[Limits of revascularization: interventional treatment possibilities in occlusion and restenosis after bypass operation]
Hans Rickli, J Muntwyler & F W Amann
abstract
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Coronary artery bypass graft (CABG) surgery may be limited by
incomplete revascularization, graft failure and progression of
narrowing in the native coronary arteries. Ischemia in the first
year after CABG, associated with anastomotic problems, can be safely
and effectively treated with angioplasty. The rate of saphenous vein
graft failure increases rapidly 8 years after CABG. Interventional
strategy depends largely on lesion morphology. Focal stenoses can be
treated with stents, with primary success rates > 90% and
complication rates < 5%. Diffusely degenerated vein grafts and
chronic total occlusions remain problematic for all catheter-based
interventions. No randomized trial exists comparing reoperative CABG
with angioplasty. In non-randomized data, neither therapy was
clearly superior to the other. The underlying extent of disease
primarily determines long-term survival. This suggests that control
of risk factors may well be beneficial. In patients with recurrent
symptoms unresponsive to medical therapy, referral for
revascularization is reasonable. The choice of additional treatment
may be made on the basis of clinical criteria and angiographic
suitability, as well as patient preference.
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citation
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Rickli H, Muntwyler J, Amann F W. [Limits of revascularization:
interventional treatment possibilities in occlusion and restenosis
after bypass operation]. Schweiz Med Wochenschr 1997; 127:2091-7.
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type
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journal paper/review (Translation2::getLang(): unknown language "".
Use Translation2::setLang() to set a default language.)
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date of publishing
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13-12-1997
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journal title
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Schweiz Med Wochenschr (127/50)
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ISSN print
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0036-7672
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pages
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2091-7
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PubMed
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9465369
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