Coronary Angiography in the Diagnosis of Graft Failure

  • P. R. Lichtlen
  • H. Hausmann


Despite its known limitations [1–3] coronary angiography has remained the standard technique to demonstrate alterations of coronary artery bypass grafts, especially so-called graft disease. This concerns above all those graft changes which lead to ischemic events such as stable and unstable angina pectoris or acute myocardial infarction. These alterations consist predominantly in localized, high-grade luminal narrowings (diameter stenoses ≥70%) of the graft body or the proximal or distal anastomoses or in occlusions of grafts due mainly to progressing atherosclerotic plaque formation with or without thrombotic occlusion. Graft angiograms are therefore always indicated when typical ischemic symptoms arise, or prophylactically when grafts approach the age at which the risk of vein graft disease increases significantly (5 and more years). This applies especially to patients with combined risk factors [4] and increased progression of graft atherosclerosis and plaque formation, as it is established that plaque rupture followed by thrombotic occlusion and myocardial infarction involves not only high-grade, symptomatic but also low-grade (<50%), clinically asymptomatic plaques not detectable by non-invasive means [2, 5, 6].


Digital Subtraction Angiography Graft Failure Vein Graft Internal Mammary Artery Native Coronary Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Lichtlen PR (1990) Koronarangiographie und Koronarchirurgie. In: Lichtlen PR (ed) Beiträge zur Kardiologie. Perimed, Erlangen, pp 537–582.Google Scholar
  2. 2.
    Lichtlen PR, Nikutta P, Jost S et al. (1992) Anatomical progression of coronary artery disease in humans as seen by prospective, repeated, quantitated coronary angiography. Relation to clinical events and risk factors. Circulation 86: 828–838.PubMedGoogle Scholar
  3. 3.
    Freudenberg H, Lichtlen PR (1981) Limitations of intravital coronary angiography. A comparison with postmortem results in 87 cases. Circulation 63/64 [Suppl IV]: 238 (abstract).Google Scholar
  4. 4.
    Lichtlen PR (1981) Koronarchirurgie. In: Krayenbühl HP, Kübier W (eds) Kardiologie in Klinik und Praxis, vol II. Thieme, Stuttgart, pp 43.1–43.22.Google Scholar
  5. 5.
    Ambrose JA, Tannenbaum MA, Alexopoulos D et al. (1988) Angiographic progression of coronary artery disease and the development of myocardial infarction. J Am Coll Cardiol 12: 56–62.PubMedCrossRefGoogle Scholar
  6. 6.
    Little WC, Constantinescu M, Applegate RJ et al. (1988) Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? Circulation 78: 1157–1166.PubMedCrossRefGoogle Scholar
  7. 7.
    Ross R (1986) The pathogenesis of atherosclerosis — an update. N Engl J Med 314: 488–499.PubMedCrossRefGoogle Scholar
  8. 8.
    Haudenschild CC (1990) Pathogenesis of atherosclerosis: state of the art. Cardiovasc Drugs Ther 4[Suppl V]: 993–1004.PubMedCrossRefGoogle Scholar
  9. 9.
    Steinberg D, Parthasarathy S, Carew T, Khoo JC, Witztum JL (1989) Beyond cholesterol: modifications of low-density lipoprotein that increase its atherogeneity. N Engl J Med 320: 915–924.PubMedCrossRefGoogle Scholar
  10. 10.
    Faggiotto A, Ross R, Herker L (1984) Studies on hypercholesterolemia in the non-human primate. I. Changes that lead to fatty streak formation. Arteriosclerosis 4: 323–340.PubMedCrossRefGoogle Scholar
  11. 11.
    Glagov S, Weisenberg E, Zarins C, Stankunavicius R, Kolettis GJ (1987) Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 316: 1371–1375.PubMedCrossRefGoogle Scholar
  12. 12.
    Liebson PR, Klein LW (1992) Intravascular ultrasound in coronary atherosclerosis: a new approach to clinical assessment. Am Heart J 123: 1643–1660.PubMedCrossRefGoogle Scholar
  13. 13.
