Till Örebro universitet

Background/objectives: To review the international literature about the use of Percutaneous Coronary Intervention (PCI) in vena saphena magna graft after a Coronary Artery Bypass Grafting (CABG).

Methods: We reviewed, from three different databases, the recent international literature (published between January 1, 2000 and December 31, 2018) regarding the use of PCI invenous grafts. Two independent researchers performed the literature search, designed after a PICO model. Forty articles were selected and a quality assessment was performed.

Results: We noticed a high percentage of short and long-term cardiac events. The peri-procedural failure rate, due to residual stenos, had a mean value around 10%. The 30-days MACE (major adverse cardiac event) had a mean value of 6-7%, with the lower rates associated with the use of embolic protection devices. The MACE rates at 1 year reported were above 10% for most reports (up to over 30%; mean 16%), with better results after the use of a drug-eluting stent (DES) instead of a bare-metal stent. The long-term MACE (2-5 years) reported was high in all studies, with values ranging between 18% and 58%, with target vessel revascularization rates between 9% and 44%. The benefits of DES no longer remain in the long term.

Conclusions: The percutaneous intervention of an occluded or stenosed saphenous vein graftis a challenge for the angiographer and is still associated with high rates of failure, MACE and restenosis. The key of the success of the procedure seems to be to optimize the quality of the venous graft itself.