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Saphenous Vein Graft Failure: From Pathophysiology to Prevention and Treatment Strategies.

Publication ,  Journal Article
Xenogiannis, I; Zenati, M; Bhatt, DL; Rao, SV; Rodés-Cabau, J; Goldman, S; Shunk, KA; Mavromatis, K; Banerjee, S; Alaswad, K; Nikolakopoulos, I ...
Published in: Circulation
August 31, 2021

Saphenous vein grafts (SVGs) remain the most frequently used conduits in coronary artery bypass graft surgery (CABG). Despite advances in surgical techniques and pharmacotherapy, SVG failure rates remain high, often leading to repeat coronary revascularization. The no-touch SVG harvesting technique (minimal graft manipulation with preservation of vasa vasorum and nerves) reduces the risk of SVG failure, whereas the effect of the off-pump technique on SVG patency remains unclear. Use of buffered storage solutions, intraoperative graft flow measurement, careful selection of the target vessels, and physiological assessment of the native coronary circulation before CABG may also reduce the incidence of SVG failure. Perioperative aspirin and high-intensity statin administration are the cornerstones of secondary prevention after CABG. Dual antiplatelet therapy is recommended for off-pump CABG and in patients with a recent acute coronary syndrome. Intermediate (30%-60%) SVG stenoses often progress rapidly. Stenting of intermediate SVG stenoses failed to improve outcomes; hence, treatment focuses on strict control of coronary artery disease risk factors. Redo CABG is associated with higher perioperative mortality compared with percutaneous coronary intervention (PCI); hence, the latter is preferred for most patients requiring repeat revascularization after CABG. SVG PCI is limited by high rates of no-reflow and a high incidence of restenosis during follow-up. Drug-eluting and bare metal stents provide similar long-term outcomes in SVG PCI. Embolic protection devices reduce no-reflow and should be used when feasible. PCI of the corresponding native coronary artery is associated with better short- and long-term outcomes and is preferred over SVG PCI, if technically feasible.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 31, 2021

Volume

144

Issue

9

Start / End Page

728 / 745

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Treatment Failure
  • Saphenous Vein
  • Perioperative Care
  • Humans
  • Disease Management
  • Coronary Artery Disease
  • Coronary Artery Bypass
  • Clinical Decision-Making
  • Cardiovascular System & Hematology
 

Citation

APA
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Xenogiannis, I., Zenati, M., Bhatt, D. L., Rao, S. V., Rodés-Cabau, J., Goldman, S., … Brilakis, E. S. (2021). Saphenous Vein Graft Failure: From Pathophysiology to Prevention and Treatment Strategies. Circulation, 144(9), 728–745. https://doi.org/10.1161/CIRCULATIONAHA.120.052163

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 31, 2021

Volume

144

Issue

9

Start / End Page

728 / 745

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Treatment Failure
  • Saphenous Vein
  • Perioperative Care
  • Humans
  • Disease Management
  • Coronary Artery Disease
  • Coronary Artery Bypass
  • Clinical Decision-Making
  • Cardiovascular System & Hematology