Long-term clinical outcome after endoluminal reconstruction of diffusely degenerated saphenous vein grafts with less-shortening Wallstents

OBJECTIVES This study was designed to evaluate the immediate and long-term clinical results of patients undergoing endoluminal reconstruction in diffu sely degenerated saphenous Vein grafts (SVGs) with elective implantation of one or more less-shortening Wallstents. BACKGROUND The optimal treatment strategy for patients with diffusely degen erated SVGs is controversial. Endoluminal reconstruction by stent implantat ion is one proposed strategy; however, there are few data regarding long-te rm clinical outcome. METHODS Between May 1995 and September 1998, 6,534 consecutive patients und erwent angioplasty in our institution, including 440 who were treated for S VG lesions. Of these, 126 (115 men, 11 women, median age 69.5 years, range: 33-86 years) with old SVGs (mean age: 13 +/- 5 years) diffusely degenerate d stenosed or occluded (mean lesion length: 27 +/- 12 mm) were treated elec tively with implantation of one or multiple (total 197) less-shortening Wal lstents. RESULTS Before discharge, 13 patients (10.3%) sustained at least one major cardiovascular event, including 4 deaths (3.2%), 11 myocardial infarctions (MI) (8.7%), and 3 repeat revascularizations (target Vessel = 1, nontarget vessel = 2, 2.4%). Surviving patients were followed for 22 +/- 11 months: 1 3 patients (11.1%) died, 11 (9.4%) sustained an MI, 37 underwent angioplast y (31.6%), and 4 (3.4%) underwent bypass surgery. The estimated three-year event-free survival rates (freedom from death, and freedom from death/MI/ta rget vessel revascularization) were (mean +/- SE) 81.1 +/- 7.8% and 43.2 +/ - 18.5%, respectively. CONCLUSIONS The long-term clinical outcome of patients undergoing endolumin al reconstruction in diffusely degenerated SVG is relatively poor, mainly b ecause of a high incidence of death or MI and the frequent need for repeat angioplasty. It is unlikely that percutaneous intervention alone will provi de a satisfactory or definitive solution for these patients. (C) 2000 by th e American College of Cardiology.