UPDATE ON INTERVENTIONS IN SAPHENOUS-VEIN GRAFTS

Interventions in saphenous vein grafts present some of the most challe nging problems in preventing acute complications and limiting restenos is. Available options include repeat bypass surgery, balloon angioplas ty, directional atherectomy, transluminal extraction atherectomy, rota tional atherectomy, laser angioplasty, and stenting. Stenting appears to provide the best acute and long-term results. Debulking with direct ional atherectomy prior to stenting may be helpful but its role is unp roven. With any device, it is essential to attain the lowest possible residual stenosis with the least amount of manipulation. Complications with vein graft interventions are most commonly related to distal emb olization, which occurs most frequently in older vein grafts with diff use disease, large plaque volume or thrombus, or those with total occl usion. Use of thrombolytics, glycoprotein IIb/IIIa receptor inhibitors , and thrombectomy devices may be helpful when thrombus is present. Ca lcium channel blockers may be beneficial when embolization of plaque d ebris results in slow flow or no-flow during interventions.