Percutaneous Coronary Intervention in a Saphenous Vein Graft Failure: A Case Report


  • Edmond L. Jim Universitas Sam Ratulangi



Abstract: Recent published data from the Society of Thoracic Surgery (STS) national database displayed that among patients aged >65 years old who survived following an initial coronary artery bypass graft (CABG) operation, rates of repeat revascularization at 1, 5, 10, and 18 years were 2%, 8%, 16%, and 25%, respectively. The most preferred mode of revascularization was percutaneous coronary intervention (PCI). While remain the most frequently used conduits beside left internal mammary artery (LIMA), saphenous vein grafts (SVGs) have high failure rates. Percutaneous coronary intervention in SVGs is associated with an increased risk of distal coronary embolization, commonly resulting in periprocedural MI. We reported a 79-year-old male patient admitted due to progressive symptoms of chronic coronary syndrome. The patient had a history of hypertension and a CABG surgery in 2012. Electrocardiogram showed ischemia and old myocardial infarction (OMI) in inferior leads as well as poor R wave progression in the precordial leads. Transthoracic echocardiogram displayed a normal ejection fraction but impaired left ventricular (LV) diastolic relaxation. Diagnostic coronary angiography revealed a 70% tubular stenosis in proximal part of SVG supplying posterior descending artery, patent LIMA graft to left anterior descending artery, and complex lesion on native vessel (chronic total occlusion in mid right coronary artery). Implantation of drug eluting stent in SVG-posterior descending artery was performed. Direct-stenting PCI technique using undersized-stent was done to prevent any complications. In conclusion, despite the high risk of complications, vein graft intervention was successfully performed without any complications. Since the high rates of in-stent restenosis following PCI in SVGs, long-term dual antiplatelet therapy should be commenced in this patient.

Keywords: saphenous vein graft; vein graft intervention; percutaneous coronary intervention

Author Biography

Edmond L. Jim, Universitas Sam Ratulangi

Department of Cardiology and Vascular Medicine, Universitas Sam Ratulangi, Manado, Indonesia


Fosbol EL, Zhao Y, Shahian DM, Grover FL, Edwards FH, Peterson ED. Repeat coronary revascularization after coronary artery bypass surgery in older adults. The Society of Thoracic Surgeons’ National Experience, 1991–2007. Circulation. 2013;127(16):1656–63. Doi: 10.1161/ CIRCULATIONAHA.113.001882.

Xenogiannis I, Zenati M, Bhatt DL, Rao SV, Cabau JR, Goldman S, et al. Saphenous vein graft failure: from pathophysiology to prevention and treatment strategies. Circulation 2021;144(9):728-45. Doi: 10.1161/CIRCULATIONAHA.120.052163.

Keeley EC, Velez CA, O’Neill WW, Safian RD. Long-term clinical outcome and predictors of major adverse cardiac events after percutaneous interventions on saphenous vein grafts. Am Coll Cardiol. 2001;38(3):659-65. Doi: 10.1016/s0735-1097(01)01420-6.

Hong MK, Mehran R, Dangas G, Mintz GS, Lansky AJ, Pichard AD, et al. Creatine kinase-MB enzyme elevation following successful saphenous vein graft intervention is associated with late mortality. Circulation. 1999;100(24):2400-5. Available from:

Yap CH, Sposato L, Akowuah E, Theodore S, Dinh DT, Shardey GC, et al. Contemporary results show repeat coronary artery bypass grafting remains a risk factor for operative mortality. Ann Thorac Surg. 2009;87(5):1386-91. Doi: 10.1016/j.athoracsur.2009.02.006.

Stefanini GG, Alfonso F, Barbato E, Byrne RA, Capodanno D, Colleran R, et al. Management of myocardial revascularisation failure: an expert consensus document of the EAPCI. Eurointervention. 2020;16(11):e875-e890. Doi: 10.4244/eij-d-20-00487.

Mack MJ, Squiers JJ, Lytle BW, DiMaio JM, Mohr FWM. Myocardial revascularization surgery: JACC historical breakthroughs in perspective, J Am Coll Cardiol. 2021;78(4):365-383. Available from:

Gharibeh L, Ferrari G, Ouimet M, Grau JB. Conduits’ biology regulates the outcomes of coronary artery bypass grafting. JACC State of the art review. JACC Basic Transl Sci. 2021;6(4):388–96. Available from:

Yazdani SK, Farb A, Nakano M, Vorpahl M, Ladich E, Finn AV, et al. Pathology of drug-eluting versus bare-metal stents in saphenous vein bypass graft lesions. JACC Cardiovasc Interv. 2012;5(6):666–74. Doi: 10.1016/j.jcin.2011.12.017.

Brilakis E, Banerjee S, Burke M. A new treatment strategy for saphenous vein graft lesions? Letting it go. J Am Coll Cardiol. 2018;71(18):1983–5. Available from: https: //

Xenogiannis I, Tajti P, Hall AB, Alaswad K, Rinfret S, Nicholson W, et al. Update on cardiac catheterization in patients with prior coronary artery bypass graft surgery. JACC: Cardiovasc Interv. 2019;12(17):1635-49. Doi: 10.1016/j.jcin.2019.04.051.

Topol EJ, Teirstein PS. Textbook of Interventional Cardiology E-Book: Elsevier Health Sciences; 2018.

Eeckhout E, et al. PCR–EAPCI textbook of percutaneous interventional cardiovascular medicine. Europa Publications; 2019.

Aggarwal V, Stanislawski MA, Maddox TM Nallamothu BK, Grunwald G, Adams JC, et al. Safety and effectiveness of drug-eluting versus bare-metal stents in saphenous vein bypass graft percutaneous coronary interventions: insights from the Veterans Affairs CART program. J Am Coll Cardiol. 2014;64(17):1825-36. Doi: 10.1016/j.jacc.2014.06.1207.

Lansky AJ, Yang YM, Khan Y, Costa RA, Pietras C, Tsuchiya Y, et al. Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. Am J Cardiol. 2006;98(3):370-4. Doi: 10.1016/j.amjcard.2006.02.041.

Hong YJ, Pichard AD, Mintz GS, Kim SW, Lee SY, Kim SY, et al. Outcome of undersized drug-eluting stents for percutaneous coronary intervention of saphenous vein graft lesions. Am J Cardiol. 2010;105(2):179-85. Doi: 10.1016/j.amjcard.2009.09.006.

Brennan JM, Al-Hejily W, Dai D, Shaw RE, Trilesskaya M, Rao SV, et al. Three-year outcomes associated with embolic protection in saphenous vein graft intervention: results in 49 325 senior patients in the Medicare-linked National Cardiovascular Data Registry CathPCI Registry. Circ Cardiovasc Interv. 2015;8(3):e001403. Doi: 10.1161/CIRCINTERVENTIONS.114.001403.

Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 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(23):e574-651. Doi: 10.1161/CIR.0b013e31823ba622.

Sachdeva A, Bavisetty S, Beckham G, Shen AY, Aharonian V, Mansukhani P, et al. Discontinuation of long-term clopidogrel therapy is associated with death and myocardial infarction after saphenous vein graft percutaneous coronary intervention. J Am Coll Cardiol. 2012;60(23):2357-63. Doi: 10.1016/j.jacc.2012.09.014.




How to Cite

Jim, E. L. (2023). Percutaneous Coronary Intervention in a Saphenous Vein Graft Failure: A Case Report. E-CliniC, 12(2), 150–156.