Angioscopic Findings of Calcification in Saphenous Vein Graft

A 58-year-old man on hemodialysis (HD) admitted for left ventricular dysfunction had undergone coronary artery bypass grafting (CABG) 3 years earlier [left internal thoracic artery-left anterior descending artery, and sequential saphenous vein graft (SVG)-obtuse marginal branch-right posterior descending artery]. Coronary angiography revealed significant stenosis in the SVG (Figure A), assumed to be an unstable lipid lesion. However, near-infrared spectroscopy with intravascular ultrasound (NIRS-IVUS) showed that the stenotic lesion included nodular calcification, and the maximum lipid core burden index in 4 mm was only 100 (Figure B). Angioscopy (Forwardlooking®, OVALIS, Osaka, Japan) revealed white-nodular calcification in the lesion (Figure B). He underwent percutaneous coronary intervention (PCI) and final angiography showed an optimal result (Figure A).

Figure.

(A) Control angiography showing significant stenosis (red arrow), and final angiography. (B) Angioscopy (Left) and near-infrared spectroscopy with intravascular ultrasound (NIRS-IVUS; Right) revealing the stenosis with nodular calcification, while the other parts included seat-calcification without lipid-rich plaque.

PCI for SVG accounts for 6% of all PCI patients,¹ and SVG failures occur more often in patients on HD.² In the morphology of SVG lesions, soft plaque and thrombotic lesions are often due to venous arterialization. Atherosclerotic changes are typically characterized by foam cell accumulation observed 2–5 years after CABG.³ The PCI strategy depends on the plaque morphology, so it is important to evaluate that by intravascular imaging such as NIRS-IVUS and angioscopy during the PCI for the SVG lesion.

Disclosures

T.I. is a member of Circulation Journal’s Editorial Team.

Supplementary Files

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https://doi.org/10.1253/circj.CJ-23-0421

References

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• 2.   Siddiqi S, Ravichandran K, Soltesz EG, Johnston DR, Roselli EE, Tong MZ, et al. Coronary artery bypass graft patency and survival in patients on dialysis. J Surg Res 2020; 254: 1–6.
• 3.   Xenogiannis I, Zenati M, Bhatt DL, Rao SV, Rodés-Cabau J, Goldman S, et al. Saphenous vein graft failure: From pathophysiology to prevention and treatment strategies. Circulation 2021; 144: 728–745.