Percutaneous Coronary Intervention of Arterial and Vein Grafts

This chapter provides an overview of the indications and challenges of percutaneous coronary intervention (PCI) in patients with failing arterial or venous bypass grafts. Long-term results of coronary artery bypass graft surgery (CABG) surgery are limited by the gradual progression of coronary artery disease in the native vessels and gradual failure of bypass conduits. Late failure of bypass graft conduits most often results from attrition of saphenous vein grafts and/or progression of atherosclerotic disease in the native coronary arteries. Graft occlusion of venous conduits within the first year after CABG surgery occurs in approximately 3–10% of patients in contemporary trials and registries. Treatment of SVGs with PCI is associated with high rates of complications and major adverse cardiac events. Factors favoring PCI over CABG include limited areas of ischemia causing symptoms, suitable PCI targets, a patent graft to the left anterior descending artery artery, poor CABG targets, and comorbid conditions.

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