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Coronary artery bypass graft surgery: Prevention and management of vein graft stenosis

Authors
Thomas Levin, MD
Donald Cutlip, MD
Section Editor
Stephan Windecker, MD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Most patients who undergo coronary artery bypass graft (CABG) surgery receive at least one saphenous vein graft (SVG) in addition to one or more arterial grafts. Compared to arterial grafts, vein grafts have a relatively high rate of clinically important stenosis at 5 and 10 years (movie 1). (See "Coronary artery bypass graft surgery: Causes and rates of graft failure", section on 'Vein grafts'.)

This topic will discuss issues related to the prevention, clinical presentation, and management of SVG stenosis. The risk factors for and rates of graft failure and long-term outcomes after CABG are discussed separately. (See "Coronary artery bypass graft surgery: Causes and rates of graft failure" and "Late recurrent angina pectoris after coronary artery bypass graft surgery" and "Coronary artery bypass graft surgery: Long-term clinical outcomes".)

PREVENTION

Secondary preventive interventions, such as aspirin and statin, achieving blood pressure goal, avoidance of smoking, and the control of serum glucose in patients with diabetes, are recommended for all patients with coronary heart disease (CHD). (See "Prevention of cardiovascular disease events in those with established disease or at high risk" and "Intensity of lipid lowering therapy in secondary prevention of cardiovascular disease" and "Goal blood pressure in patients with cardiovascular disease or at high risk".)

As discussed below, antiplatelet agents and statins are of proven efficacy for the prevention of saphenous vein graft (SVG) stenosis.

Antiplatelet agents — We recommend that, among patients not treated with aspirin before coronary artery bypass graft surgery (CABG), aspirin (75 to 162 mg/day) be started as soon after surgery as possible and continued indefinitely. For patients who are allergic to aspirin, clopidogrel (300 mg loading six hours after surgery, followed by a maintenance dose of 75 mg/day) is recommended. The management of patients allergic to aspirin is discussed elsewhere. (See "Diagnostic challenge and desensitization protocols for NSAID reactions", section on 'Aspirin desensitization following a procedure'.)

                   

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Literature review current through: Nov 2016. | This topic last updated: Tue Jun 30 00:00:00 GMT+00:00 2015.
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