    Fitzgerald PJ, St Goar FG, Conolly AJ et al. (1992) Intravascular ultrasound imaging of coronary arteries. Is three layer the norm? Circulation 86: 154–158.PubMedGoogle Scholar
  14. 14.
    Tobis JM, Mallery J, Mahon D et al. (1991) Intravascular ultrasound imaging of human coronary arteries in vivo. Analysis of tissue characteristics with comparison to in vitro histologic specimen. Circulation 83: 913–926.PubMedGoogle Scholar
  15. 15.
    Gibson CM, Saffian RD (1992) Limitations of cineangiography; impact of new technologies for image processing and quantitation. Trends Cardiovasc Med 2: 156–160.PubMedCrossRefGoogle Scholar
  16. 16.
    Hermiller JB, Kusma JT, Spero LA, Fortin DF, Harding MB, Bashore TM (1992) Quantitative and qualitative coronary angiographic analysis: review of methods, utility and limitations. Cathet Cardiovasc Diagn 25: 110–131.PubMedCrossRefGoogle Scholar
  17. 17.
    Campeau L, Enjalbert M, Lesperance J (1983) Atherosclerosis and late closure of aortocoronary vein bypass grafts: sequential angiographie study at 2 weeks, 1 year, 5–7 years and 10–12 years after surgery. Circulation 68[Suppl II]: 1–7.Google Scholar
  18. 18.
    Herrmann G, Simon R, Amende I, Frank G, Borst HG, Lichtlen PR (1987) Late increase in luminal diameter of aorto-coronary venous bypass grafts associated with an increase in the vascular region under supply. J Am Coll Cardiol 10: 10–16.PubMedCrossRefGoogle Scholar
  19. 19.
    Lawrie GM, Lie JT et al. (1976) Vein graft patency and intimal proliferation after aortocoronary bypass: early and long-term angiopathologic correlations. Am J Cardiol 38: 856–861.PubMedCrossRefGoogle Scholar
  20. 20.
    Lichtlen P, Moccetti T, Halter J, Schönbeck M, Senning A (1972) Postoperative evaluation of myocardial blood flow in aorto-to-coronary vein bypass grafts using the Xenon-residue-detection technique. Circulation 46: 445–455.PubMedGoogle Scholar
  21. 21.
    Meester K, Veldkamp R, Tijssen JGP et al. (1991) Clinical outcome of single vessel sequential grafts in coronary bypass operations at 10 years follow-up. Eur J Cardiothorac Surg 101: 1076–1081.Google Scholar
  22. 22.
    Green GE (1972) Internal mammary artery for coronary artery anastomosis. 3 year experience with 165 patients. Ann Thorac Surg 14: 260.PubMedCrossRefGoogle Scholar
  23. 23.
    Loop FD, Little BW, Cosgrove DM (1986) Influence of the internal mammary artery graft in 10 year survival and other cardiac event. N Engl J Med 314: 1–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Grondin CM, Campeau L, Lespérance J, Enjalbert M, Bourassa MG (1984) Comparison of late changes in internal mammary artery and saphenous vein grafts in two consecutive series of patients 10 years after operation. Circulation 70[Suppl I]: 208–212.Google Scholar
  25. 25.
    Lytle BM, Loop FD, Cosgrove DM (1985) Long-term (5–12 years) serial studies of internal mammary artery and saphenous vein coronary bypass graft. J Thorac Cardiovasc Surg 89: 248–258.PubMedGoogle Scholar
  26. 26.
    Lüscher TF, Diederich D, Siebenmann R, Lehmann K et al. (1988) Difference between endothelium-dependent relaxation in arterial and in venous coronary bypass grafts. N Engl J Med 319: 462–467.PubMedCrossRefGoogle Scholar
  27. 27.
    Kuttler H, Hauenstein KH, Kameda T, Wenz W, Schlosser V (1988) Significance of early angiographic follow-up after internal artery anastomosis in coronary surgery. Thorac Cardiovasc Surg 36: 96–99.PubMedCrossRefGoogle Scholar
  28. 28.
    Dincer B, Barner HB (1983) The “occluded” internal mammary artery graft: restoration of patency after apparent occlusion associated with progression of coronary disease. J Thorac Cardiovasc Surg 85: 318–320.PubMedGoogle Scholar
  29. 29.
