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| {{SI}}
| | #redirect[[Saphenous Vein Graft]] |
| {{WikiDoc Cardiology Network Infobox}}
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| {{CMG}}<br/>
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| '''Associate Editors-In-Chief:''' Jason C. Choi, M.D., Xin Yang, M.D.
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| {{Editor Help}}
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| ==Background==
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| Coronary artery revascularization with [[saphenous veins]] ([[saphenous vein grafts]] or [[SVGs]]) has become a modern surgical standard for the treatment of [[coronary artery disease]]. This technique can be employed when a native [[coronary artery]] is blocked, thus causing a reduction or obstruction in [[blood flow]]. [[Cardiac surgeons]] use the sutured graft to connect the [[aorta]] to the coronary artery beyond the area of obstruction, so that [[blood flow]] may resume.
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| Despite their ability to restore [[blood flow]], SVGs commonly encounter [[stenosis]] problems. The incidence of SVG stenosis is 15-30% one year after surgery, and it increases to 50% 10 years after surgery. Several factors contribute to [[stenosis]] of [[saphenous vein grafts]], including [[intimal hyperplasia]], [[plaque]] formation, and graft remodeling. Additionally, arterialization of the graft accelerates [[atherosclerosis]]. Furthermore, [[atheroma]] found in SVGs are more friable (easily break into small pieces) and more prone to [[thrombus]] than [[plaques]] found in native vessels. Another reason why SVGs are more susceptible to [[thrombotic occlusion]] is that they lack side branches.
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| Although intervention on a chronic total occlusion of an SVG may seem like an effective treatment strategy, it is best avoided.
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| ==Goals of Treatment==
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| Primarily, the goal should be to detect and treat a SVG [[stenosis]] early in the development of [[ischemia]] while the SVG is still [[patency|patent]]. As long as the SVG is not completely [[occlusion|occluded]], intervention can be performed.
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| Two additional overall goals of treating [[SVG]] [[stenosis]] include the resolution of symptomatic [[ischemia]] and the prevention/treatment of [[embolism|distal embolization]].
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| ==Treatment Options==
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| There are many different choices to consider when deciding the most appropriate treatment for SVG [[stenosis]], including [[PTCA]], [[PCI]] with [[bare metal stent|bare metal]] or [[drug-eluting stents]], PCI with covered [[stents]], embolic protection devices, [[debulking]]/[[thrombus]] removal, and surgical [[revascularization]].
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| ===Percutaneous Transluminal Coronary Angioplasty (PTCA)===
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| [[PTCA]] has high initial [[revascularization]] success rates in the treatment of SVG [[stenosis]]. However, it is also associated with high rates of periprocedural complications, including acute vessel closure secondary to [[dissection]] and in-situ [[thrombosis]]. Additional complications include [[embolism|distal embolization]] and [[no reflow]], which can lead to periprocedural [[infarction]].
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| In modern [[interventional cardiology]], PTCA is not often used as the sole means of treatment for SVG [[stenosis]]. Instead, [[stenting]] has become the cornerstone of treatment, while the use of PTCA has been limited to pre-dilation and post-dilation.
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| {{SIB}}
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| [[Category:Cardiology]]
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