Percutaneous transluminal angioplasty of a totally occluded venous bypass graft: a challenge that should be resisted.

P ercutaneous transluminal angioplasty is an accepted treatment for stenoses of bypass graft& and for total coronary artery occlusions.3-5 It follows that the same treatment would also be appropriate for total occlusions of saphenous aortocoronary bypass grafts. This report describes our clinical experience with attempted dilatation of totally occluded saphenous bypass grafts. Of the 2,679 consecutive patients referred for percutaneous transluminal coronary angioplasty at the Thoraxcenter, Rotterdam, between September 1980 and December 1988,96patients underwent percutaneous transluminal angioplasty of an obstruction in a saphenous aorta coronary bypass graft. This report describes the outcome of attempted angioplasty in 15patients, 12 men and 3 women, who presented with total occlusion of a venous bypass graft. The baseline clinical characteristics are listed in Table I. The mean age was 57 f 9 years (range 42 to 73). Most patients had significant narrowings in 3 major coronary arteries. Eleven patients received an aortocoronary circular sequential saphenous vein bypass graft. The number of anastomoses rangedfrom 2 to d/patient (mean 4 f 1). A proximal occlusion was located between the connection of the aorta and the first anastomosis, a midocclusion was located after the first anastomosis and before the