    Grondin CM, Lespérance J, Bourassa MB, Campeau L (1975) Coronary artery grafting with the saphenous vein or internal mammary artery. Comparison of late results in 2 consecutive series of patients. Ann Thorac Surg 20: 605–618.PubMedCrossRefGoogle Scholar
  30. 30.
    Schmid C, Heublein B, Reichelt S, Borst HG (1990) Steal phenomenon caused by a parallel branch of the internal mammary artery. Ann Thorac Surg 50: 463–464.PubMedCrossRefGoogle Scholar
  31. 31.
    Pelias AJ, del Rossi AJ (1985) A case of postoperative internal mammary steal. J Thorac Cardiovasc Surg 90: 794–796.PubMedGoogle Scholar
  32. 32.
    Stolte M (1977) Postmortale Untersuchungen nach Revaskularisations-Operation. Thoraxchirurgie 25: 181.Google Scholar
  33. 33.
    Herrmann G, Simon R, Haverich A, Lichtlen PR, Borst HG (1986) Langzeitergebnisse aortokoronarer Venenbypasschirurgie. Z Kardiol 75;[Suppl 1]: 68 (abstr.).Google Scholar
  34. 34.
    Vlodaver Z, Edwards JE (1971) Pathologic changes in aorto-coronary arterial saphenous vein grafts. Circulation 44: 719.PubMedGoogle Scholar
  35. 35.
    Lichtlen P (1974) The aorto to coronary vein bypass graft: postoperative clinical and functional evaluation. J Cardiovasc Surg 15: 163.Google Scholar
  36. 36.
    Sheldon WC (1978) Effect of bypass graft surgery on survival; a 6–10 year follow-up study of 741 patients. Cleve Clin Q J Med 45: 166.Google Scholar
  37. 37.
    Buis B, Endlich B, Arntzenius AC (1975) A technique for measuring the diameter of coronary arteries and venous bypass grafts from 70 mm spot films. In: Lichtlen PR (ed) Coronary angiography and angina pectoris. Thieme, Stuttgart, p 265.Google Scholar
  38. 38.
    Lawrie GM, Weilbacher DE, Henry PD (1990) Endothelium-dependent relaxation in human saphenous vein grafts. Eur J Cardiothorac Surg 100: 612–620.Google Scholar
  39. 39.
    Reiber JHC, Serruys PW, Kooijman CJ et al. (1985) Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantitation of coronary cineangiograms. Circulation 71: 280–288.PubMedCrossRefGoogle Scholar
  40. 40.
    Liese W, Leitz K, Borst HG, Lichtlen P (1977) Patency-Rate im Früh-und Folgestadium des aorto-koronaren Venenbypass in Abhängigkeit vom Venentransplantat und intraoperativen Fluss. Schweiz Med Wochenschr 107: 1581–1584.PubMedGoogle Scholar
  41. 41.
    Neville RF, Sidway AN, Foegh ML (1992) The molecular biology of vein graft atherosclerosis and myointimal hyperplasia. Curr Opin Cardiol 7: 930–938.CrossRefGoogle Scholar
  42. 42.
    Campeau L, Enjalbert M, Lespérance J et al. (1984) The relationship 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 aorto-coronary bypass surgery. N Engl J Med 311: 1329–1332.PubMedCrossRefGoogle Scholar
  43. 43.
    Johnson WD, Brenowitz JB, Kasper KL (1989) Factors influencing long-term (10 years to 15 years) survival after a successful coronary artery bypass operation. Ann Thorac Surg 48: 19–25.PubMedCrossRefGoogle Scholar
  44. 44.
    Lawrie CM, Morris GS, Earle N (1991) Long-term results of coronary bypass surgery. Ann Surg 213: 377–387.PubMedCrossRefGoogle Scholar
  45. 45.
    Holman WL (1992) Long-term results of coronary artery bypass grafting. Curr Opin Cardiol 7: 990–996.PubMedCrossRefGoogle Scholar
  46. 46.
