An 82-year-old man presented with angina pectoris. Thirty-three years earlier, he had undergone 3-vessel coronary artery bypass grafting that included a saphenous vein graft to the left anterior descending coronary artery (LAD). A current transthoracic echocardiogram revealed an aortic valve peak velocity of 4.4 m/s and an estimated aortic valve area of 0.7 cm2. Results of carotid ultrasonography showed occlusion of the right internal carotid artery. Coronary angiograms revealed LAD occlusion just distal to the diagonal branch (Fig. 1) and a patent saphenous vein graft to the mid LAD (Fig. 2). The right coronary artery was occluded. Fluoroscopy revealed calcification of the ascending aorta. The patient was diagnosed with aortic valve stenosis and coronary artery disease.
Fig. 1 Coronary angiogram (right anterior oblique view) shows left anterior descending coronary artery occlusion just distal to the diagonal branch.
CB = circumflex branch; DB = diagonal branch; LAD = left anterior descending coronary artery; LCA = left coronary artery
Fig. 2 Coronary angiograms in A) anterior and B) right anterior oblique views show a patent saphenous vein graft (SVG) to the left anterior descending coronary artery (LAD).
Comment
The long-term patency of saphenous vein grafts is typically shorter than that of arterial grafts.1 The odds ratio for late patency (longer than 5 yr) of radial artery-to-saphenous vein grafts was reported as 2.28 (95% confidence interval, 1.32–3.91) in 2011.2 Our literature search for venous graft patency beyond 10 years revealed 2 case reports of patent vein grafts: one was 19 years old3 and the other was 30 years old.4 Our patient's saphenous vein graft was patent at 33 years. This case exemplifies the different lifespans of saphenous vein grafts.
Footnotes
Address for reprints: G. Hossein Almassi, MD, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Froedtert East, Suite 5700, 9200 W. Wisconsin Ave., Milwaukee, WI 53226, E-mail: halmassi@mcw.edu
References
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- 2.Athanasiou T, Saso S, Rao C, Vecht J, Grapsa J, Dunning J, et al. Radial artery versus saphenous vein conduits for coronary artery bypass surgery: forty years of competition–which conduit offers better patency? A systematic review and meta-analysis. Eur J Cardiothorac Surg 2011;40(1):208–20. [DOI] [PubMed]
- 3.Mariscalco G, Blanzola C, Leva C, Bruno VD, Luvini M, Sala A. 19-year patency of a coronary-coronary venous bypass graft. Tex Heart Inst J 2005;32(4):583–5. [PMC free article] [PubMed]
- 4.Ozcan A, Evrengul H, Goksin I, Gur S, Kaftan A. 30-year patency of a saphenous vein graft in coronary bypass graft surgery. Ann Thorac Surg 2008;85(4):e23. [DOI] [PubMed]