Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft

Paul Charbel; Joe Shaffu; Nadine Kaoukabani; Pierrette Habib

doi:doi:10.11648/j.ijcts.20190501.11

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Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft

Paul Charbel, Joe Shaffu, Nadine Kaoukabani, Pierrette Habib

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 5, Issue 1)

Received: 20 January 2019 Accepted: 25 February 2019 Published: 16 March 2019

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Abstract

Management of stenosis of saphenous vein grafts in Coronary artery bypass graft (CABG) patients remains challenging despite the advance in interventional cardiology techniques. Rotational atherectomy is an adjunctive technique used in certain anatomical conditions in native coronary arteries; its use in saphenous vein graft is still contra-indicated by the manufacturer, and has only been reported in few cases in the literature. We report a case of a calcified, non-dilatable, distal saphenous vein graft to Circumflex lesion in a heart failure patient presenting with Non STEMI. The lesion was just proximal to the anastomosis and could not be crossed. Because of high surgical risk, and against manufacturer guidelines, rotational atherectomy of the lesion was performed and was successful with a very good angiographic result. Rotational atherectomy to facilitate percutaneous interventions in saphenous vein graft lesions is feasible, and could be attempted in experienced centers provided the absence of luminal thrombus or dissection.

Published in	International Journal of Cardiovascular and Thoracic Surgery (Volume 5, Issue 1)
DOI	10.11648/j.ijcts.20190501.11
Page(s)	1-5
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Rotational Atherectomy, Saphenous Vein Graft, Non STEMI, Percutaneous Coronary Intervention

References

[1]	Goldman S, Zadina K, Moritz T, et al. Long term patency of saphenous veins and left internal mammary grafts after coronary artery bypass surgery: results of a department of Veterans Affairs Cooperative Study. J Am Coll Cardiol. 2004; 44: 2149-56.
[2]	Bain DS. Percutaneous treatment of saphenous vein graft disease: the ongoing challenge JACC 2003; 42: 1370-2.
[3]	2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions Circulation. 2011; 124: e574-e651.
[4]	J. R. Cardenas, R. K. Strumpf, and R. R. Heuser. Rotational Atherectomy in Restenotic Lesions at the Distal Saphenous Vein Graft Anastomosis Catheterization and Cardiovascular Diagnosis 3653-57 (1995).
[5]	E. Cavusoglu, A. S. Kini,, J. D. Marmur, and S. K. Sharma. Current Status of Rotational Atherectomy Catheterization and Cardiovascular Interventions 62: 485–498 (2004).
[6]	http://www.bostonscientific.com/Device.bsci?page=ResourceDetail&navRelId=1000.1003&method=DevDetailHCP&id=10081831&resource_type_category_id=1&resource_type_id=91&pageDisclaimer=Disclaimer.ProductPag
[7]	S. Leal, R. Campante Teles, et al. Percutaneous revascularization strategies in saphenous vein graft lesions: Long-term results Rev Port Cardiol. 2012; 31 (1): 11-18.
[8]	Holmes DR Jr, Topol EJ, Califf RM, et al. A multicenter, randomized trial of coronary angioplasty versus directional atherectomy for patients with saphenous vein bypass graft lesions. CAVEAT-II Investigators. Circulation 1995; 91: 1966–1974.
[9]	Jackman J, Hermiller J, Sketch M, Davidson C, Tcheng J, Phillips H, Stack R. Combined rotational and directional atherectomy guided by intravascular ultrasound in an occluded vein graft. Am Heart J 1992; 124: 214–216.
[10]	Baron S, Arthur A. Rotational atherectomy for resistant anastomotic saphenous vein bypass graft stenosis. J Invas Cardiol 1996; 8: 120-122.
[11]	Abhyankar A, Vaidya K, Bernstein L. Rotational atherectomy of calcified ostial saphenous vein graft lesion with long term follow-up: a case report. Int J Cardiol 1995; 52: 11–12.
[12]	Cardenas J, Strumpf R, Heuser R. Rotational atherectomy in restenotic lesions at the distal saphenous vein graft anastomosis. Cathet Cardiovasc Diagn 1995; 36: 53–57.
[13]	Coto H. Intravascular ultrasound-guided rotational atherectomy and stent implant in a previously undilatable saphenous vein graft lesion. J Invasive Cardiol 1998; 10: 451–453.
[14]	Thomas WJ, Cowley MJ, Vetrovec GW, Malloy W, Goudreau E. Effectiveness of rotational atherectomy in aortocoronary saphenous vein grafts. Am J Cardiol 2000; 86: 88–91.
[15]	J. BENREY, M. D., A. MESA, M. D., S. JAIN, M. D., and J. A. GARCIA-GREGORY, M. D Successful Rotational Atherectomy of Mid-Saphenous Vein Graft Lesions. Interven Cardiol 1999; 12: 205-208.
[16]	C. W. Don, MD, I. Palacios, MD, K. Rosenfield, MD Use of Rotational Atherectomy in the Body of a Saphenous Vein Coronary Graft J INVASIVE CARDIOL 2009; 21: E168–E170.

