Percutaneous revascularization strategies in saphenous vein graft lesions: long-term results

Abstract

Aims: Although half of saphenous vein grafts (SVGs) present obstructive atherosclerotic disease 10 years after implantation, controversy remains concerning the ideal treatment. Our aim was to compare percutaneous revascularization (PCI) options in SVG lesions, according to intervention strategy and type of stent.

Methods: A retrospective single-center analysis selected 618 consecutive patients with previous bypass surgery who underwent PCI between 2003 and 2008. Clinical and angiographic parameters were analyzed according to intervention strategy - PCI in SVG vs. native vessel vs. combined approach - and type of stent implanted - drug-eluting (DES) vs. bare-metal (BMS) vs. both. A Cox regressive analysis of event-free survival was performed with regard to the primary outcomes of death, myocardial infarction (MI) and target vessel failure (TVF).

Results: During a mean follow-up of 796±548 days the rates of death, MI and TVF were 10.9%, 10.5% and 29.5%, respectively. With regard to intervention strategy (74.4% of PCI performed in native vessels, 17.2% in SVGs and 8.4% combined), no significant differences were seen between groups (death p=0.22, MI p=0.20, TVF p=0.80). The type of stents implanted (DES 83.2%, BMS 10.2%, both 3.2%) also did not influence long-term prognosis (death p=0.09, MI p=0.11, TVF p=0.64). The implantation of DES had a favorable impact on survival (p<0.001) in the subgroup of patients treated in native vessels but not in SVG.

Conclusions: Among patients with SVG lesions, long-term mortality, MI and TVF were not affected by intervention options, except for the favorable impact on survival of DES in patients treated in native vessels.