Early ostial saphenous vein graft stenosis associated with the use of Symmetry sutureless aortic proximal anastomosis device: Successful percutaneous revascularization

Abstract

A recent advance in technology permits the creation of sutureless proximal aortic anastomosis during coronary artery bypass graft surgery. This new tool has significant potential benefit by minimizing aortic manipulation with subsequent reduction in neuroembolization. Implantation of a nitinol-based proximal aortic connector (Symmetry) has a potential to elicit intimal hyperplastic reaction analogous to restenosis after coronary stent placement. We report cases of early vein graft stenosis in association with the use of the Symmetry device. Three patients suffered from severe ostial stenosis within 6 months of bypass surgery with symptomatic presentation. Of these three patients, two underwent successful percutaneous revascularization. Fluoroscopic star-shaped appearance of the metallic Symmetry allows device recognition during angiography. We review current data regarding graft patency with the use of Symmetry device and discuss technical issues to address specific problems during percutaneous revascularization.