Vein Graft Stenosis

Excerpt

Bypass surgery with a greater saphenous vein graft or another alternative autologous venous graft is a well-established treatment of peripheral arterial disease in the lower limbs. A wide spectrum of peripheral arterial disease with different underlying causalities, including chronic limb-threatening ischemia, intermittent claudication, peripheral limb aneurysms, and major arterial trauma, might be managed with bypass procedures. Bypass surgery has satisfactory outcomes, considering limb preservation and long-term graft patency rates. However, the possibility of vein graft failure due to stenoses significantly limits the durability of the procedure. Diagnosing stenoses through clinical and ultrasonographic surveillance, followed by treatment, avoids the grafts' complete occlusion.

The long-term patency and success of vein grafts in bypass surgery remain challenging due to their accelerated atherosclerotic rates compared to their arterial counterparts. Preventing vein graft stenosis (VGS) is the cornerstone of management and includes tight control of blood pressure, blood sugars, lipid levels, body weight, and smoking cessation. Nearly all patients with vein grafts should be treated with daily aspirin and statin. Further anticoagulation and antiplatelet therapy are determined by specific interventions performed and individualized patient factors. Angina is the most common presentation of VGS following coronary artery bypass grafting (CABG). VGS presents as rest pain, non-healing wounds, and claudication in the peripheral vascular system. If revascularization is necessary, endovascular therapy or surgical bypass should be offered to improve the arterial circulation of the obstructed native vessel. Endovascular therapy of the vein graft itself may be attempted first to improve the primary or secondary patency.[10] An open approach is reserved for multivessel disease or patients for whom endovascular methods are impossible. This topic discusses VGS in the context of patients following CABG or peripheral artery bypass grafting (PABG) using the great saphenous vein as the most common venous conduit.