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Saphenous Vein Graft (saphenou + vein_graft)
Selected AbstractsA Large Saphenous Vein Graft Aneurysm Presenting as a Right Atrial Mass: A Case ReportECHOCARDIOGRAPHY, Issue 6 2006Shemy Carasso M.D. An aneurysm of a saphenous vein graft (SVG) is a rare but potentially fatal complication of coronary artery bypass grafting (CABG). We describe a case of a large SVG aneurysm (7 × 6 cm) compressing the right atrium. The patient presented with chest pain, dyspnea and desaturation, and a right intra-atrial mass was revealed on echocardiography. The differential diagnosis of intracardiac masses revealed by echocardiography should include extrinsic lesions. Due to its potential lethal complications, an SVG aneurysm should be considered in a post-CABG patient presenting with acute coronary syndrome or heart failure. [source] Saphenous Vein Graft Aneurysm Masquerading as a Right Atrial MassECHOCARDIOGRAPHY, Issue 3 2005Leonid Yatskar M.D. We report a case of a large saphenous vein graft (SVG) aneurysm masquerading as a right atrial mass on transesophageal echocardiogram. Cardiac magnetic resonance angiography reliably made a diagnosis of SVG aneurysm extrinsically compressing right atrium. This case illustrates the importance of using combined imaging modalities for the diagnosis and management of cardiac masses. [source] The Use of Intraoperative Doppler Assessment to Guide the Surgical Treatment of Anomalous Right Coronary ArteriesJOURNAL OF CARDIAC SURGERY, Issue 5 2008Louis H. Stein M.H.S. Because of this risk, many patients elect surgical correction of this anomaly. Surgical strategies for correction of this include ostioplasty, coronary artery reimplantation, and, more commonly, coronary artery bypass grafting. After coronary artery bypass grafting, some advocate ligation of the proximal RCA, speculating that competitive flow will cause graft failure. As no objective criteria for this have been established, we propose a method using of intraoperative Doppler flow measurements to guide the decision to preserve the proximal anomalous native vessel. We present three cases in which an RCA with an anomalous origin from the left sinus was corrected with coronary artery bypass grafting with the assistance of intraoperative Doppler flow measurements to guide the decision to preserve the proximal anomalous native vessel. In each case, the RCA was bypassed using a saphenous vein graft (SVG) that was used to bypass origin of the RCA. Flow through the graft was compared with and without ligation of the proximal RCA, before creation of the proximal anastomosis. In each case, flow through the SVG was not significantly reduced with the proximal RCA patent and ligation was not performed. [source] A Xiphoid Approach for Minimally Invasive Coronary Artery Bypass SurgeryJOURNAL OF CARDIAC SURGERY, Issue 4 2000Federico Benetti M.D. However, opening the pleura has been a limitation of using these approaches. Aim: We used the xiphoid approach as an alternative to opening the pleura and to minimize pain after minimally invasive coronary artery bypass surgery. Methods: We review our surgical experience in 55 patients who underwent minimally invasive direct coronary artery bypass (MIDCAB) surgery through a xiphoid approach between October 1997 and August 1999. Thoracoscopy (n = 31) or direct vision (n = 24) were used for internal mammary artery (IMA) harvesting. Mean patient age was 67 ± 10 years and 65% were men. The mean Parsonnet score was 23 ± 10. Performed anastomoses included left IMA (LIMA) to the left anterior descending (LAD) artery (n = 53), LIMA-to-LAD and saphenous vein graft from the LIMA to the right coronary artery (n = 1), and LIMA-to-LAD and right IMA (RIMA) to right coronary artery (n = 1). Results: Postoperative complications included atrial fibrillation (12%), acute noninfectious pericarditis (12%), and acute renal failure (5%). Mean postoperative length of stay was 4 ± 2 days. Angiography was performed in 16 patients and demonstrated excellent patency of the anastomoses. There was no operative mortality. Actuarial survival was 98% in a mean follow-up period of 11 ± 5 months. Conclusions: Minimally invasive coronary artery bypass can be performed safely through a xiphoid approach with low morbidity, mortality, and a relatively short hospital stay. [source] Contemporary use of embolic protection devices in saphenous vein graft interventions: Insights from the stenting of saphenous vein grafts trial,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2010Neeraj Badhey MD Abstract Background: We sought to evaluate the contemporary use of embolic protection devices (EPDs) in saphenous vein graft (SVG) interventions. Methods: We examined EPD use in the stenting of saphenous vein grafts (SOS) trial, in which 80 patients with 112 lesions in 88 SVGs were randomized to a bare metal stent (39 patients, 43 grafts, and 55 lesions) or paclitaxel-eluting stent (41 patients, 45 grafts, and 57 lesions). Results: An EPD was used in 60 of 112 lesions (54%). A Filterwire (Boston Scientific) was used in 70% of EPD-treated lesions, Spider (ev3, Plymouth, Minnesota) in 12%, Proxis (St. Jude, Minneapolis, Minnesota) in 12%, and Guardwire (Medtronic, Santa Rosa, California) in 7%. Of the remaining 52 lesions, an EPD was not utilized in 13 lesions (25%) because the lesion was near the distal anastomosis, in 14 lesions (27%) because of an ostial location, in one lesion (2%) because of small SVG size, in two in-stent restenosis lesions (4%) because of low distal embolization risk, and in 22 lesions (42%) because of operator's preference even though use of an EPD was feasible. Procedural success was achieved in 77 patients (96%); in one patient a Filterwire was entrapped requiring emergency coronary bypass graft surgery and two patients had acute stent thrombosis. Conclusion: In spite of their proven efficacy, EPDs were utilized in approximately half of SVG interventions in the SOS trial. Availability of a proximal protection device could allow protection of ,25% of unprotected lesions, yet operator discretion appears to be the major determinant of EPD use. © 2010 Wiley-Liss, Inc. [source] "Over-and-under" pericardial covered stent with paclitaxel balloon in a saphenous vein graft,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2010Joanna J. Wykrzykowska MD Abstract Treatment of vein graft disease remains a challenge in interventional cardiology because of the risk of embolization and no-reflow phenomenon. Currently available distal protection devices have their limitations. The PTFE-covered stents may be well suited for venous graft lesion treatment, but those available commercially to date have poor crossing profiles, and deliverability and high rates of restenosis. We report the first use of over-and-under pericardium-covered stent in combination with drug-eluting balloon to treat venous graft disease. © 2009 Wiley-Liss, Inc. [source] Temporal Trends in the Use of Drug-eluting Stents for Approved and Off-label Indications: A Longitudinal Analysis of a Large Multicenter Percutaneous Coronary Intervention RegistryCLINICAL CARDIOLOGY, Issue 2 2010Sarah K. Gualano MD Background We sought to examine the temporal variations in the rate of both bare-metal stent (BMS) and drug-eluting stent (DES) use for off-label indications after the reports of an increased risk of very late stent thrombosis in patients with DES at the 2006 meeting of the European Society of Cardiology (ESC). Hypothesis To determine whether the decrease in use of DES has affected both on and off-label indications. Methods The study cohort included patients undergoing coronary intervention in a large regional registry, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Patient demographic and clinical characteristics for patients with DES in the third quarter of 2006 (pre-ESC) were compared to those from the fourth quarter of 2008 (post-guideline changes). Use of DES for off-label indications, such as ST-segment elevation myocardial infarction (STEMI), in-stent restenosis (ISR), and saphenous vein graft (SVG) interventions, were evaluated. Results The overall deployment of DES fell sharply from 83% pre-ESC to a plateau of 58% in the first quarter of 2008. This corresponded to a rise in BMS use, while angioplasty procedures stayed the same. The STEMI subgroup showed the most dramatic change, from 78% to only 36%. Off-label use in SVGs showed a similar trend, from 74% to 43%. Drug-eluting stent deployment for ISR was less affected, though it also fell 25% (from 79%,56%). Conclusions The use of DES has fallen dramatically from June 2006 to December 2008, particularly for nonapproved indications. Our study provides a real-world assessment of contemporary change in DES use in response to the presentation of negative observational studies. Copyright © 2010 Wiley Periodicals, Inc. [source] Does Mediastinitis Affect the Graft Patency?JOURNAL OF CARDIAC SURGERY, Issue 3 2005Denyan Mansuro, lu M.D. There are many studies that have focused on the graft patency. But, till now, no study has been done to detect the effects of mediastinitis to graft patency. So, we aimed to detect the effect of mediastinitis on the graft patency in patients who have undergone coronary artery bypass surgery. Sixteen of 45 patients who have been operated upon for coronary artery bypass surgery and developed mediastinitis, which was treated with open drainage and mediastinal irrigation with late wound closure, were included in the study. The mean age of the patients was 55 ± 11 (range 35,69) and nine of the patients were male. The graft patency was evaluated with control coronary angiographies after a mean period of 30.42 ± 43.17 months (range 1,132). The left internal thoracic artery was patent in all patients (100%). Right internal thoracic artery patency rate was 50% (1/2). One individual bypassed radial artery was patent, whereas the sequential bypassed graft was occluded. The patency ratio of radial artery anastomosis was 33% (1/3). Twelve of the 17 saphenous vein grafts were patent (70.58%). The total number of patent distal anastomosis was 30/38 (78.94%). When compared with the graft patency of patients without infection, it was found that mediastinitis does not affect the graft patency rates adversely. [source] Contemporary use of embolic protection devices in saphenous vein graft interventions: Insights from the stenting of saphenous vein grafts trial,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2010Neeraj Badhey MD Abstract Background: We sought to evaluate the contemporary use of embolic protection devices (EPDs) in saphenous vein graft (SVG) interventions. Methods: We examined EPD use in the stenting of saphenous vein grafts (SOS) trial, in which 80 patients with 112 lesions in 88 SVGs were randomized to a