Document Detail

Arterial versus venous bypass grafts in patients with in-stent restenosis.
MedLine Citation:
PMID:  16159829     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In patients who develop in-stent restenosis, successful revascularization can be difficult to achieve using percutaneous methods. This study was designed to verify the surgical results in this setting and to evaluate the potential beneficial role of arterial bypass conduits. METHODS AND RESULTS: Sixty consecutive coronary artery bypass patients with previous in-stent restenosis and 60 control cases were randomly assigned to receive an arterial conduit (either right internal thoracic or radial artery; study group) or a great saphenous vein graft (control group) on the first obtuse marginal artery to complete the surgical revascularization procedure. At a mean follow-up of 52+/-11 months, patients were reassessed clinically and by angiography. Freedom from clinical and instrumental evidence of ischemia recurrence was found in 19 of 60 subjects in the study group versus 45 of 60 in the control series (P=0.01). The results of the arterial grafts were excellent in both the study and control groups (right internal thoracic artery patency rate, 19 of 20 for both, and radial artery patency rate, 20 of 20 versus 19 of 20; P=0.99). Saphenous vein grafts showed lower patency rate than arterial grafts in both series and had extremely high failure rate in the study group (patency rate, 10 of 20 in the study group versus 18 of 20 in the control group; P=0.001). Use of venous graft was an independent predictor of failure in the study group, whereas hypercholesterolemia was associated with graft failure in both series. CONCLUSIONS: Venous grafts have an high incidence of failure among cases who previously developed in-stent restenosis, whereas the use of arterial conduits can improve the angiographic and clinical results. Arterial grafts should probably be the first surgical choice in this patient population.
Mario Gaudino; Carlo Cellini; Claudio Pragliola; Carlo Trani; Francesco Burzotta; Giovanni Schiavoni; Giuseppe Nasso; Gianfederico Possati
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Circulation     Volume:  112     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-09-14     Completed Date:  2006-02-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  I265-9     Citation Subset:  AIM; IM    
Department of Cardiac Surgery, Catholic University, Rome, Italy.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Angiography
Coronary Artery Bypass / methods*,  statistics & numerical data
Coronary Restenosis / surgery*
Coronary Stenosis / therapy
Follow-Up Studies
Graft Occlusion, Vascular / surgery*
Internal Mammary-Coronary Artery Anastomosis / statistics & numerical data
Middle Aged
Radial Artery / transplantation*
Reoperation / methods*
Saphenous Vein / transplantation*
Transplantation, Heterotopic
Treatment Outcome
Vascular Patency

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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