brintellex
  • Users Online: 178
  • Print this page
  • Email this page
CASE REPORT
Year : 2020  |  Volume : 10  |  Issue : 2  |  Page : 92-96

Multivessel percutaneous coronary intervention in midterm anastomotic failure of all grafts post CABG: An unpredictable enigma?


Department of Cardiology, Aayush Hospital, Vijayawada, Andhra Pradesh, India

Correspondence Address:
Dr. Raghuram Palaparti
Department of Cardiology, Aayush Hospitals, Ramachandra Nagar, Vijayawada - 520 008, Andhra Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JICC.JICC_5_20

Rights and Permissions

Coronary bypass graft failure can be divided into three temporal categories: Early (0–30 days), midterm (30 days to 1 year), or late (after 1 year). Early to midterm graft failure is still a significant problem in the clinical practice and often under reported. Here, we report a case of midterm failure of all grafts post CABG. A 56-year-old male presented to us with unstable angina and found to have triple vessel disease. He underwent CABG with left internal mammary artery (LIMA) to left anterior descending, venous grafts to diagonal and obtuse marginal. As ostial right coronary artery disease was moderate, it was not grafted. Three months later, he presented with acute coronary syndrome, acute heart failure, and moderate left ventricular (LV) dysfunction. Coronary and graft angiogram revealed critical anastomotic lesions of LIMA and both the venous grafts. Rapid progression of native vessel disease was also observed. He underwent successful multivessel percutaneous coronary intervention (PCI) with improvement in LV function. Midterm saphenous venous graft failure is mainly caused by neointimal hyperplasia leading to occlusive stenosis. Midterm failure of coronary artery bypass grafts is not a uniformly predictable response and has been the focus of extensive clinical research. Various mechanical strategies involving improvement of surgical techniques and various pharmacological strategies have been studied but did not address the problem adequately. PCI is the preferred strategy in these high-risk patients as it is less invasive and gives excellent results. Graft surveillance, early recognition of the problem and aggressive management has shown to improve the graft patency rates and decrease recurrent cardiovascular events in these patients.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed68    
    Printed0    
    Emailed0    
    PDF Downloaded10    
    Comments [Add]    

Recommend this journal