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Abstract
Coronary artery bypass grafting using saphenous vein graft represents an
important option in the treatment of intractable angina due to coronary artery
occlusive disease. from its beginning in the late sixties[1], this procedure has been
widely applied as a treatment for obstructive coronary artery disease.[2]
Following coronary artery bypass surgery (CABG), 15% of vein grafts occlude in
the first year, with increasing graft attrition rate of 1-4% per year, such that by 10
years after surgery, only 50-60% of grafts are patent. Up to 20% of patients
experience recurrent angina in the first year after CABG, and up to 4% of patients
per subsequent year. Furthermore, reoperation carries an increased risk of mortality
(3-7%) and perioperative myocardial infarction (4-11%) [3, 4].
Percutaneous stenting of atherosclerotic vein graft lesions has been complicated by
high rates of subsequent in-stent restenosis (ISR) and morbidity from distal
embolisation of atherosclerotic debris [3, 4]. However, recent advances in drugeluting
stents to reduce ISR for de novo lesions are likely to translate to reductions
in ISR in vein graft treatment. The use of distal protection devices (DPDs), that
trap material embolised at the time of intervention, reduce periprocedural
myocardial infarction rates from 14-24% to 7-16% [4].