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APA Style

Paul Charbel, Joe Shaffu, Nadine Kaoukabani, Pierrette Habib. (2019). Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft. International Journal of Cardiovascular and Thoracic Surgery, 5(1), 1-5. https://doi.org/10.11648/j.ijcts.20190501.11

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ACS Style

Paul Charbel; Joe Shaffu; Nadine Kaoukabani; Pierrette Habib. Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft. Int. J. Cardiovasc. Thorac. Surg. 2019, 5(1), 1-5. doi: 10.11648/j.ijcts.20190501.11

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AMA Style

Paul Charbel, Joe Shaffu, Nadine Kaoukabani, Pierrette Habib. Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft. Int J Cardiovasc Thorac Surg. 2019;5(1):1-5. doi: 10.11648/j.ijcts.20190501.11

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@article{10.11648/j.ijcts.20190501.11,
  author = {Paul Charbel and Joe Shaffu and Nadine Kaoukabani and Pierrette Habib},
  title = {Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {5},
  number = {1},
  pages = {1-5},
  doi = {10.11648/j.ijcts.20190501.11},
  url = {https://doi.org/10.11648/j.ijcts.20190501.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20190501.11},
  abstract = {Management of stenosis of saphenous vein grafts in Coronary artery bypass graft (CABG) patients remains challenging despite the advance in interventional cardiology techniques. Rotational atherectomy is an adjunctive technique used in certain anatomical conditions in native coronary arteries; its use in saphenous vein graft is still contra-indicated by the manufacturer, and has only been reported in few cases in the literature. We report a case of a calcified, non-dilatable, distal saphenous vein graft to Circumflex lesion in a heart failure patient presenting with Non STEMI. The lesion was just proximal to the anastomosis and could not be crossed. Because of high surgical risk, and against manufacturer guidelines, rotational atherectomy of the lesion was performed and was successful with a very good angiographic result. Rotational atherectomy to facilitate percutaneous interventions in saphenous vein graft lesions is feasible, and could be attempted in experienced centers provided the absence of luminal thrombus or dissection.},
 year = {2019}
}

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TY  - JOUR
T1  - Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft
AU  - Paul Charbel
AU  - Joe Shaffu
AU  - Nadine Kaoukabani
AU  - Pierrette Habib
Y1  - 2019/03/16
PY  - 2019
N1  - https://doi.org/10.11648/j.ijcts.20190501.11
DO  - 10.11648/j.ijcts.20190501.11
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 1
EP  - 5
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20190501.11
AB  - Management of stenosis of saphenous vein grafts in Coronary artery bypass graft (CABG) patients remains challenging despite the advance in interventional cardiology techniques. Rotational atherectomy is an adjunctive technique used in certain anatomical conditions in native coronary arteries; its use in saphenous vein graft is still contra-indicated by the manufacturer, and has only been reported in few cases in the literature. We report a case of a calcified, non-dilatable, distal saphenous vein graft to Circumflex lesion in a heart failure patient presenting with Non STEMI. The lesion was just proximal to the anastomosis and could not be crossed. Because of high surgical risk, and against manufacturer guidelines, rotational atherectomy of the lesion was performed and was successful with a very good angiographic result. Rotational atherectomy to facilitate percutaneous interventions in saphenous vein graft lesions is feasible, and could be attempted in experienced centers provided the absence of luminal thrombus or dissection.
VL  - 5
IS  - 1
ER  -

