Author/Editor		Mrak, Miha; Bunc, Matjaž
Title		PCI strategy in a patient with multi venous grafts failure after second CABG and multi-vessel CTOs
Type		članek
Vol. and No.		Letnik 3, št. 1
Publication year		2015
Volume		str. 1-10
ISSN		1314-7676
Language		eng
Abstract		Long-term patency of saphenousvein grafts remains low. Recurrent ischemia after late graft failure can be treated by re-operation or percutaneous coronary intervention(PCI). The intervention can be performed in the native artery or the bridging vein graft.We report a case of 62-year-old patient, whopresented witharecurrent ischemic heart diseasedespitemany revascularization attempts. In 1991, CABGwith three saphenous vein grafts (SVGs)was performed after STEMI of the inferior wall. Due to unstable anginaand occlusion of all SVGs, a second CABG with two SVGswas performed in 2005. In 2009, SVG anastomosis to OM2 was stented with DES due to NSTEMI. Later he experienced someepisodes of exertionalangina pectoris. Coronary angiograms revealed occlusionsof RCA and OM2 SVGs. We decided foratwo staged PCIwith stenting of SVG to OM2 andof CTO in the native RCA. SVG was again occluded3 years after stenting. We successfully performed PCI of LCX CTO.Decision about revascularization must consider possible risks of both surgical and percutaneous revascularization procedures. Guidelines prefer percutaneous treatment tore-operation, and PCI in the native artery to that ina vein graft. Our experience shows that management remains complex and that long-termresults remain unsatisfying.
Keywords		percutaneous coronary intervention revascularization vein graft perkutana koronarna intervencija revaskularizacija venski presadek