Catheter-Based Therapy for Saphenous Vein Bypass Graft Disease.

Improved patient survival and the limitations of repeat coronary artery surgery have generated a growing population of patients referred for catheter-based treatment of vein graft lesions. In this subject review, the current state of knowledge regarding therapeutic options for these difficult lesions is discussed. Despite improvements in technique and materials, risks of treatment with balloon angioplasty remain higher than for other lesion types. The underlying lesion pathology determines therapeutic risk to a large degree. Newer therapeutic alternatives appear to offer advantages over balloon angioplasty, but improved clinical outcomes have not been demonstrated in appropriate trials for most new devices and treatment strategies. On-going studies will clarify the utility of some new devices, and other studies are needed.