Sudden occlusion of a saphenous vein bypass graft relieved by direct injection of nitroglycerine

Abstract

An unusual case of sudden occlusion of a saphenous vein bypass graft to the right coronary artery, during a coronary angiographic study, is presented. Such occlusion was relieved by direct intragraft nitroglycerin injection, as typically happens in case of coronary arterial spasm. A possible pathogenetic mechanism, based on the present knowledge of platelet aggregation and the role of the powerful vasoactive agent Thromboxane A2, is discussed.

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

“…However, obstructive lesions are more likely to occur in SVGs (53% within 5 years, 76% at 5 to 10 years, and 92% at greater than 10 years) (822), and there is a high rate of early graft failure in current practice (occlusion in up to one third at 1 year). Spasm in grafts or native vessels (823,824) and technical complications may also play a role in the development of UA/NSTEMI during the early postoperative period (815,825). Both angioscopic and angiographic findings indicate that SVG disease is a serious and unstable process.…”

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

“…820,821 However, obstructive lesions are more likely to occur in SVGs (53% within 5 years, 76% at 5 to 10 years, and 92% at greater than 10 years), 822 and there is a high rate of early graft failure in current practice (occlusion in up to one third at 1 year). Spasm in grafts or native vessels 823,824 and technical complications may also play a role in the development of UA/NSTEMI during the early postoperative period. 815,825 Both angioscopic and angiographic findings indicate that SVG disease is a serious and unstable process.…”

2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

“…933,934 However, obstructive lesions are more likely to occur in SVGs (53% within 5 years, 76% at 5 to 10 years, and 92% at greater than 10 years), 935 and there is a high rate of early graft failure in current practice (occlusion in up to one third at 1 year). Spasm in grafts or native vessels 936,937 and technical complications may also play a role in the development of UA/NSTEMI during the early postoperative period. 928,938 Both angioscopic and angiographic findings indicate that SVG disease is a serious and unstable process.…”