Interventions in Patients after Coronary Artery Bypass Graft (CABG)

This chapter discusses interventions in patients after coronary artery bypass graft (CABG). Patients who experience a recurrence of ischemia after CABG surgery have lesions in diverse anatomic distributions: saphenous vein graft (SVG), internal mammary artery (IMA) graft, radial graft, gastroepiploic graft, native arteries, or proximal subclavian artery before the IMA graft. Selection of lesions for percutaneous coronary intervention must be based on careful analysis of the probabilities of initial success, complications, and long-term safety and efficacy compared with surgical strategies and medical therapies. Balloon angioplasty and stenting are feasible in arterial in situ or free arterial grafts removed from the radial site. Using a novel dynamic angiography technique that highlights coronary flow patterns, it was observed that, following CABG, the predominant flow through IMA and SVG grafts occurs during systole. The chapter lists practical tips and tricks for difficult scenarios and complications, as well as key interventional procedures and techniques.