INITIAL AND LONG-TERM OUTCOME OF 83 PATIENTS AFTER BALLOON ANGIOPLASTY OF TOTALLY OCCLUDED BYPASS GRAFTS

Objectives. This study was designed to evaluate the safety and short- and long-term results of coronary angioplasty of totally occluded bypa ss grafts in patients with clinical conditions other than acute myocar dial infarction. Background. Total occlusion of bypass grafts after co ronary artery surgery often causes recurrent ischemia. The safety and results of percutaneous transluminal coronary angioplasty in occluded bypass grafts are controversial. Methods. All patients with dilation o f a totally occluded bypass graft attempted between 1981 and 1991 were retrospectively identified from a data base. Patients treated in the setting of an acute myocardial infarction were excluded. Eighty-three patients met these criteria and constitute the study group. Hospital r ecords, office charts and procedural reports were reviewed in all pati ents to supplement details available in the data base. Results. The ti me from bypass surgery to attempted coronary angioplasty ranged from 1 to 226 months (mean time 88 months). The mean (+/-SD) duration of gra ft occlusion was 31 +/- 46 days (range 1 to 180). In 27 attempts the b ypass graft was the only site dilated, and in 56 attempts (68%) one to six other sites (n = 101) were dilated. Angiographic success (less th an or equal to 40% residual lumen stenosis) was achieved in 61 grafts (73%) and 98 of the additional sites (97%) (p < 0.001). Major complica tions included one procedural death and two Q wave infarctions. Follow up for a mean of 32 months demonstrated a 1- and 3-year actuarial sur vival rate of 94% and 80%, respectively. At 3 years, only 34% of patie nts were free of repeat angioplasty or surgery. Conclusions. Angioplas ty of totally occluded bypass grafts can be successful in the majority of selected patients, although major complications can occur. Strateg ies for sustained patency are needed to improve the long-term results.