bare metal stent (39 patients, 43 grafts, and 55 lesions) or paclitaxel-eluting stent (41 patients, 45 grafts, and 57 lesions). Results: An EPD was used in 60 of 112 lesions (54%). A Filterwire (Boston Scientific) was used in 70% of EPD-treated lesions, Spider (ev3, Plymouth, Minnesota) in 12%, Proxis (St. Jude, Minneapolis, Minnesota) in 12%, and Guardwire (Medtronic, Santa Rosa, California) in 7%. Of the remaining 52 lesions, an EPD was not utilized in 13 lesions (25%) because the lesion was near the distal anastomosis, in 14 lesions (27%) because of an ostial location, in one lesion (2%) because of small SVG size, in two in-stent restenosis lesions (4%) because of low distal embolization risk, and in 22 lesions (42%) because of operator's preference even though use of an EPD was feasible. Procedural success was achieved in 77 patients (96%); in one patient a Filterwire was entrapped requiring emergency coronary bypass graft surgery and two patients had acute stent thrombosis. Conclusion: In spite of their proven efficacy, EPDs were utilized in approximately half of SVG interventions in the SOS trial. Availability of a proximal protection device could allow protection of ,25% of unprotected lesions, yet operator discretion appears to be the major determinant of EPD use. © 2010 Wiley-Liss, Inc. [source] Revitalizing embolic protection in saphenous vein grafts,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2010Lowell F. Satler MD No abstract is available for this article. [source] Late outcomes of drug-eluting versus bare metal stents in saphenous vein grafts: Propensity score analysisCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2008Robert J. Applegate MD Abstract Objective: To compare late outcomes with the routine use of drug-eluting stents (DES) compared with bare-metal stents (BMS) during percutaneous intervention (PCI) of saphenous vein grafts (SVGs). Background: Safety concerns >1 year from stent implantation have been raised about DES used for PCI of SVGs in a small randomized clinical trial. However, there are few studies comparing late outcomes of DES and BMS in routine clinical practice. Methods: Clinical outcomes (nonfatal MI, cardiac mortality) were assessed in 74 consecutive patients who received BMS and 74 consecutive propensity score matched patients that received DES for PCI of SVGs. Clinical follow-up was censored at 2 years ± 30 days for both stent groups. Results: At 2 years, the hazard ratio for DES compared with BMS for PCI of SVGs for target vessel revascularization was 0.54 (0.21,1.36), nonfatal MI or cardiac death was 0.68 (0.27,1.68), cardiac mortality 1.19 (0.32,4.45), and stent thrombosis 0.49 (0.09,2.66). Similar outcomes were observed stratified by propensity score quintile. Conclusions: The routine clinical use of DES for PCI of SVGs was associated with a safety profile that was similar to that of bare metal stents with a clear trend toward a less frequent need for reinterventions. © 2008 Wiley-Liss, Inc. [source] Initial clinical experience with distal protection using the FilterWire in patients undergoing coronary artery and saphenous vein graft percutaneous interventionCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2002Jeffrey J. Popma MD Abstract Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) and native coronary arteries may be associated with embolization of particulate debris into the distal microcirculation. The FilterWire uses a polyurethane filter bag contained on a radiopaque loop to trap embolic debris during native vessel and SVG intervention. The objectives of this study were to assess the feasibility and safety of the FilterWire during PCI and to examine the size and content of the particulate debris captured during SVG and native vessel intervention. Early angiographic, in-hospital, and 30-day clinical outcomes were reviewed in 35 patients with 36 lesions treated with the FilterWire during PCI. Lesions were located in 22 (61%) native coronary arteries and in 14 (39%) SVGs. Multivessel coronary artery disease was present in 75% of patients. Lesions were complex (ACC/AHA complexity B2 or C) in 81% of cases. The FilterWire was successfully delivered and deployed distal to the site of coronary intervention in 92% of lesions, including 95% of native vessels and 82% of SVG lesions. Embolic debris was entrapped in 82% of these cases. The average particulate debris had a mean major axis of 490 ,m (range, 45,3,302 ,m) and minor axis of 226 ,m (range, 33,1,677 ,m). Although reduced flow was common (36.1%) when the FilterWire was in place, there were no sustained episodes of abrupt closure and only one (2.8%) patient developed sustained no-reflow after FilterWire removal. Distal branch vessel embolization was found in four (11.1%) cases. Major adverse cardiac events occurred in 5 (14%) of 35 patients treated with the device, although 2 of these patients were evolving an acute myocardial infarction at the time of the procedure; in patients meeting the prospectively defined inclusion criteria, the major adverse cardiac event was 6%. These results suggest that the FilterWire is a feasible and safe method of collecting particulate debris released during SVG and native vessel coronary intervention. Its benefit over conventional therapy and other distal protection devices is currently under study. Cathet Cardiovasc Intervent 2002;57:125,134. © 2002 Wiley-Liss, Inc. [source] | ||||||||||