Percutaneous transluminal angioplasty of coronary saphenous vein bypass grafts.

: Between December 1981 and August 1983, percutaneous transluminal angioplasty of saphenous vein grafts was performed in 14 men and 4 women, selected because of recurrent anginal symptoms and graft stenosis. The interval from bypass to angioplasty was 41 +/- 36 months. Of 24 lesions, 9 were at the proximal anastomosis, 13 in the distal segment and 2 in the middle segment of the vein graft. The primary success rate was 79%. Failure to cross the stenosis occurred in three patients and failure to dilate in one. The stenosis was reduced from a mean of 82% +/- 13% to 26% +/- 15%. No patient required emergency coronary artery bypass grafting but two underwent elective grafting after the angioplasty had failed. No patient sustained a Q-wave myocardial infarction and all who had a successful angioplasty were asymptomatic or much improved after the procedure. Angiographic follow-up was available in 12 of 14 patients (86%). Six patients had significant symptoms (Canadian Cardiovascular Society class II to III) and five of these had evidence of restenosis. Among the six patients who were asymptomatic, two had angiographic evidence of restenosis. The overall rate of restenosis was 58% (7 of 12). Repeat angioplasty was successful in three of the five patients in whom it was attempted. The authors conclude that percutaneous transluminal angioplasty of a saphenous vein graft for a localized area of stenosis is effective and safe, but there is a high rate of restenosis that possibly is due to intimal fibrous proliferation in saphenous vein grafts.