J Cardiovasc Interv.  2022 Jan;1(1):17-27. 10.54912/jci.2021.0004.

Comparison of IVUS Findings Between Arterial and Venous Grafts in Patients After Coronary Artery Bypass Surgery

• Lee SY
• Kim SW
• Hong YJ
• Doh JH

• KMID: 2561236
• DOI: http://doi.org/10.54912/jci.2021.0004

Abstract

Background
This study was designed to use intravascular ultrasound (IVUS) to define the mechanisms of graft failure comparing arterial vs. saphenous vein grafts (SVG).
Methods
We compared pre-intervention IVUS findings in 23 patients with arterial grafts (15 left internal mammary artery, 3 right internal mammary artery, 5 radial artery) vs. 45 patients with SVGs; all had significant de novo lesions.
Results
Most lesions were located in distal-shaft (33.8%) and ostium (27.9%) of the graft. Ostial lesions in arterial graft is 7/23 (30.4%), in SVG 14/45 (31.1%), there were no difference in incidence of ostial lesions between two groups(P = 0.59). There was no significant difference in graft age (5.0 ± 2.0 vs. 6.2 ± 3.5 years, P = 0.11) or other risk factors including diabetes mellitus (60.9% vs. 55.6%, P = 0.44) except patients with venous grafts were older (58.1 ± 9.5 vs. 66.7 ± 13.5 years, P = 0.013). In diseased SVGs reference vessel area (7.35 ± 2.83 vs. 16.92 ± 6.85 mm² , P < 0.001), lesion site vessel area (5.84 ± 2.66 vs. 18.25 ± 6.90 mm² , P < 0.001), lesion site lumen area (1.93 ± 0.59 vs. 3.35 ± 1.63 mm² , P < 0.001), minimal lumen diameter, plaque area (3.91 ± 2.46 vs. 14.85 ± 6.66 mm² , P < 0.001) and plaque burden (63.4 ± 14.0 vs. 79.8 ± 11.0%, P < 0.001) were significant greater; and calcification (17.4% vs. 42.2%, P = 0.035) was more common. Positive remodeling was more common in SVGs while negative remodeling was present in almost 78% of arterial grafts. Plaque rupture (17.4% vs. 28.9%, P = 0.23) and a lobulated mass (13.3% vs. 17.8%, P = 0.45) were similar between the two groups.
Conclusions
SVG failure is associated with positive remodeling and large plaque burden while arterial graft failure is associated with negative remodeling and modest amounts of plaque. This indicates fundamentally different pathophysiologic mechanisms of venous and arterial conduit failure.

Keyword

Coronary artery bypass; Atherosclerosis; Arteries; Veins