A major problem in saphenous vein graft interventions is distal embolization resulting in no-reflow following successful intervention leading to elevated cardiac enzymes and Q non-Q wave myocardial infarctions. This is particularly worrisome in older degenerated grafts. In fact using distal protection devices, plaque debris can be retrieved which would otherwise go distally. In addition, older grafts tend to redevelop ischemia due to new disease in the unstented segment of the saphenous vein graft as well as restenosis.
Revascularization of totally occluded saphenous vein graft is associated with a lower initial success rate and higher complication rate. However, when no other options are available, these can be achieved. Interventionalists at BIDMC have recently started taking a step approach to these totally occluded vein grafts with recanalization.