

    Article  CAS  PubMed  Google Scholar 

  28. Giugliano GR, Kuntz RE, Popma JJ, Cutlip DE, Baim DS. Determinants of 30-day adverse events following saphenous vein graft intervention with and without a distal occlusion embolic protection device. Saphenous Vein Graft Angioplasty Free of Emboli Randomized (SAFER) Trial Investigators. Am J Cardiol. 2005;95(2):173–7.

    Article  PubMed  Google Scholar 

  29. Sturm E, Goldber G, Goldberg S. Embolic protection devices in saphenous vein graft and native vessel percutaneous intervention: a review. Curr Cardiol Rev. 2012;8:192–9.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Stone G, Rogers C, Hermiller J, et al. 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;108:548–53.

    Article  PubMed  Google Scholar 

  31. Dixon SR. Saphenous vein graft protection in a distal embolic protection randomized trial. Paper presented at: Transcatheter Cardiovascular Therapeutics, Washington, DC, Oct 2005.

    Google Scholar 

  32. Mathew V, Lennon RJ, Rihal CS, Bresnahan JF, Holmes Jr DR. Applicability of distal protection for aortocoronary vein graft interventions in clinical practice. Catheter Cardiovasc Interv. 2004;63:148–51.

    Article  PubMed  Google Scholar 

  33. Ebersole D, Dahm JB, Das T, et al. Excimer laser revascularisation of saphenous vein grafts in acute myocardial infarction. J Invasive Cardiol. 2004;16(4):177–80.

    PubMed  Google Scholar 

  34. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124(23):e574–651.

    Article  PubMed  Google Scholar 

  35. Topaz O, Das T, Dahm J, et al. Excimer laser revascularisation: current indications, applications and techniques. Laseres Med Sci. 2001;16(2):72–7.

    Article  CAS  Google Scholar 

  36. Litvack F, Grundfest WS, Goldenberg T, et al. Percutaneous excimer laser angioplasty of aortocoroanry saphenous vein grafts. J Am Coll Cardiol. 1989;14(3):803–8.

    Article  CAS  PubMed  Google Scholar 

  37. Eigler NL, Weinstock B, Douglas JS, et al. Excimer laser coronary angioplasty of aorto-ostial stenoses. Results of the excimer laser coronary angioplasty (ELCA) registry in the first 200 patients. Circulation. 1993;88:2049–57.

    Article  CAS  PubMed  Google Scholar 

  38. Bittl JA, Sanborn TA, Yardley DE, et al. Predictors of outcome of percutaneous excimer laser coronary angioplasty of Saphenous vein bypass graft lesions. The Percutaneous Excimer Laser Coronary Angioplasty Registry. Am J Cardiol. 1994;74(2):144–8.

    Article  CAS  PubMed  Google Scholar 

  39. Topaz O, Ebersole D, Das T, et al. Excimer laser angioplasty in acute myocardial infarction (the CARMEL multicentre trial). Am J Cardiol. 2004;93:694–701.

    Article  PubMed  Google Scholar 

  40. Strauss BH, Natarajan MK, Batchelor WB, et al. Early and late quantitative angiographic results of vein graft lesions treated by excimer laser with adjunctive balloon angioplasty. Circulation. 1995;92:348–56.

    Article  CAS  PubMed  Google Scholar 

  41. Holmes DR, Mehta S, Georgre CJ, et al. Excimer laser coronary angioplasty: the New Approaches to Coronary Intervention (NACI) experience. Am J Cardiol. 1997;80(10A):99K–105.

    Article  PubMed  Google Scholar 

  42. Köster R, Hamm CW, Seabra-Gomes R, et al. Laser angioplasty of restenosed coronary stents: results of a multicenter surveillance trial. J Am Coll Cardiol. 1999;34:25–32.

    Article  PubMed  Google Scholar 

  43. Ahmed JM, Hong MK, Mehran R, et al. Comparison of debulking followed by stenting versus stenting alone for saphenous vein graft aortoostial lesions: immediate and one-year clinical outcomes. J Am Coll Cardiol. 2000;35:1560–8.

    Article  CAS  PubMed  Google Scholar 

  44. Ajani AE, Waksman R, Kim H-S, et al. Excimer laser coronary angioplasty and intracoronary radiation for in-stent restenosis: six-month angiographic and clinical outcomes. Cardiovasc Radiat Med. 2001;2:191–6.

    Article  CAS  PubMed  Google Scholar 

  45. Dahm JB, Ebersole D, Das T, et al. Prevention of distal embolisation and no-reflow in patients with acute myocardial infarction and total occlusion in the infarct-related vessel: a subgroup analysis of the cohort of acute revascularisation in myocardial infarction with excimer laser – CARMEL multicentre study. Catheter Cardiovasc Interv. 2004;64:67–74.

    Article  Google Scholar 

  46. Giugliano GR, Falcone MW, Mego D, Ebersole D, Jenkins S, Das T, Barker E, Ruggio JM, Maini B, Bailey SR. A prospective multicenter registry of laser therapy for degenerated saphenous vein graft stenosis: the COronary graft Results following Atherectomy with Laser (CORAL) trial. Cardiovasc Revasc Med. 2012;13(2):84–9.

    Article  PubMed  Google Scholar 

  47. Niccoli G, Belloni F, Cosentino N, et al. Case-control registry of excimer laser coronary angioplasty versus distal protection devices in patients with acute coronary syndromes due to SVG disease. Am J Cardiol. 2013;112:1586–91.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK

    William R. Davies BSc, PhD, MB ChB, MRCP, MRCS & Simon R. Redwood MBBS, MD, FRCP, FACC, FSCAI

  2. Cardiovascular Division, King’s College London British Heart Foundation Centre of Research Excellence, Rayne Institute, St Thomas’ Hospital, St Thomas’ Campus, Westminster Bridge Road, London, SE1 7EH, UK

    Tiffany Patterson BSc, MBBS, MRCP

  3. Cardiovascular Department, Guy’s and St Thomas’ NHS Foundation Trust, 6th Floor East Wing, Westminster Bridge Road, London, SE1 7EH, UK

    Simon R. Redwood MBBS, MD, FRCP, FACC, FSCAI

Authors
  1. William R. Davies BSc, PhD, MB ChB, MRCP, MRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tiffany Patterson BSc, MBBS, MRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simon R. Redwood MBBS, MD, FRCP, FACC, FSCAI
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simon R. Redwood MBBS, MD, FRCP, FACC, FSCAI .

Editor information

Editors and Affiliations

  1. Division of Cardiology, Charles George VA Medical Center, Asheville, North Carolina, USA

    On Topaz

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Davies, W.R., Patterson, T., Redwood, S.R. (2015). Laser Revascularisation in Saphenous Vein Grafts. In: Topaz, O. (eds) Lasers in Cardiovascular Interventions. Springer, London. https://doi.org/10.1007/978-1-4471-5220-0_5

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5220-0_5

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5219-4

  • Online ISBN: 978-1-4471-5220-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation