Balloon angioplasty of aortocoronary saphenous vein bypass grafts: A histopathologic study of six grafts from five patients, with emphasis on restenosis and embolic complications

Among 103 patients undergoing percutaneous transluminal balloon angioplasty of obstructed aortocoronary saphenous vein bypass grafts at the Mayo Clinic, six grafts from 5 patients were available for histopathologic examination. The interval from graft insertion to angioplasty ranged from 5 to 105 months and that from angioplasty to graft excision ranged from 6 h to 24 months. Angioplasty produced intimai fissures in three grafts initially obstructed by intimai fibromuscular proliferation. Healing and restenosis resulted from filling of lacerations with fibrocellular tissue and apparently also from restitution of muscular tone. In two of three grafts initially narrowed by atherosclerosis, balloon angioplasty caused extensive plaque rupture and restenosis resulted from extrusion of plaque debris and secondary luminal thrombosis. In the third graft, angioplasty produced no distinct lesions and late restenosis was due to progressive atherosclerosis of the vein graft. Atheroembolization was observed in both patients with plaque rupture and was associated with reoperation in one and death in the other. In conclusion, the results derived from six saphenous vein bypass grafts subjected to balloon angioplasty indicate that restenosis may result from intimai fibrocellular proliferation, thrombosis, restitution of muscular tone and progressive atherosclerosis. Symptomatic atheroembolization may occur in grafts >1 year old.