Spontaneous Resolution of Catheter-Induced Iatrogenic Vein Graft Dissection: First Case Report and Review of Literature

Abstract

An 86-year-old female patient with a history of bypass surgery was admitted for recurrent dyspnea and chest pain on exertion. She underwent coronary angiography showing high-grade saphenous vein graft stenosis supplying the right coronary. During an attempt to perform percutaneous intervention, saphenous vein graft to the right coronary artery was injured by the guide catheter resulting in dissection with thrombus formation but with normal distal blood flow. The procedure was abandoned since she had normal distal flow and also due to a fear of causing extension of the dissection with further manipulation. The patient was hemodynamically stable and free of chest pain after 30 minutes of observation. The patient was later discharged home on medical treatment. After 1 month, a repeat angiography showed patent saphenous vein graft to the right coronary artery with healed dissection. This is the first case report of spontaneous recovery of iatrogenic saphenous vein graft dissection. This case is followed by the review of literature.

Keywords

dissection - saphenous vein graft - angiography - cardiac catheterization - coronary intervention

• References

• 1 Garrett HE, Dennis EW, DeBakey ME. Aortocoronary bypass with saphenous vein graft. Seven-year follow-up. JAMA 1973; 223 (7) 792-794
• 2 Favaloro RG. Saphenous vein graft in the surgical treatment of coronary artery disease. Operative technique. J Thorac Cardiovasc Surg 1969; 58 (2) 178-185
• 3 Yusuf S, Zucker D, Peduzzi P , et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 1994; 344 (8922) 563-570
• 4 Davis KB, Chaitman B, Ryan T, Bittner V, Kennedy JW. Comparison of 15-year survival for men and women after initial medical or surgical treatment for coronary artery disease: a CASS registry study. Coronary Artery Surgery Study. J Am Coll Cardiol 1995; 25 (5) 1000-1009
• 5 Weintraub WS, Jones EL, Craver JM, Guyton RA. Frequency of repeat coronary bypass or coronary angioplasty after coronary artery bypass surgery using saphenous venous grafts. Am J Cardiol 1994; 73 (2) 103-112
• 6 Hannan EL, Kilburn Jr H, O'Donnell JF, Lukacik G, Shields EP. Adult open heart surgery in New York State. An analysis of risk factors and hospital mortality rates. JAMA 1990; 264 (21) 2768-2774
• 7 Lefkovits J, Holmes DR, Califf RM , et al. Predictors and sequelae of distal embolization during saphenous vein graft intervention from the CAVEAT-II trial. Coronary Angioplasty Versus Excisional Atherectomy Trial. Circulation 1995; 92 (4) 734-740
• 8 Athanasiadis A, Haase KK, Wullen B , et al. Lesion morphology assessed by pre-interventional intravascular ultrasound does not predict the incidence of severe coronary artery dissections. Eur Heart J 1998; 19 (6) 870-878
• 9 Black AJ, Namay DL, Niederman AL , et al. Tear or dissection after coronary angioplasty. Morphologic correlates of an ischemic complication. Circulation 1989; 79 (5) 1035-1042
• 10 Matthews BJ, Ewels CJ, Kent KM. Coronary dissection: a predictor of restenosis?. Am Heart J 1988; 115 (3) 547-554
• 11 Ellis SG, Roubin GS, King III SB , et al. Angiographic and clinical predictors of acute closure after native vessel coronary angioplasty. Circulation 1988; 77 (2) 372-379
• 12 Huber MS, Mooney JF, Madison J, Mooney MR. Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty. Am J Cardiol 1991; 68 (5) 467-471
• 13 Meerkin D, Tardif JC, Bertrand OF, Vincent J, Harel F, Bonan R. The effects of intracoronary brachytherapy on the natural history of postangioplasty dissections. J Am Coll Cardiol 2000; 36 (1) 59-64
• 14 Cappelletti A, Margonato A, Rosano G , et al. Short- and long-term evolution of unstented nonocclusive coronary dissection after coronary angioplasty. J Am Coll Cardiol 1999; 34 (5) 1484-1488
• 15 Albertal M, Van Langenhove G, Regar E , et al; DEBATE II Study Group. Uncomplicated moderate coronary artery dissections after balloon angioplasty: good outcome without stenting. Heart 2001; 86 (2) 193-198