Retrograde coronary angioplasty of isolated arterial segments through saphenous vein bypass grafts

Abstract

Progression of native coronary artery disease proximal to the placement of saphenous vein grafts may leave arterial segments isolated by stenoses on either side. In 16 patients, we attempted coronary angioplasty in a retrograde direction through saphenous vein grafts to revascularize 17 isolated arterial segments. The retrograde dilatation was successful in 12 of 17 attempts (71%). Failure in 5 attempts was due to severe angulation between the graft insertion site and the retrograde proximal arterial limb. There were no major complications of these procedures. Symptoms and signs of myocardial ischemia were relieved following successful retrograde dilatation. Thus, retrograde dilatation through saphenous vein grafts provides another means of achieving complete revascularization using coronary angioplasty in patients with prior coronary bypass surgery.

Retrograde Percutaneous Recanalization of Chronic Total Occlusion of the Coronary Arteries

“…Retrograde approach has been described initially via the bypass grafts 20 and more recently the use of septal collaterals has been described 18 to be safe and effective. Retrograde approach for recanalization of CTO has gained popularity recently with improved success rates as shown in several case reports and small series of selected patients.…”

Chronic Total Coronary Artery Occlusion Recanalisation with Percutaneous Coronary Intervention — Single Centre 10-Year Experience

“…Many techniques and devices (wires, microcatheters) have been introduced into clinical practice to improve the effectiveness of CTO revascularisation (Sumitsuji et al, 2011). One of the most important and popular techniques is the retrograde approach, nowadays widely used, and first described in 1990 by Kahn and Hartzler (1990). The first report of retrograde crossing via septal collaterals was published in 2006, starting the modern era, rapidly evolving with the introduction of specialised equipment (Surmely et al, 2006).…”

“…In 1990, the first report of a retrograde approach for CTO was published, in which the retrograde wire crossing technique was applied via a degenerated saphenous vein graft (SVG) (Kahn et al, 1990). Later septal collaterals were considered to provide potential access for the retrograde approach.…”

Krónikus jobb koronária-elzáródás megnyitása homokoronáriás kollaterálison keresztüli retrográd megközelítéssel

“…F: A stentek implantációját követően készült felvétel re, amelyek jellemzően az elzáródás anterográd megnyitását célozták meg, azonban ezek eredményessége az elvárttól elmaradt. Az 1990-ben publikálták amerikai szerzők a koronária kollaterálisokon történő megközelí-tés kivitelezhetőségét nonokklúzív léziók esetében, míg a krónikus elzáródások retrográd, szeptális kollateráli-sokon keresztül történő megnyitását Surmely és munkatársai 2007-ben közölték (1,2). Az elmúlt 10 évben a retrográd CTO-rekanalizáció a krónikus elzáródások megnyitásának eszköztárába beépült (3).…”