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Author Information

Paul Charbel

Cardiology Division, Department of Medicine, Saint George Hospital, UMC-University of Balamand, Faculty of Medical Sciences, Beirut, Lebanon
Joe Shaffu

Cardiology Division, Department of Medicine, Saint George Hospital, UMC-University of Balamand, Faculty of Medical Sciences, Beirut, Lebanon
Nadine Kaoukabani

Cardiothoracic Anesthesia Division, Anesthesia Department, Saint George Hospital, UMC-University of Balamand, Faculty of Medical Sciences, Beirut, Lebanon
Pierrette Habib

Cardiology Division, Department of Medicine, Saint George Hospital, UMC-University of Balamand, Faculty of Medical Sciences, Beirut, Lebanon

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Plain Text BibTeX RIS

APA Style

Paul Charbel, Joe Shaffu, Nadine Kaoukabani, Pierrette Habib. (2019). Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft. International Journal of Cardiovascular and Thoracic Surgery, 5(1), 1-5. https://doi.org/10.11648/j.ijcts.20190501.11

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ACS Style

Paul Charbel; Joe Shaffu; Nadine Kaoukabani; Pierrette Habib. Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft. Int. J. Cardiovasc. Thorac. Surg. 2019, 5(1), 1-5. doi: 10.11648/j.ijcts.20190501.11

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AMA Style

Paul Charbel, Joe Shaffu, Nadine Kaoukabani, Pierrette Habib. Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft. Int J Cardiovasc Thorac Surg. 2019;5(1):1-5. doi: 10.11648/j.ijcts.20190501.11

Copy | Download

@article{10.11648/j.ijcts.20190501.11,
  author = {Paul Charbel and Joe Shaffu and Nadine Kaoukabani and Pierrette Habib},
  title = {Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {5},
  number = {1},
  pages = {1-5},
  doi = {10.11648/j.ijcts.20190501.11},
  url = {https://doi.org/10.11648/j.ijcts.20190501.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20190501.11},
  abstract = {Management of stenosis of saphenous vein grafts in Coronary artery bypass graft (CABG) patients remains challenging despite the advance in interventional cardiology techniques. Rotational atherectomy is an adjunctive technique used in certain anatomical conditions in native coronary arteries; its use in saphenous vein graft is still contra-indicated by the manufacturer, and has only been reported in few cases in the literature. We report a case of a calcified, non-dilatable, distal saphenous vein graft to Circumflex lesion in a heart failure patient presenting with Non STEMI. The lesion was just proximal to the anastomosis and could not be crossed. Because of high surgical risk, and against manufacturer guidelines, rotational atherectomy of the lesion was performed and was successful with a very good angiographic result. Rotational atherectomy to facilitate percutaneous interventions in saphenous vein graft lesions is feasible, and could be attempted in experienced centers provided the absence of luminal thrombus or dissection.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft
AU  - Paul Charbel
AU  - Joe Shaffu
AU  - Nadine Kaoukabani
AU  - Pierrette Habib
Y1  - 2019/03/16
PY  - 2019
N1  - https://doi.org/10.11648/j.ijcts.20190501.11
DO  - 10.11648/j.ijcts.20190501.11
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 1
EP  - 5
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20190501.11
AB  - Management of stenosis of saphenous vein grafts in Coronary artery bypass graft (CABG) patients remains challenging despite the advance in interventional cardiology techniques. Rotational atherectomy is an adjunctive technique used in certain anatomical conditions in native coronary arteries; its use in saphenous vein graft is still contra-indicated by the manufacturer, and has only been reported in few cases in the literature. We report a case of a calcified, non-dilatable, distal saphenous vein graft to Circumflex lesion in a heart failure patient presenting with Non STEMI. The lesion was just proximal to the anastomosis and could not be crossed. Because of high surgical risk, and against manufacturer guidelines, rotational atherectomy of the lesion was performed and was successful with a very good angiographic result. Rotational atherectomy to facilitate percutaneous interventions in saphenous vein graft lesions is feasible, and could be attempted in experienced centers provided the absence of luminal thrombus or dissection.
VL  - 5
IS  - 1
ER  -

Copy | Download