PCI in Saphenous Vein Grafts: Difference between revisions
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==Goals of Treatment== | ==Goals of Treatment== | ||
Primarily, the goal should be to detect and treat a SVG [[stenosis]] early in the development of [[ischemia]] while the SVG is still patent. As long as the SVG is not completely [[occlusion|occluded]], intervention can be performed. | Primarily, the goal should be to detect and treat a SVG [[stenosis]] early in the development of [[ischemia]] while the SVG is still [[patency|patent]]. As long as the SVG is not completely [[occlusion|occluded]], intervention can be performed. | ||
Two additional overall goals of treating [[SVG]] [[stenosis]] include the resolution of symptomatic [[ischemia]] and the prevention/treatment of distal [[embolism]]. | |||
Revision as of 16:34, 18 May 2010
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Background
Coronary artery revascularization with saphenous veins (saphenous vein grafts or SVGs) has become a modern surgical standard for the treatment of coronary artery disease. This technique can be employed when a native coronary artery is blocked, thus causing a reduction or obstruction in blood flow. Cardiac surgeons use the sutured graft to connect the aorta to the coronary artery beyond the area of obstruction, so that blood flow may resume.
Despite their ability to restore blood flow, SVGs commonly encounter stenosis problems. The incidence of SVG stenosis is 15-30% one year after surgery, and it increases to 50% 10 years after surgery. Several factors contribute to stenosis of saphenous vein grafts, including intimal hyperplasia, plaque formation, and graft remodeling. Additionally, arterialization of the graft accelerates atherosclerosis. Furthermore, atheroma found in SVGs are more friable (easily break into small pieces) and more prone to thrombus than plaques found in native vessels. Another reason why SVGs are more susceptible to thrombotic occlusion is that they lack side branches.
Although intervention on a chronic total occlusion of an SVG may seem like an effective treatment strategy, it is best avoided.
Goals of Treatment
Primarily, the goal should be to detect and treat a SVG stenosis early in the development of ischemia while the SVG is still patent. As long as the SVG is not completely occluded, intervention can be performed.
Two additional overall goals of treating SVG stenosis include the resolution of symptomatic ischemia and the prevention/treatment of distal embolism.