Percutaneous transluminal angioplasty in the management of occlusive disease involving the coronary arteries and saphenous vein bypass grafts: preliminary results.

Since January, 1978, we have evaluated 18 patients in whom segmental occlusive disease of the aorta-coronary saphenous vein graft or the native coronary circulation was present. The significantly occluded vessels were restored to relatively normal circulation by means of percutaneous transluminal dilatation in 10 of these patients, with technical failures in seven patients and the occurrence of a thrombosis during the procedure in one other. Successful dilatation occurred in six of the seven patients with saphenous vein graft stenosis. Percutaneous transluminal angioplasty of the native coronary arteries in 11 patients resulted in five successful dilatations. All dilatation procedures are performed with the use of local anesthesia with an open-heart team standing by. In the event of technical failure or incipient thrombosis with developing infarction, the patient is transferred for immediate bypass. On the basis of these early results, we have developed guidelines of the indications for percutaneous transluminal dilatation of the coronary arteries and their saphenous vein grafts. The need for improved instrumentation to broaden these guidelines is discussed. Case histories of five patients are presented, and a summary table for all 18 patients is also provided. Certain inherent complications are discussed, but our preliminary results are encouraging, particularly with regard to stenoses of saphenous vein bypass grafts.