    Sergeant P, Lesafre E, Flameng W, Suy R, Blackstone E (1991) The return of clinically evident ischemia after coronary bypass grafting. Eur J Cardiothorac Surg 5: 447–457.PubMedCrossRefGoogle Scholar
  47. 47.
    Sheldon WC (1978) Factors influencing patency of coronary bypass grafts. Cleve Clin Q J Med 45: 109.Google Scholar
  48. 48.
    Gottlieb SO, Brinker JA, Mellits ED et al. (1989) Effect of nifedipine on the development of coronary bypass graft stenoses in high-risk patients: a randomized, double-blind, placebo-controlled trial. Circulation 80[Suppl]: 11–228 (abstract).Google Scholar
  49. 49.
    Cox JL, Chiasson DA, Gotlieb AI (1991) Stranger in a strange land: the pathogenesis of saphenous vein graft stenosis with emphasis on structural and functional differences between veins and arteries. Prog Cardiovasc Dis 34: 45–68.PubMedCrossRefGoogle Scholar
  50. 50.
    Davies MJ (1990) A macro and micro view of coronary vascular insult in ischemic heart disease. Circulation 82[Suppl II]: 38–46.Google Scholar
  51. 51.
    Quist WC, Haudenschild CC, LoGefro FW (1992) Qualitative microscopy of implanted vein grafts: effects of graft integrity of morphologic fate. Eur J Cardiothorac Surg 103: 671–677.Google Scholar
  52. 52.
    Sheldon WC, Rincon D, Effler DB, Proudfit WL, Sones FM (1973) Vein graft surgery for coronary artery disease. Survival and angiographic results in 1000 patients. Circulation 47/48: 111–184.Google Scholar
  53. 53.
    Feigl O (1987) The paradox of adrenergic coronary vasoconstriction. Circulation 76: 737–745.PubMedCrossRefGoogle Scholar
  54. 54.
    Gage JE, Hess OM, Murakami T, Ritter M, Grimm J, Krayenbühl HP (1986) Coronary artery stenosis vasoconstriction during dynamic exercise in patients with classical angina pectoris: reversibility by nitroglycerin. Circulation 73: 865–876.PubMedCrossRefGoogle Scholar
  55. 55.
    Brown G, Cuningham RA, DeRouen T et al. (1985) Improved graft patency in patients treated with platelet-inhibiting therapy after coronary bypass surgery. Circulation 72: 138–146.PubMedCrossRefGoogle Scholar
  56. 56.
    Angelini GD (1992) Saphenous vein graft failure: etiologic considerations and strategies for prevention. Curr Opin Cardiol 7: 939–944.PubMedCrossRefGoogle Scholar
  57. 57.
    Hausmann D, Nikutta P, Hartwig CA, Daniel WG, Lichtlen PR (1987) ST-segment analysis in the 24-h Holter ECG in patients with stable angina pectoris and proven coronary artery disease. Z Kardiol 76: 554–562.PubMedGoogle Scholar
  58. 58.
    Jost S, Gulba D, Eckert S, Simon R, Amende I, Lichtlen P (1990) Angiographischer und klinischer Verlauf nach PTCA von aortokoronaren Venenbypass (ACVB)-Grafts. Z Kardiol 79[Suppl]: 1–20 (abstract).Google Scholar
  59. 59.
    Luska G, Hendrickx PH, Kuhl A, Lichtlen P (1985) Peripher-venöse digitale Subtraktions-angiographie (DAS) zur Kontrolle von aorto-koronaren Venenbypass-Grafts (ACVB). Fortschr Röntgenstr 142: 35–40.CrossRefGoogle Scholar
  60. 60.
    Daniel WG, Döring W, Stender H, Lichtlen P (1983) Value and limitation of computed tomography in assessing aorto-coronary bypass graft patency. Circulation 67: 983–987.PubMedCrossRefGoogle Scholar
  61. 61.
    Guthaner EF, Robert EW, Aldermann EL, Wexler L (1979) Long-term serial angiographic studies after coronary artery bypass surgery. Circulation 60: 250–259.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • P. R. Lichtlen
  • H. Hausmann

There are no affiliations available

Personalised recommendations