Reconstruction of saphenous vein grafts with wallstent endoprostheses. Immediate and medium term results.

Balloon angioplasty of degenerated saphenous vein grafts is associated with a high incidence of restenosis and of cardiac events in the medium and lon g term. Implantation of stents has reduced the incidence of these complicat ions in patients with focal lesions. The authors report the short and medium term clinical results of saphenous Vein grafts reconstruction in cases of diffuse graft disease with Wallstent endoprostheses in a series of 73 patients. All were pretreated with aspiri n, ticlopidine and enoxaparine started 72 hours before the procedure and 15 also received c7E3Fab during angioplasty. One hundred and twenty stents we re implanted in 90 saphenous vein grafts. There were 5 deaths (6.9%), 2 of which were cardiac, during the hospital period. One patient (1.4%) underwen t secondary coronary bypass surgery. Eight patients (11%) suffered distal e mbolisation resulting in non-Q wave infarction. Clinical follow-up for an a verage of 13 months (3-26 months) was obtained in 91% of patients. Five (8. 1%) died, three of cardiac causes, and one patient (1.7%) suffered a non-le thal myocardial infarction. A repeat revascularisation procedure of the cul prit lesion was performed in 9 patients (15.8%). Angioplasty of other lesio ns was carried out in 7 patients (12.3%). Reconstruction of venous bypass grafts with diffuse lesions by implantation of Wallstent endoprostheses associated with preventive antiaggregant and a nticoagulant therapy is associated with a risk of immediate complications. The medium-term results indicate high morbidity and cardiac mortality rates .