Transluminal atherectomy of saphenous vein aortocoronary bypass grafts.

Angioplasty of stenotic saphenous vein aortocoronary bypass grafts is often unsatisfactory because of the relatively high incidence of acute complications and restenosis. During an initial evaluation of transluminal coronary atherectomy, 14 patients had atherectomy of saphenous vein graft lesions (15 grafts). Atherectomy was successful in 13 of 14 patients, decreasing the mean diameter of stenosis from 85 to 15%. In 1 patient, the lesion could not be crossed by the atherectomy device. The following 3 minor complications occurred: 1 embolus of atheromatous material; 1 air embolism; and 1 transient thrombosis leading to subendocardial myocardial infarction. Of the 14 patients, 8 underwent angiography 4 to 6 months after atherectomy; 5 patients had restenosis and 3 had widely patent grafts. Four other patients were clinically evaluated at 3 months after atherectomy. Two were asymptomatic, 1 had class II angina and 1 had class III angina. Transluminal atherectomy achieved excellent immediate results with a low incidence of major complications in the treatment of stenosed saphenous vein bypass grafts. However, preliminary follow-up results suggest a high incidence of restenosis.